Gyne’s Best: The Gynecologist’s Favorite Product of the Week- Boric Acid

As a practicing OBGYN,

I am asked practically every day about what I use for various feminine care products. I have decided to share some of my favorite products here every week, especially those found on my FAVORITE, Amazon Prime.

For mildly irritating vaginal discharge or odor, I commonly recommend Boric Acid suppositories. This particular one is my favorite.

I use it every couple of weeks, or any time I feel a little “off.” I can not stress the following point enough.

These are suppositories. They are NOT to be taken orally. ONLY USED INSIDE THE VAGINA.

If ingested by mouth, a person can get very sick and possibly die. It is not absorbed through the vagina, which is why vaginal use is safe.  Boric acid re-acidifies the vagina and makes the environment pro-good bacteria, anti-bad bacteria.

Read more about how boric acid works in THIS popular post.

Leave me a comment here or on social media letting me know how you like it. You don’t have to give me details. A simple thumbs up will do. I hope you like it!

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Now You AND Your Sons and Daughters Can Get the HPV Vaccine up to age 45. Here’s why you should…

On October 5th, 2018, the FDA approved the HPV vaccine for men and women between the ages of 27 and 45.

That is in addition to the already established population and youth and young adults between the ages of 9 and 26 regardless of gender.

But recently I came across THIS post on Instagram:

Before getting your daughter or son vaccinated, read this book [The HPV Vaccine on Trial: Seeking justice for a generation betrayed.] It’s a real page turner. This vaccine can severely disable young people and even result in infertility and death. Side effects are very under reported. I have been speaking out about this since the vaccine was fast tracked. Here’s the proof.

I was especially shocked that this post was written BY A GYNECOLOGIST!

The HPV vaccine should not be feared.

Rather it is many boys’ and girls’ first line of defense against a virus that is literally around practically every

HPV, or human papillomavirus, is a sexually transmitted virus that can cause many types of cancer.

Yes, HPV is the cause of 75-95% of all cervical, vulvar and penile cancers. (Source: The CDC.)  Not only is HPV the cause of most cervical cancers and GENITAL WARTS, but most people in their lifetime will also be exposed to HPV during sexual intercourse. Quoting a Pubmed article from the Journal, Sexually Transmitted Diseases from 2014:

We estimated the average lifetime probability of acquiring HPV among those with at least 1 opposite sex partner to be 84.6% (range, 53.6%-95.0%) for women and 91.3% (range, 69.5%-97.7%) for men. Under base case assumptions, more than 80% of women and men acquire HPV by age 45 years.

“More than 80% of woman and men acquire HPV by the age of 45.”

That. Is. A. Lot.


While that number seems high, many will never know they have the virus. Our immune system in many cases is strong enough to fight off the HPV virus.

Now, to be fair, vaccines work best before a person is exposed to whatever the vaccine is for. Like if you get the flu, the ACTUAL FLU, the flu vaccine afterward will likely do you no good. Likewise, if you have already been exposed to a strain of HPV, the vaccine won’t protect you against THAT strain. The current HPV vaccine, however, has 9, yes 9 strains of HPV in it. That means, if you haven’t yet been exposed to all 9 of those strains, you will still benefit from it.

Side effects can occur with ANY medication.

What The Hair

Many HPV vaccination nay-sayers quote adverse events that have occurred with the vaccine. Regarding the safety of the vaccine, the CDC says:

More than 80 million doses of HPV vaccine have been distributed since the vaccine was introduced in 2006.

The most common side effects associated with HPV vaccines are mild, and include pain, redness, or swelling in the arm where the shot was given.

All vaccines used in the United States, including HPV vaccines, are required to go through years of extensive safety testing before they are licensed by the U.S. Food and Drug Administration (FDA). During clinical trials conducted before they were licensed:

  • 9-valent HPV vaccine was studied in more than 15,000 males and females

  • Quadrivalent HPV vaccine was studied in more than 29,000 males and females

  • Bivalent HPV vaccine was studied in more than 30,000 females

Each HPV vaccine was found to be safe and effective.

