Vagina, Penis, and Poop Problems in Psychiatry

Let’s set this straight. I work in mental health. Psychiatry. I am a psychiatric mental health nurse practitioner. Technically.

Yet when I go to my “open recent” tab in Word I find “Bowel Regimens” as a commonly and recently opened file. I prescribe many medications that cause constipation. So we talk a lot about poop in my office.

Diarrhea is often also a symptoms of anxiety so yeah, poop comes with the territory of mental health.

Nothing surprised me more though than the first time someone told me about their vagina problems. Or their penis problems. I have made the following statements in my office:

“You can use plain yogurt as lubricant because it doesn’t affect your ph so it shouldn’t cause a yeast infection, just make sure it’s plain. No sugar added.”

“Is the rash on the shaft of the penis or are you talking upper thighs?”

“‘Down there’ doesn’t cut it my friend, and remember I’m married to a woman, so you’re gonna have to be wicked specific.” 

“An odor can be caused by many things. Don’t douche that’s so bad for your ph. Stop using all the wipes and scented crap. Let your body regulate itself. I promise your vagina will thank you for it.” 

“That sounds like Herpes. Get that shit tested.” 

“Pull your damn pants up, NO I don’t want to see your rash! Go see your gyno!!”

“So are you able to ejaculate or no?” 

“You understand this means that your testicles will be removed permanently from your body?” 

“You can still orgasm, you just need a partner who’s committed to getting you there. You are familiar with your clitoris yes?…NO!? okay. Here’s a drawing for you. Start externally. Move internally. Use a vibrator at the same time as internal stimulation. From the expression on your face you’ve never used a vibrator. Okay you ever heard of one?” 

“Very rarely this medication can cause a sustained erection. Take sudafed. It works.” 

“Have you ever heard of the jade egg? Well you can pop it in before you start making dinner, by the time you’re done with dinner you will definitely be ready to have sex.”

“Yes there are some that are made with a stringy thing attached so you can pull it out.”

“Your how old? Ugh…okay….let me take a breath here….okay yes we can talk about sex but just know that I think you’re not old enough and the only reason I’m entertaining this conversation is because if you’re going to have intercourse anyway I’d rather you do it safely, but good lord please God wait!”

“To clarify condoms protect against STDs and birth control only protects against getting pregnant and only if you take your pill every day.” 

“And you’re sure there’s no possible way you are pregnant?…..I think you’re pregnant.” (I have said this on multiple occasions and have yet to be wrong. Four times I told the patient before they knew and they later called me to confirm and ask how the hell I knew.)

“Well your partner is stating that douching before anal sex is important to them. How do you feel about that?”

“I’m not the person to tell if you should or shouldn’t have an abortion. I’m just here to support you. I see you. I am here for you no matter what you decide. Let’s keep talking.” 

“You’ve decided to keep it. Okay. Let’s talk about how you’ll finish high school and the stigma of being a young mom. There are people who will want you to fail. But I know you won’t. I know you have what it takes to do this. You’re going to be a great Mom.” 

“The abortion was when? Okay, so let’s talk about how you’ve been feeling since.” *

There are a couple reasons I end up talking about vaginas and penises. Medications I prescribe have sexual side effects. Depression causes a decrease in sex drive. Bipolar mania can cause an increase in sex drive. So people’s sex lives can directly correlate with their mood.

But also, what I’ve discovered, is people want a safe space to talk about sex and sexual organs.

MD’s in their white coats draping patients in awkward paper create a sterile environment. One in which patients don’t feel like people. They feel like specimens. Whereas in my office we may never have touched physically but I know intimate secrets about them and their mental health.

I also treat them like humans. Not specimens.

I also ask. Not about their actual parts. But about their sex lives. Do they have one? Are they satisfied with it? Do they use protection? What kind? I ask these questions and then they know it’s okay to talk about that stuff here.

No I was not expecting the questions about vaginal odors and rashes that accompanied the safe space sex talk. But after it started happening and my initial shock and horror subsided I realized that it was actually complementary. I made them feel comfortable. When I asked why they didn’t ask their medical doctor these questions they often shift in their chair and look down, “Well, I dunno, it always feels like she’s in a rush,” or “I dunno I mean I’m naked and they are in and out, and it’s embarrassing talking about this.”

They are less embarrassed asking me whose never seen their vagina, then asking the doctor who is up their elbows in their vagina.

I also treat a lot of transgender and non-binary individuals who are pursuing surgical intervention for their gender journey. If I’m writing the letter of mental health clearance I have to bluntly say what exactly will happen and what the consequences are so I can write they have a true understanding and can consent to the surgery.

It’s not that I’m uncomfortable talking about sex and sexual parts. It’s that it shocked me at first because I went to school to treat the brain. I felt like I was at the wrong end.

Disclaimer: I have never diagnosed or treated with medicine or assessed visually any of the issues that are brought to me by my clients when it comes to anything below the brain. I listen and provide feedback and refer them to a specialist. I am obviously very careful about not practicing outside of my scope.

I think it’s wonderful that clients feel safe with me. I think it’s disheartening that so many don’t feel safe enough to say these things without my support to their primary OB/GYN or urologist or primary. Modern medicine has become so forced, quick, and detached that patients are missing a connection with their providers. They are missing the opportunity to feel safe and supported by all their healthcare providers. Not just in mental health.

It used to bother me. The vagina and penis questions. But now I take it as an opportunity to try and understand what’s missing from their relationship with their medical provider. Why don’t they feel safe saying this to the people who can actually assess, diagnose, and treat it?

I’ve learned a lot about sexual health and sexual dysfunction. I’m proud to say I could likely help any one with difficulty orgasming. I also know more than I ever imagined one could possibly know about anal and vaginal intercourse. I can say the words: penis, vagina, anus, ejacualation, masturbation etc. without blinking an eye or making faces and changing my body language. I mean that’s a score one for me. Try it. Try saying any of the phrases I quoted above to anyone and try keeping a poker face.

My point to all of this: If you are a healthcare provider: people WANT to talk about sex. They need to. They need guidance and help and they have questions. Be open to it. Welcome it. Create a safe space.

If you are not a healthcare provider: ask the questions. You deserve the answers. There is nothing wrong with you for asking.

To all the Mental Health Practitioners: God bless. Find a quality picture of the anatomy of a vagina and a penis. Trust me. You’ll use it.

****To any one who thinks any woman makes the choice to have an abortion lightly: they don’t. We don’t. I have held clients as they wept over the loss. I have treated teenage moms in the thick of it. Society doesn’t like teenage mom’s yet we also judge those who have abortions or who become pregnant. The young women I’ve treated who have faced abortion versus becoming a teenage mom have continuously impressed me with their grace, their strength, and their pain no matter what path they choose.

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