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From pain during sex to abnormal bleeding, there are a host of signs that things aren't quite right 'down there'.

At the same time, many of us worry about whether we're 'normal' - in terms of appearance and how our vagina behaves. 


PAINFUL SEX

The vagina can become painful during sex - a condition known as superficial dyspareunia, which usually occurs when the vagina is too dry or inflamed because of an infection. Foreplay and lubrication helps. 

As opposed to superficial dyspareunia - which is felt in the entrance or wall of the vagina - deep dyspareunia is pain in the lower abdomen or pelvis during sex.

This can happen due to several conditions including endometriosis (a common condition in which small pieces of the womb lining are found outside the womb) and fibroids (non-cancerous tumours that grow in or around the womb).

If you are concerned you have an infection or suffer from deep dyspareunia, see your healthcare professional.

BLEEDING

Taking the combined contraceptive pill irregularly can cause bleeding or spotting in between your periods. 

If this bleeding persists after taking the Pill regularly then a visit to your doctor is warranted.

Other forms of contraception such as the mini-pill (the one with one hormone), the injection, the implant (the one in the arm) and the intra-uterine system (known as Mirena, or the coil) can cause your periods to be irregular.

As long as there no concerns regarding infections and scans, if indicated are normal, this tends to settle over time.

Bleeding after intercourse also needs a review as it could be due to a polyp – this is a benign growth and easily removed.

Other causes include changes on the cervix and cervical or rarely, vaginal cancer. 

Indeed, a common symptom of cervical cancer is bleeding after sex.

With these, in addition to bleeding after intercourse, you may get copious amounts of discharge.

However a one off mild bleed after a particularly vigorous episode of intercourse is probably no cause for concern.

DISCHARGE

From puberty to menopause, having some vaginal discharge is normal. 

The quantity can vary from woman to woman and throughout the monthly cycle.

The first few days of the cycle is your period, following this, the discharge can be white, creamy or yellow, thick and sticky. 

Ovulation then occurs and the discharge changes to slippery, clearer, stretchy and wet. 

Following this, if you don’t become pregnant, it then changes to thick and sticky, becoming hostile to sperm.

Discharge becomes abnormal if there are other symptoms with it or the colour and amount changes, for example, becoming chalky white with candida (thrush) or frothy yellow or green with trichomonaisis, a sexually transmitted infection. 

It is therefore important to be sexually responsible. 

Hormonal contraceptions and having a condition where the inner lining of the cervix protrudes outward (called, ectropion) can also change the discharge so it becomes copious. 

Other causes of an increase in the amount of discharge include cervical polyps (a non serious growth on the cervix which can easily be removed), forgotten tampon, douching, allergic reaction for example to a spermicide, and rarely, a connection between the bladder or bowel and the vagina (a fistula). 

A condition we worry about is cancer and if affecting the vagina, cervix or lining of the womb, can also cause an increase and change in the type of discharge such that it becomes thinner and blood stained. 

Should this happen, see your health care professional, who would offer a vaginal examination to ensure it looks healthy and onward referral if required.

Just like the armpits, the skin around the labia has a lot of sweat glands. 

The vagina also produces fluid to keep it healthy and maintain balance at an acidic level. 

With exercise, it is normal to sweat more in these areas, so dont be alarmed if the crotch of your gym wear is damp after exercise. It is a good thing as it prevents friction, chaffing and overheating.

LUMPS AND BUMPS

Most commonly due to an ingrowing hair, this is more common in those with elliptical shaped hair shafts. 

Shaving or waxing contributes to this and can be best prevented by shaving or waxing in the direction the hair grows. 

Hair removal using a depilitator or laser by a trained professional also helps. Depilitators, however, can make the vulva skin dry and irritable.

Other non-worrying lumps are remnant of the hymen (redundant, irregular bits of skin), which may become more obvious with weak pelvic floor muscles (causing a prolapse), or glands on either side of the vagina called bartholins which produce bits of mucous. 

These can become infected so if painful and swollen, require medical attention and drainage. Keep up with the pelvic floor exercises (kegels). 

Just like with any part of the body, sebaceous cysts (fluid filled sac that is not infected or painful), warts, boils or abscesses can also occur around the vulva. 