In 2014, CDC published a report analyzing health events reported to VAERS following Gardasil vaccination from June 2006 through March 2014. About 92% of the Gardasil reports were classified as non-serious. (Source: CDC.)

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Here’s to those who saw this change coming before the benefit to people over the age of 26 was established. If I had a nickel for every time someone has asked me,

Doc, I know I am over the age to get the HPV vaccine, but should I get it anyway?

… I would have… maybe 50 cents. So, I guess people don’t ask me a lot about vaccines that they don’t qualify for, but the handful of times the subject has come up, I have always thought that it would be beneficial. At least in theory.

If I were you, I would give it a couple of months before asking your doctor for the vaccine. I only say that because sometimes it takes insurance companies some time to recognize guideline changes and to cover them. Also, check out this post I wrote about Abnormal Pap Tests and what they mean.

Thank you for reading.

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That’s What’s Pap-pening!


Something Is Growing On My Vagina: Here Is Your Top 10 List

Don’t worry, I won’t get graphic.

Photo by Alexander Krivitskiy on

Descriptive yes, but not overly striking images of lesions will be found here. I will leave it to Google Images to show you the absolute worst case of any disease, because that is what Google is good for: Making sure that you know that you could drop dead at any given moment. #ThanksGoogle

Back to the lesson at hand…

Imperfection needs inspection so I’m’ma let ’em understand.

From a Gyn-NE’s perspective,

Every lesion has a reason, look for classic signs and symptoms.

Sidebar- I actually can appreciate the fact that Snoop Dogg included contraceptive use in Nuthin’ But A “G” Thang back in the day. These rappers these days could take a lesson in that, cause ain’t no lovin’ good enough to get burnt while… you know the rest.

Ending that LONG parenthetic pause, again, sometimes even I don’t know what a lesion is until I swab it or take a biopsy. There are some rules of the road that can narrow suspicion though. I am going to try break the top 10 down in systematic way so as to help you know how concerned you need to be, or how far out you can chill.

Ask yourself the following questions. Your answers will narrow down the diagnosis.

  1. Does it hurt?
  2. How long has it been there, and how long did it take to go away if it went away?
  3. Has it changed in appearance or color or multiplied?
  4. Are you sexually active, especially unprotected, and especially with a new partner? (Though things can be transmitted even if you have had the same partner for a long time and use condoms consistently.) 
  5. Is your groin sore/are lymph nodes swollen and tender right in that crease between your legs and your pubic region? 

I tried to color code a key for ease in matching symptoms with the alleged diagnosis, but the complexity was blocking my greatness and giving me a headache. Text colors- back to black for you. 

Here are some common causes of growth on the vagina/vulva as well as their various characteristics.

Get out your handheld mirror and let’s get started.

1. Folliculitis or hidradenitis- aka an ingrown hair or infected sweat gland


These are ingrown hairs and infected hair follicles and sweat glands, classically known as boils. If you have course curly hair, shaving can increase your risk for ingrown hairs. You may need to use an electric hair clipper instead so as to not cut the hair beneath the skin. This doesn’t leave you skin super smooth, but you have to choose which is worst: Stubble or numerous puss filled painful bumps. Being overweight can also increase the risk of developing infected sweat glands that will classically grow and cause pain, prior to rupture. Weight loss can decrease their frequency and severity. These can be treated with warm compresses twice daily and baths. If that doesn’t help, you may need to have them drained by a doctor. Put the needle away, lady. Occasionally I have women use topical or oral antibiotics as well. Let your doctor make that call.

2. Skin tag

Skin tags are fleshy, not painful, small growths that show up usually slowly, and then just stay. They don’t usually enlarge over time, but a person can develop multiple, much like a person can develop multiple moles over time. Skin tags aren’t dangerous but can sometimes be annoying if they get caught in clothing or jewelry. There is nothing wrong with showing them to your doctor to make sure that’s what they are. Biopsies are last resort for any lesion to confirm the diagnosis. Often that is not needed for a skin tag.

