By Corrie Pikul
We get the answers from doctors who have heard it all.
If you've got a mortifying, bizarre, out-there problem, not to worry. We've got the answer. We brought our awkward questions to these top doctors -- who not only see patients but also instruct students at some of the country's best medical schools -- and also inquired about the concerns they've heard during office hours. These are professionals who deal with conditions that afflict women in their twenties and beyond, like herpes, skin fungus and folliculitis (that's what many of us think of as, um, buttock acne), every day. "We don't even think to be embarrassed about these kinds of things," said Daniela Carusi, MD, the director of general gynecology at Brigham and Women's Hospital in Boston (a teaching affiliate of Harvard medical school).
Q: I recently noticed these large, irregular patches of white on my back -- it almost looks like my skin has lost pigment in that area. What's going on?
A: "This sounds like tinea versicolor, which is actually a fungus," says Isaac M. Neuhaus, MD, assistant professor of dermatology at the University of California in San Francisco. The white color makes this more noticeable on darker skin. Neuhaus says that this fungus is unrelated to hygiene or cleanliness -- you didn't do anything wrong to make it happen. "These organisms live everywhere, and they just happened to show up on your back," says Neuhaus. You can treat this condition with an inexpensive drugstore product: dandruff shampoo. "The selenium sulfide in the shampoo that helps with an itchy, flaky scalp can also clear up this skin condition," says Neuhaus. Lather up the affected area, let it sit for about 10 minutes and then rinse. You should see results in about a week. For very large patches, you may need to talk to your doctor about prescription cream or pills.
Q: I found one tiny, flesh-colored bump on my chin, and then I found another, and another... how can I make them go away?
A: You've got flat warts, Neuhaus says, and you're not alone. He's used to women coming into his office frantic after noticing warts on their face, hands, legs or feet. The viruses that cause warts are extremely easy to pick up. Once you have them, they tend to spread, so don't pick or scratch the bumps on your face, and avoid shaving over the ones on your legs. Stubborn warts resist hand washing and antibacterial gel as well as many medical treatments. "For whatever reason, the body doesn't recognize that they're a problem," says Neuhaus. "The treatments we use are our attempts to trigger the body's immune system to recognize the warts are there." Your dermatologist may prescribe cream medication, cryotherapy (freezing with liquid nitrogen) or lasers. There's no one cure that works for everyone, but when something finally gets rid of one wart, the rest frequently disappear.
Q: What's the deal with the acne on my bottom?
A: These small, white-headed pimples are symptoms of folliculitis. Unlike acne on the face, which is often attributed to blocked pores, bacteria or hormones, Neuhaus says that the bumps on your other cheeks are caused by friction. Wearing nylon stockings, nubby workout pants or tight jeans (especially without underwear) makes them worse. To clear up the skin, he advises his patients to try a roll-on antiperspirant. "The alcohol can dry out the area and help get rid of the bumps."
Q: Do thick and discolored toenails only happen to older people?
A: Nope. These are also caused by a fungus, and as we mentioned when discussing the white patches, these things really are everywhere. This variety starts in the matrix of the nail, which is behind the cuticle, and grows out from the base of the nail. "It's very difficult for topical ointments to get deep enough to kill this, so you'd be better off trying oral antifungal pills that can be prescribed by your doctor," says Neuhaus. As for the newer laser treatments, he says that he's still not convinced. "The evidence isn't there yet." If you do nothing and leave the nail alone, it will continue to look bad, but there aren't usually any long-term negative effects on your feet (unless you have diabetes or nerve problems in your feet -- in that case, a doctor may want you to take next steps).
Q: Should I pluck the tiny hairs on my breasts?
A: Many women do, says Carusi. But that doesn't mean that she would recommend it. Plucking occasionally leads to ingrown hairs and blocked hair follicles. If you must, use tweezers, pull in the same direction as hair growth, and avoid depilatories, wax and lasers that could irritate the sensitive skin in that area.
Q: I've noticed a tiny bit of white discharge from my nipples, but I don't have a baby. Does this mean I'm pregnant?
A: You could be. Some women notice clear discharge in the beginning of a pregnancy, and a watery, milky fluid during later stages. If you've never had kids and there's no reason to think you're pregnant, Carusi says that it wouldn't be a bad idea to have your gynecologist take a look, especially if it becomes colored or bloody (which could be related to breast disease). "New discharge is always worth checking out. This could be a sign of a hormonal imbalance, excessive stimulation or, in some cases, a small, often benign tumor in the pituitary gland in the brain. Your doctor can schedule tests to see what's causing this and how to treat it," she says.
Q: Are large or lopsided labia more prone to bacterial infections?
A: Carusi and her colleagues have a message for the many young women they see who are self-conscious about their labia to the point of obsession: "Labia come in all shapes and sizes, and none of those sizes have been proven to cause infection or other medical issues," Carusi says. "There are no negative medical implications to having enlarged or asymmetrical labia."
Q: I have a small bump on the skin near my vagina. How do I know if it's an STD?
A: Here's a good way to tell: If the skin around the bump is red, swollen, painful and feels hot, then it could be herpes, Carusi says, which is one of the only STDs that causes skin lesions outside the vagina. Also, check for other small sores in a cluster that look like chicken pox. If this sounds like what you've got, then Carusi advises you to get checked out right away. The other sexually transmitted infection that results in bumps is genital warts, and these are usually raised, flesh-colored and painless. Genital warts can be caused by HPV and can only be treated by a doctor (avoid over-the-counter medications). More likely, this could be a pimple resulting from a blocked gland or hair follicle, or oil that has accumulated under the skin. Try a hot compress, and if it hasn't gone away after a week, then make an appointment with your doctor.
Q: In a situation when I don't have time to shower -- after a surprise sleepover, for example -- can I use those facial cleansing cloths to wash my private parts?
A: If they contain makeup remover, hydroxy acids or acne medication (like salicylic acid or benzoyl peroxide), then Carusi strongly advises against it. But if the package of towelettes is marked "fragrance-free" or is meant for babies, then you might be able to get away with it once in a while, but you shouldn't make a habit of it. Carusi says that while it's highly unlikely that these will cause serious problems, they might result in dermatitis, a painful skin irritation that needs to be treated with prescription creams.
Q: Do women get worse hangovers than men?
A: Yes -- even if differences in the amount of alcohol consumed are taken into consideration. A 2003 study conducted by researchers at the University of Missouri confirmed that women are more likely than men to suffer from day-after headaches, nausea, dizziness and dry mouth, and more likely to feel the effects more intensely. This is because women have less water in their bodies to dilute the alcohol and have lower amounts of the enzyme dehydrogenase, which helps break down alcohol. Hormonal changes in the days before a woman's period also speed up the rate of intoxication.
As a reminder, always consult your doctor for medical advice and treatment before starting any program.