Welcome to OBGYN Champs, the show where no question is off limits. Join host Morgan Allen and board-certified OB/GYN Dr. Suny Caminero, MD, as they tackle the topics women are often too embarrassed, afraid, or unsure to ask about. From hormones, menopause, and sexual wellness to pregnancy, pelvic health, cosmetic gynecology, and everything in between, each episode delivers honest conversations, expert advice, and practical insights to help women take control of their health with confidence.
Whether you’re in your 20s, navigating motherhood, approaching menopause, or simply looking for trustworthy answers, OBGYN Champs is your place for real talk, myth-busting, and empowering education. Tune in, ask your questions, and join the conversation because your health deserves to be talked about.
Dr. Suny Caminero, MD, OB/GYN
Founder of Cosmetic Gynecology Florida
Website Address: https://cosmeticgynecologyfl.com/
Why does my vagina smell bad after sex?
Dr. Suny Caminero:
Most of the time, it is bacterial vaginosis because the pH of the vagina has changed after a certain age, with the lack of estrogen in the vagina. And with the lack of estrogen, the tissue gets really thin.
You have very few of the normal bacteria that are supposed to be in the vagina, and then the bacteria that normally live in the rectum can enter the vagina very easily. There’s a very short kind of highway distance between the rectum and the vagina. Typically, when bacteria enter a normal woman who has normal estrogen, your own bacteria in the vagina just get rid of it, and it cleans itself.
When you don’t have that anymore, and your tissue is really thin, and there’s no estrogen there, and there is no place for your bacteria to live. The vagina changes, which then allows bacteria to enter and overgrow.
When semen is present, it changes the pH even more. The vagina is supposed to be acidic, so it’s supposed to be much lower than the semen. The semen goes into the vagina and makes the pH even more basic than it was before, increasing the chances of having more infection. You don’t even have to have sex. Many women without even having sex have that odor because of the lack of bacteria.
The pH is low, the tissue is thin, and bacteria just overgrow in the vagina, and the vagina isn’t able to keep up.
Morgan Allen:
Is this more common for a certain age group?
Dr. Suny Caminero:
Anytime there is a lack of estrogen in the vagina, it is very common. Typically, women in perimenopause and women in the menopausal period.
Is boric acid safe to use regularly to clean my vagina, or are there better long-term solutions?
Dr. Suny Caminero:
The better long-term solution, if it’s a lack of estrogen, is estrogen in the vagina. That really fixes the problem over time.
Put vaginal estrogen cream in the vagina twice a week, and that’s it. It keeps the vagina healthy, makes the tissue thicker, and makes it lubricate better. And it brings back your normal bacteria in the vagina. It doesn’t fix it right away. It takes about three months to start noticing a difference.
Over time, six months or longer, then you don’t have that issue anymore.
Morgan Allen:
Can you get it on Amazon?
Dr. Suny Caminero:
It’s a prescription. I wish that you could get it on Amazon or over the counter. I wish that most birth control was also over the counter as well.
For cleaning, boric acid isn’t wrong, and I can see why you’d want to do that. You don’t want to go to the doctor every time you have something, so you want to get over-the-counter products to help.
Boric acid does help initially, but it’s like a bomb in your vagina. It just kills everything, including your normal bacteria. So if you have any normal bacteria in there, it just kills it off too.
And then you have an inflammatory response. You get this liquid kind of inflammatory stuff that comes out of the vagina that cleans it, right? So for the first week or two, you’re like, “Oh, it’s gone. It feels great,” because it cleaned out. But now you have no good bacteria, and then it tends to recur.
So you have a recurrent infection that the acid isn’t necessarily taking care of for the long term. The whole idea is to repopulate the vagina with the good bacteria so that the good bacteria is able to fix that problem.
Morgan Allen:
So can you use boric acid for yeast infections?
Dr. Suny Caminero:
You can.
Morgan Allen:
But you don’t want to take it too often.
Dr. Suny Caminero:
No, because you’re getting rid of your own bacteria. You want to repopulate with normal vaginal bacteria and get that tissue healthy again.
What symptoms help differentiate a yeast infection from bacterial vaginosis?
Dr. Suny Caminero:
With a yeast infection, you typically have white discharge, often with itching. A lot of times you just kind of have itching, that burning sensation. Bacterial vaginosis doesn’t have that unless the vagina is really, really thin.
You really don’t have symptoms except for the odor, meaning that you sit down to pee and you’re like, “Oh, what is that odor?” It’s a very unpleasant odor. Or when women are having sex, they’ll smell that kind of fishy-like odor.
What is vulvar lichen sclerosis? Why are some women prescribed steroids like clobetasol for the rest of their lives? Are there other treatment options?
Dr. Suny Caminero:
Lichen sclerosis is more common than people think. Many people haven’t heard of it, but it’s very common. Lichen sclerosus is an autoimmune skin disease. This autoimmune condition causes inflammation in the skin.
It makes the skin really, really thin. It gets really itchy, especially for women. That’s why clobetasol, a high-dose steroid, works: it reduces inflammation and helps with the itching. It doesn’t treat the condition. It just helps with that inflammation.