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3. Genital warts

Caused by the HPV virus and often sexually transmitted, painless, genital warts also grow slowly but multiply more rapidly than skin tags. They may even grow on top of each other like broccoli or cauliflower. They are also flesh colored but often slightly harder than skin tags. They are not always easy to distinguish from molluscum (next possibililty) even by a trained eye. This is where biopsies come back into the conversation. The skin can be cleaned, numbed and a scalpel can be used to remove a sample. Pathologists can then look at the tissue and tell me what it is. Genital warts are usually pretty easy to treat with medication or manual removal. The pathologists also help to make sure no advanced precancer or cancer is present in the lesion.  #ilovemypathologists

4. Molluscum contagiosum

Constipation Wash Your Hands Small

This is another virus that is transmitted by skin contact and can lead to painless fleshy growths. Biopsies are often necessary to confirm this diagnosis, and these can also be removed in  the office by a gynecologist or dermatologists. In the genital region, these often are sexually transmitted, but they can be present on any part of the body and passed from any skin to skin contact. Hand washing is extremely important with any contact with the genital region. SIDEBAR: LADIES, PLEASE stop showing me your new lumps or bumps by touching your genital region, then without any involvement of soap and water, touching your hair, your phone, my doorknobs in the office etc. Just because you are comfortable with your body, doesn’t mean you need to share that love all around the office. Wash your hands or just tell me where your area of concern is and let me find it without you bare-finger touching the area and carrying on like it’s a regular day. I wash my hands like I have OCD and wear gloves for a reason. I don’t want my pen that you want to borrow to be an unsuspecting vessel for your personal places. 

5. A Mole

A pigmented mole that has any irregularity or is changing in any way should be evaluated for possible melanoma or any other abnormality. If you have had that same pigmented or non-pigmented mole forever and it never has changed, leave that bad boy alone. It isn’t bothering anybody. If it really bothers you, it can be removed, but the likelihood of danger in a painless stable lesion is slim to none.

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6. Herpes

Herpes hurts. An initial outbreak is usually the cause of significant pain and swollen, tender inguinal lymph nodes for days to weeks. Recurrences are usually not as significant. They can cause more mild tenderness, small lesions, itching or tingling. This is where that mirror can come into play. When I diagnose a person with herpes who is having an outbreak but didn’t know she even had the disease, it is usually someone who thinks she just has a yeast infection or “scratched” herself, but never looked down there to see if there was any localized skin break. If you see a small cluster of clear vesicles, or even a single tender pimple like structure or open sore, it is probably worth seeing your gynecologist right away to check it out and run some tests.

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7. Yeast or Candidiasis:

If you are itching and nothing seems to help, the cause may be yeast. Itching is the hallmark. Abnormal smell is an uncommon symptom. Some can develop small bumps from yeast. This is not a common symptom, but I have definitely seen it. I don’t fault a woman for trying an over the counter yeast medication prior to coming in to see her gynecologist. I am not a huge fan of the 1-day over-the-counter meds. I like a 3-day or longer treatment for the best possible chance of treatment.

8. Syphilis

Though it sounds like a diagnosis of yesteryear, it is not. Syphilis is still an STD that is alive and well. If you have a painless ulcerated lesion that is not easily explained or swollen lymph nodes without a good cause (what is a good cause for swollen lymph nodes?), call your Gyne and come in for testing. This lesion could last for 3-6 weeks without treatment but then resolve. That, unfortunately, is the 1st of the 3 stages of syphilis. The good news is that this disease is curable with antibiotics, but the diagnosis needs to be made first.

9. A Tick Bite

You would be surprised how easy it is to not realize that you have a tick that is stick and burrowed into your skin. This can cause a sore lesion with a black scab-like thing in the middle. That “thing” will have legs at first, but then the legs will burrow under the skin along with the head. The problem with pulling ticks out on your own is that the head can break off and stay in your skin. That needs to be removed to avoid infection, and any other tick-bite repercussions need to be monitored for. You won’t find me camping again after it happened to me in elementary school that ONE GOOD TIME. One got me on my torso by my bottom rib. Talk about wanting to jump up out of your OWN SKIN. Ughhhh (as I shake in my seat almost 3 decades later).