A review by your doctor is warranted should these occur as if infected, would need treatment. 

The surface of the vaginal wall can also feel bumpy as it is made of tissue which can retract and expand when needed.

ITCH

The most common, familiar reason for this is thrush, which is often accompanied with a chalky discharge. 

Easily treated by over the counter antifungals such as as Canesten, if this is the first time or not settled with treatment, it is worth seeing your healthcare provider to rule out other causes. 

We can easily disrupt the normal vagina flora and protective layer of outer skin by using scented products, douching and over drying. 

This can lead to dermatitis - inflamed skin.

Other skin conditions can also affect areas around the vagina and cause itch. 

This includes eczema, lichen planus (itchy and sore white streaks or patches with discharge around the vulva and vagina) and the vulval dystrophies (disorders of the skin growth around the vulva.

It can also be caused by lichen sclerosus - an itchy, sore area around the vulva which then changes to a pale colour and the skin looks shrunken. 

These can be treated by vulval dermatologists, specialists in conditions affecting the skin around the vagina, which you can ask your GP for a referral to.

There are various simple actions you can take to try and address or prevent the problem:

* Refraining from douching (washing out the vagina)

* Wearing cotton underwear or none, refraining from tight clothes such as skinny jeans

* Decreasing hot baths, always cleaning from front to back (and the area in between) 

* Using water only and if you have to, non scented, hypoallergenic, pH-balanced washes and changing cloth washing products should you suspect a skin reaction 

* Changing condoms if you practice anal and vaginal sex or develop itching or a rash after using a condom 

DRYNESS

Rigorous cleaning, the use of hormonal medications (especially those with progesterone hormone), post pregnancy (as oestrogen levels drops), breastfeeding, other medications such as antihistamines and antidepressants and age all contribute to the vagina feeling dry. 

Discussing contraceptive choices with your health care professional will help to ensure you are on one without the side effect of vaginal dryness. 

As we get older and become perimenopausal and into the menopause, this can happen and there are vaginal moisturisers, lubricants and hormonal treatment that can help. 

These are available over the counter or on prescription. It is important to test a patch of skin, for example, your inner thigh, before using it freely. This is to ensure you are not allergic.

SMELL

There are so many reasons why your vagina might smell, from overgrowth of the normal bacteria because the vagina environment becomes less acidic (this is called bacterial vaginosis) to a retained (not lost) tampon or condom.

A fishy smell is usually due to bacterial vaginosis and is always advisable to have checked. Unless you have been diagnosed and treated with bacterial vaginosis previously and know the symptoms, treatment is available over the counter. 

Some women find this is triggered by their periods or intercourse. In this situation, using a lactic acid gel, such as Balance Activ, regularly can prevent a recurrence.

It gives the vagina the nutrients it requires to remain in balance.

Like everything else in our bodies, good nutrition is vital in vaginal health. Nutrient-rich foods in general help to maintain a healthy acid level and prevent overgrowth of the bacteria that causes the fishy smell. 

Maintaining the good bacteria known as lactobacilli in the vagina is also helpful, hence why taking live active yogurt or probiotics has been linked to decreasing the occurrence of bacterial vaginosis. 

Retained tampons or condoms can easily be removed by your healthcare provider.

URINE CHANGES

Passing urine can become painful and the most common reason for this is a urine infection. 

This can happen after sex and is best prevented by passing urine before and after to decrease any bad bacteria that may be hanging around. 

Also being well-lubricated during intercourse can be helpful to decrease any chaffing or sores. 

Urine incontinence can occur if the muscles become weak and cause a prolapse – see your doctor should this be of concern.

NUMBNESS

With the advent of increased cycling, numbness or pain has also become a fairly common problem. The pressure from sitting on a cycle sit can affect the skin and nerves in that area. 

It usually settles and can be prevented by wearing padded shorts and getting a good supporting firm cushion so you don’t sink into the seat. 

If there are other problems with it, like swelling, urine or bowel problems or back pain, or it persists, a visit to your doctor is warranted.

Cycling is a great and fun way to increase fitness levels but some preparation beforehand is essential to prevent problems.