With lichen sclerosis, many women do respond well to clobetasol, and they don’t have really any issues. They use it, and then they switch to a less potent steroid long term to keep the inflammation down.
The important thing is that if the inflammation continues, the tissue changes. The skin gets very thin, and white plaques can build up. That can actually turn into skin cancer for some women. You have to pay attention to it, and often you’ll need a biopsy if it doesn’t respond to treatment. So clobetasol is one of the things that you can use.
We can also use another medicine, tacrolimus. Another one that we use can modulate that immune response. We also use anything that hydrates the skin; that’s good. In my office, we use a CO2 laser, and it works amazingly because it thickens and heals the skin. We also use PRP to help in that area. We sometimes use stem cell growth factors. There are many things you can do.
One of the things that I see is that some women have been on steroids, and they’re not necessarily responding. For them, the architecture of the vagina and the vulva gets completely changed.
They lose their labia. They lose their clitoris; it gets hidden completely. At that point, it’s not only itchy; it really affects them significantly. I don’t want women to get to that point. The idea is to prevent them from getting there.
It’s a very common condition, and it happens more frequently when estrogen is low. Estrogen is an amazing thing for us. Young girls can have lichen sclerosis before puberty because they don’t have really mature hormones. It also happens to women in perimenopause and certainly in the menopausal stage, when they have less estrogen as well.
Sometimes we also will put topical estrogen on that area as well. There are many different things we can do. It’s not just steroids, but it is a lifelong thing because it’s an autoimmune disease. It is a lifelong condition, so you’ll need to do something topical. It doesn’t necessarily have to be clobetasol.
Morgan Allen:
But the CO2 laser will help relieve it?
Dr. Suny Caminero:
Yes, it’s incredible. The CO2 laser works incredibly well for people who have failed steroid treatments. I’ve had so many women that we have changed the architecture of the vulva back to normal when they have completely lost their labia, completely buried their clitoris.
It’s not with one treatment. It takes multiple laser treatments to regenerate the skin, but it works so well. Almost nobody knows that it’s out there. It’s really very common to go, “Okay, you have lichen sclerosis. Here’s clobetasol.” For the most part, it does work. But when it doesn’t work, we have to try other therapies. You can’t just stay on that. We can’t let the architecture of the vagina, of the vulva, just change, trying the same thing that isn’t working.
Can surgical menopause affect a woman for a long period of time?
Dr. Suny Caminero:
It can happen forever. If she had a complete hysterectomy, meaning that the uterus was removed and both ovaries were removed, she should have been placed on hormone therapy, particularly at 38.
The effects of the cardiovascular risk, the genitourinary risk, the dementia risk, the skin—everything gets affected by the surgical menopause. It wasn’t uncommon for women to just be allowed to suffer through it. And thankfully, I don’t think that’s happening nowadays anymore. Usually she would have been on hormone therapy. If you take somebody’s pancreas out, then they need insulin, and they get put on insulin. If you take somebody’s ovaries out, they need hormones.
If a woman had her uterus and cervix removed, does she still need annual gynecological exams or Pap smears?
Dr. Suny Caminero:
If she has had no abnormal Pap smears in the past, she doesn’t need a Pap smear. She must show at least three negative Pap smears and then may not need Pap smears. If she has had precancerous cells or cancer cells of the cervix, she will need them for 20 years, even if she doesn’t have her uterus and cervix anymore.
Women who have had hysterectomies still need a gynecologic exam because during the gynecologic exam, you look at the outside of the vagina and skin for skin cancer. You also look at the vagina to see if there’s any prolapse of the bladder or rectum, and you’re also palpating the ovaries to make sure that the ovaries are not abnormal on the exam. A breast exam is also done at that same visit.
You still have to do a vaginal exam. You don’t necessarily have to do the Pap smear, the little brush thing. We’ve always thought that Pap smear was like when you go to the gyno, and it’s like—that’s called the Pap smear.
For us, that is the Pap smear. It really is just those cells. The gyno exam is different. It’s like going to primary care and having an exam. They listen to your lungs, they listen to your heart, and you have to do that, right, as a screening. So that part is still—
Does taking estrogen during or after menopause increase your risk of breast cancer?
Dr. Suny Caminero:
Estrogen itself is not going to cause you to have breast cancer. If you have abnormal cells in your breast- cells that have gone through changes that are precancerous cells or cancer cells of the breast- those cancer cells will use estrogen just like your non-breast-cancer cells use estrogen.
So without having that issue, the estrogen itself is not going to cause you to have cancer. Otherwise, you would have had cancer already, right? Our estrogen starts to increase in puberty, and we have estrogen throughout our lives until menopause, and really, really high in pregnancy.
So estrogen itself is not going to cause you to have breast cancer, particularly if you’re using what we call the bioidentical estrogen, which is the same exact thing that your ovary produces, as opposed to the synthetic estrogens, which are the ones that are made in the lab to be more potent.
Can menopause actually change the smell, pH, or overall health of your vagina?
Dr. Suny Caminero:
Yes, because of lower hormone levels. Hormones change everything.