10. Bartholin Gland cyst or abscess


This is a painful enlargement of the labia on one side or the other caused by either a blocked or both blocked and infected Bartholin gland. With a mirror, one side of the labia will appear significantly swollen and asymmetric. This is not just a pimple or small lesion. These can sometimes resolve on their own with warm compresses and warm baths. Sometimes, they need to be drained by a doctor and antibiotics may be necessary. Again, PUT THE NEEDLE DOWN. In extreme and recurrent cases, a small catheter needs to be placed inside of it to allow complete drainage or the entire gland needs to be removed. These extremes are infrequent, so starting with tolerable heat twice daily down below is a great first step to try to stop it in it’s tracks. 

If you were looking for more details, feel free to take your curiosity back to Google. Enter Images at your own risk. Better for you to stick with this general guideline and call your doctor for an ASAP appointment if you need more answers to your specific issue.

Don’t worry, you can’t gross me out. I’m a GYNECOLOGIST.

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Take care of her

Photo by Samay Bhavsar on Unsplash

Photo by Warlen G Vasco on Unsplash

3 Things You Should Know BEFORE Your First IVF appointment: This is not just for Kate and Toby

The episode of NBC’s hit show This Is Us that aired October 9th, 2018 featured a risky procedure that left us wondering if Kate was going to make it through.

Kate and Toby are trying to have a baby.

Kate’s doctor didn’t want to take her as a patient initially because she said the risks were too great. I almost said too large. That was the problem though. Kate’s weight increased her risks of having complications while going through IVF.

What this episode of This Is Us and previous episodes didn’t explain was what those risks were and how likely complications were. They also didn’t talk about one of the largest risks of IVF, which is not affected at all by Kate’s starting BMI. I think it is important to be specific.

Having a baby can bring about immeasurable joy. I don’t fault couples for accepting certain risks in pursuit of pregnancy. I think that couples should do and know 3 things before pursuing assisted reproductive technologies, like IVF. By the way, I am not an IVF doctor, so my recommendations are not laced with any motive other than to provide information.

Let’s get into it.

Do You Meet Criteria for the diagnosis of Infertility or Subfertility?

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People spend so much time and energy trying to not get pregnant that, when birth prevention is removed, they expect to get pregnant right away. Now, start taking prenatal vitamins 3 months prior to attempting pregnancy because you may get pregnant right away. If you don’t though, things may still be fine. Women under 35 can take up to one year of unprotected intercourse and still be normal. We give women who are 35 years old or older 6 months before pursuing further evaluation.

Well, Doc, we’ve only been “trying” for 3 months, but we haven’t used condoms or any form of birth control for over a year.

Then, ma’am, you have been “trying” for over a year. By a gynecologist’s definition, not preventing is considered trying. You don’t have to be tracking every change in your temperature or urinating on sticks to be trying. Simple sperm in vagina action counts.

It is nice to know even an estimate of when you are ovulating. A free period tracker app should do it. Intercourse at least every other day in your 3-5 day ovulation window should give you the best shot. Do your best to keep it fun and low stress. Get massages. Go on vacation. Relax.

Oh, and don’t go to any Zika territories. It’s still a thing.

Click here to see an up to date list of Zika territories you and your partner should avoid if you are or are planning to be pregnant.nrfspr3_4ye-klara-sasova

The point of meeting criteria for infertility is 2-fold. One, if you know that it may take a year, hopefully that takes some of the pressure off month to month. Stress and anxiety are counterproductive for fertility. Two, insurance companies often require a certain duration of attempted conception before they will pay for assistance.

Do You Have Insurance for Infertility Coverage?

If you are thinking about trying to conceive and your open enrollment for your health insurance is coming up, just check to see what your infertility coverage is. It is just good to know if you will need additional coverage if conception isn’t easy. Infertility coverage is not a part of all policies.

