February 2023
This month, we chatted with Corey Babb, DO, FACOOG, IF, NCMP, who shares his expertise on vulvovaginal health and explains the multifactorial causes behind vulvovaginal diseases. He also shares tips for at-home vulvar care practices.
Dr. Babb is a Tulsa native who has dedicated his life to bringing awareness and acceptance to female sexual health. Though education, activism, and empathy, he helps people feel heard and validated, empowering them to find answers in a complicated medical environment. In addition to being a board-certified gynecologist, he has also achieved the prestigious designation of IF – Fellow of the International Society for the Study of Women’s Sexual Health (ISSWSH). Additionally, he has earned the distinction of North American Menopause Society Certified Menopause Practitioner (NCMP), and has been accepted for membership in the International Society for the Study of Vulvovaginal Disorders (ISSVD). Dr. Babb's private practice Haven Center specializes in sexual medicine and vulvovaginal disorders.
SHWI: What led you to becoming a physician, and to specialize in sexual medicine and vulvovaginal disorders?
My journey to becoming a physician was a very convoluted one. My father was an OB/GYN, and always told me to never go into medicine, and if for some reason I did, to never go into obstetrics and gynecology. Of course, I rebelled, and so medical school was basically a combination of a “screw you, Dad,” type of activity, as well as a love-affair with the ideal of medicine, and the idea of being a “healer” as well. I chose women’s health because I loved the connections you could make with your patients, and since you were trained in both medicine and surgery, you could really help them. After residency, my practice was very obstetrics heavy. As time passed, however, I kept having patients ask about sexual problems, as well as complex vulvar concerns – topics I was not really taught about in residency or medical school. I chose to seek answers for these questions and found an entire subspeciality of medicine that I never really knew about and fell in love with it. The more I delved into sexual medicine, the more I felt that I was truly helping people, especially when it seemed nobody else could. As time passed, I sought more and more training, and that journey has allowed me to become the subspecialist I am today.
SHWI: Can you explain what vulvovaginal disorders are, how they occur, and why they can sometimes be difficult to treat? What are some unique approaches you’ve taken to address some of your more complex cases?
Simply put, vulvovaginal diseases are those that affect the vulva, vestibule, and vagina – basically the lower reproductive tract. This includes common conditions such as bacterial vaginosis and vulvovaginal candidiasis, as well as more complex ones like lichen sclerosus and vulvodynia. The causes of vulvovaginal diseases are often multifactorial, and include infectious, inflammatory, and autoimmune etiologies. There is often a significant hormonal component to these conditions as well. The combination of these causes is what makes vulvovaginal conditions complex to treat – there’s often not a simple answer or explanation.
As a provider, you have to have a solid understanding of dermatology, infectious disease, endocrinology and sometimes even psychology to really find the cause of the symptoms. I think for vulvovaginal disorders as a whole, you really need to look at the whole person, an integrative approach, if you will. The more complex the case, the more wide-angle you need to be. In vulvodynia, for instance, it’s often important to determine if there’s been any history of hip or coccygeal trauma. This means you may be asking about injuries a patient sustained as a teenager that over time, have progressed and now are part of the problem. I also find it’s very important to ask about diet – and not just how much sugar a person eats. High oxalate foods, as well as nightshades, have been implicated in chronic vulvovaginal conditions.
SHWI: What are some of the most common vulvovaginal conditions you see in your practice and what are your approaches to treatment?
As a subspecialist, I often see the really complex vulvovaginal cases – it’s rare that a patient comes to me with more than an acute episode of BV. As such, my patients often have recurrent infections, lichenoid dermatoses or chronic vulvodynia, and it’s not uncommon for them to have seen multiple practitioners before I see them. I am blessed to own my own practice, so I can spend an hour or more with them on their initial visit, and can take a very thorough history to look at not only common causes of their complaints, but also potential outside-the-box ones. I feel that if you understand the disease process, and are not pigeonholed when looking at a problem, you can figure out the cause.
SHWI: This month's topic is focused on learning about vulvar care and hygiene. What are some ways women can improve their vulvovaginal health through their regular routines at home?
Vulvovaginal health starts with good hygiene-not only knowing how to properly clean the area, but also understanding what things can increase the risk for vulvovaginal conditions. With bathing, there's really no need to use any type of specific soap or body wash, although I would recommend staying away from products that are highly scented. In terms of douching, the vagina is “self-cleaning,” and I do not recommend douching a means of promoting vaginal health for the majority of patients. As for clothing, breathable, loose underwear is preferred while sleeping, and some people find it helpful to not sleep in any type of underwear at all. Likewise, if you are going to wear tight fitting pants, such as exercise clothing, I would make sure you change them immediately after you are done working out to keep the area as dry as possible. I also recommend monthly self-vulvar exams. This involves getting a mirror and checking the vulva for anything that appears different. If you notice something that wasn't there before, it's a good time to see with your healthcare provider.
SHWI: What do you think is the most important research that need to be addressed for vulvovaginal disorders? Specifically, what do you see on the horizon for vulvar research?
As for research, there’s SO much that needs to be done. Prevention of recurrent vaginal infections, pudendal neuralgia, persistent genital arousal disorder/genito-pelvic dysesthesia – the list goes on. I hope that as more patients realize that there are providers that can help them, and that they don’t have to suffer, that more money will be put into researching these types of conditions. Statistically speaking, more than half of the population has two X chromosomes, so why is research into women’s health so lacking? In the near future, I foresee more research into the vaginal biome, and that’s especially exciting for people that have chronic vulvar diseases – and for those that treat them!