Why do some women experience recurring vaginal infections or irritation?
Dr. Suny Caminero:
The lack of estrogen. The roof of the vagina is what holds your bladder, and that tissue gets weak with aging and with the lack of estrogen. That increases the risk of prolapse of the bladder.
Not having the normal bacteria of the vagina also makes you have more UTIs, and you see urinary leakage. You see women who end up using diapers or in nursing homes using diapers, or even older women who have died because of sepsis from a urinary tract infection. And that is truly preventable by just having vaginal estrogen. It’s really that simple.
Morgan Allen:
Is it that simple? Why isn’t this more known?
Dr. Suny Caminero:
It is known. It’s just that people have been so scared of hormones until recently. There was a black box warning that was really erroneous, and that just made everybody scared of hormones. Now, slowly, we’re trying to come out of those dark ages.
Are compounded bioidentical hormones actually better or safer than FDA-approved hormone replacement therapy?
Dr. Suny Caminero: They’re fantastic. So great. Compounded really means that it is made for you in particular. They are FDA-approved hormones that we can prescribe. Bioidentical hormones mean they’re made with the exact chemical composition your ovary produces. Think of estradiol as the estrogen your ovary produces, versus ethinyl estradiol, which is what you see in birth control.
There are different types of estrogen: synthetic versus bioidentical. You can buy bioidentical estrogen from the pharmacy. You can also get it from FDA-approved formulations.
Now, let’s say that I have a patient and I want to give them a type of estrogen that I can’t get from the regular pharmacy because I want a different milligram. Let’s say the regular dose is 1 milligram, but I want this patient on 1.2 milligrams. I’m going to have the pharmacy make that because I want her at 1.2. I don’t want her on 1.
The pharmacy is great because you can do it in different ways. You can do it as a cream through the compounding pharmacy. You can do it sublingually through the pharmacy. You can formulate it in a way that women can use. It also happens with pediatric formulations sometimes, like when the medicine isn’t available. It’s always a pill, so the pharmacy can make it into a lollipop or a liquid the child can take.
So the compounding pharmacy isn’t better or safer than the other. It’s that they can do something that is for that particular person versus having this number of that. This is what you can get from the regular pharmacy.
For me, the vaginal estrogen that I prescribe a lot for women, I get it through the regular pharmacy. But sometimes I want to add a little testosterone to that vaginal estrogen, so I’ll get it from the pharmacy because they can mix it for me, and they can have estradiol and testosterone in the same formulation, so that you don’t have to have two tubes and then put that in the vagina because it helps for all of it as well.
Morgan Allen:
Compounding pharmacies, are they everywhere?
Dr. Suny Caminero:
They are everywhere. You’ll only know about them if you need a certain prescription that you can’t get through the regular pharmacy, through the FDA-approved kind of regular pharmacy methods.
If a woman is already in her late 60s, is it too late to start estrogen therapy? What are the potential benefits and risks?
Dr. Suny Caminero:
The main potential risk is really a cardiovascular risk, particularly if they have cardiovascular disease already. If they have cardiovascular disease, you have to do different tests, like coronary calcium score tests and other tests, to make sure that she could still benefit from hormone replacement therapy. Sometimes you have to work with a cardiologist to make sure that it’s okay for that person to be on hormone replacement therapy.
So for the most part, after a certain age, particularly if it’s ten years postmenopausal, it doesn’t mean there’s a no. You just have to be careful and do other testing to make sure you’re not going to cause a problem, but that the person will benefit from it.
Can women safely use vaginal estrogen for dryness and painful sex, even if they aren’t candidates for systemic hormone therapy?
Dr. Suny Caminero:
Yes, yes. I think I’ve said this before in one of the episodes, but the vagina is really greedy when it comes to estrogen. The amount that you put in the vagina is such a low dose that almost none of it—very little—gets into your system.
It’s not hormone replacement therapy. Vaginal estrogen is not hormone replacement therapy in the traditional sense. When you put it in, even if you are not a candidate because you have cardiovascular disease, whatever the case may be, you are still a candidate for vaginal estrogen.
It’s incredible, the amount of things that happen to the vagina with the lack of estrogen. And we talked about, you know, the infection, the urinary tract infections, the prolapse, the painful sex, the odor.
The painful sex is often what gets women through the door. It’s like they haven’t had sex in months or sometimes years because they call it “shattered glass” or “sandpaper vagina,” just because of lacking estrogen.
What is one intimate health issue that women over 50 are embarrassed to discuss but shouldn’t ignore?
Dr. Suny Caminero: The lack of libido. They talk to doctors about it, but often they’re embarrassed to discuss the lack of libido.
And that, in combination with the painful sex, are the two things that women are very embarrassed to talk about. They feel alone, or that’s only happening to them because most women who are having a lot of sex, for example, a lot of them are very vocal about having sex. They’re enjoying themselves. They’re happy about it.
The rest just stay quiet, like, “Well, that’s not me.” And so then you think that you’re alone when you’re not. So the low libido and also the setting of having vaginal dryness and painful sex are very, very common.
