Interesting, the questions women have sometimes.
I was asked how a fat woman's vagina differs from a thin woman's. I thought, "What a great topic to write about!" Some of this might be TMI for those that know me. But, what the hey.
Pre-gastric bypass, I couldn't keep a tampon in. I had no idea it was because I was fat. I thought it was because I'd had three giant-sized children and was getting older (30). I peed with nearly every exertion, which, many times, was just bending over for something on the floor. I couldn't orgasm with anything but a vibrator for 20 years or so. I just thought I was "addicted" to orgasms that way. I knew my vagina was so horribly lax that giant-sized specs were needed to open it and even then, the walls drooped in, covering the view to the cervix. Embarrassed, I just kept kegeling my ass... er... vagina off. Nothing seemed to help.
I'd done a lot of vaginal exams pre-surgery, but never had any ah-ha moments or realizations that the size of the woman might have a corresponding geography in the nether regions.
When I had my gastric bypass, as I've said, I lost a LOT very fast. 100 pounds in 10 weeks... 190 pounds in a year. Within 6 months, I was having orgasms without the vibe (oral sex). I could FEEL so much more! Everything seemed... hmm... so... accessible! It was all right out there. No wonder women went without undies in jeans!
When I went for a Pap, I no longer needed the giant-sized speculum. A medium was perfectly fine. And lo and behold, my vaginal walls did not cave in on the spec, either.
Neither did I projectile my tampons with every cough anymore. (One of the MOST embarrassing moments for my kids was when I sneezed while swimming in a public pool and the tampon shot out like a champagne cork and floated to the surface. Eek!)
It took awhile and a lot of humility to understand that not only did I have fat all over my ass, my liver and my stomach, but also inside my vagina. No one ever told me that.
Once I realized this, I began feeling vaginas differently, watching what happened with speculums and talking about orgasms with fat women. Over and over, women who could kegel the circulation out of my fingers still had their vaginal walls cave in, surrounding the speculum during that portion of the exam.
All of that information is well and good, but what do healthcare providers do when they have a fat woman that needs her Pap done?
I learned to use a condom and keep them in our exam tables just in case. Take the speculum and roll the condom onto it. Using scissors cleaned with alcohol, cut the reservoir tip off the end of the condom that is now on the spec. Insert the spec as usual, but be prepared to have a LOT of resistance in opening the blades. It is worth it, though. The condom holds the walls back beautifully and the exam is able to be completed.
I let my clients know that I will be using a condom to assist - if they are over about 300 pounds as a matter of course. If I know their history of fat walls, they'll know I will be using one, but I remind the women anyway. Surprises suck when you're nekkid from the waist down.
Newer speculums do exist that hold the walls open, but I'm still in the speculum dark ages.
I know there is a movement to ask women if they want to insert the speculum themselves, but for fat women, it can be an uncomfortable question. I couldn't reach my clitoris at 350 pounds, much less the introitus of my vagina. I might say something when the woman is still sitting on the couch, perhaps while I am laying out the Chux and drape... something like... "Some women are more comfortable putting their own speculums in, so if you would rather do that, let me know when we get to that part of the exam. Otherwise, I'll just ask permission before I insert the speculum and we can go from there."
I asked my partner if she could tell a difference pre- and post-op and she said, "Absolutely!" (More TMI - sorry.) She isn't prone to exaggeration and was very honest about the difference she felt. I could absolutely understand what she was talking about after doing a variety of exams on fat and not-so-fat women.
I don't think discussing fat vaginas is really one of the required topics a doctor, nurse or midwife needs to do, but if you have a fat woman sitting in front of you who cannot orgasm easily or who can't wear a tampon... perhaps mention of fat vaginas is called for.
Do other practitioners talk about things like this?