If it is a part of your policy, you may have a maximum allowable expense. All infertility treatments do not cost the same. In Vitro Fertilization (IVF) is significantly more expensive than Intrauterine insemination, or IUI. Quite honestly, Kate and Toby may have been candidates for IUI with Clomiphene.

Clomiphene, known by the brand name Clomid, is a medication that helps women ovulate, or release an egg. This is especially helpful for women who have very irregular periods because they may not be ovulating regularly, like women with PCOS. The story of Kate and Toby included Toby’s sperm that were underperforming. If they were just slightly low-functioning, IUI is a fertility treatment that can turn a sperm marathon into a 5K.

Don’t miss this article about how sperm quality can be dramatically improved by diet.twenty20_94092d03-c911-469a-bdec-d74a7069a4eb

Ultrasound and hormone testing are also evaluations that can often be done for women even if they don’t have insurance coverage for infertility. Still, though, waiting until you have given trying a good run is appropriate.

Risks of IVF are high, but so are risks of pregnancy.

Some of the risks of IVF are related to the high doses of hormones administered. Blood clot risks are higher, ovarian hyperstimulation is a significant complication, and ectopic pregnancy risk is higher with IVF  than with spontaneous pregnancy, to name a few. Blood clot risks are also higher than baseline for spontaneous pregnancy.

IVF can also increase your risk for twins or higher order multiples. This is because two embryos are sometimes placed in the uterus in hopes that at least one will implant. Well, sometimes both implant. A single embryo can also split, causing twins. Twins are cute and all, but twin pregnancies also lead to higher risks, like gestational hypertension, diabetes, preeclampsia, c-section etc.

So are you saying we shouldn’t try IVF, Doc?

Absolutely not. I just think that knowing your risks is better than being afraid of some unknown TV Land risks. Surveillance and monitoring are always high for women undergoing reproductive assistance, with hopes that catching any complications early will help improve the overall outcome.

chuttersnap-233105 smallWomen’s ages of first attempted conception are getting higher and higher.

The use of assisted reproductive technologies is becoming more and more common. Rebecca, Randal, hell EVERYONE was worried about Kate. I personally was happy when Toby spoke up and reminded everyone that this was their decision. If they understood what they were getting into, the risks, the benefits and the alternatives, they could make their own informed choices.

Check out another popular post from The Gyneco-bLogic about lesser known facts related to being pregnant at higher ages.

And as always, like and follow us here and on social media. Thanks for the LOVE!

Kate and Toby


Before You Hit The Beach or Waterpark In Your Mom-Suit, READ THIS

We’ve been to Wisconsin Dells countless times.

The Indoor Waterparks are just as fun in the fall and winter as the outdoor parks are in the summer. My kids have a blast while my blood pressure skyrockets. See, my nerves is bad. My grammar in that statement is intentional. My Nerves Is BAD.*

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Photo by Marc Richards on

Sidebar: I swear waterpark lifeguards must take a Xanax before their shift. They are cool as a fan while these kids and adults stand on the edge of safety. They are one slip, one back flip, one lazy pontoon away from tragedy x 100, and the lifeguards seem unfazed. If you aren’t ACTUALLY drowning, they’re at the ready. Otherwise, a quick whistle chirp is about all you are gonna get out of any one of them when things are just a little too close to danger.

But I digress.

Here I am, a mother of three, with a pretty decent midsection, thanks to rare exercise, good genes and my best friend SculpSure (a little laser body sculpting never hurts.) Still, confidence is not one of my strengths. I searched long and hard for this swim dress that said “cute” without being too revealing. It has the cutest shorts underneath too. I got a lot of compliments on it.

Cute, right? Click the pick to see it in other colors on Amazon.

I’m styling and mom-profiling, and I start to notice something. There is body confidence everywhere. I’m talking about 2-pieces of ALL shapes and sizes. I was in awe. Post-baby bellies, pre-baby bellies, and a LOT of non-Instagram model bellies. I had to ask myself, why am I here worried about my lack of packs (get it? Not a six, four or two pack in sight) and these ladies could care less about their rather abundant midsections.

Love Your Body In Every State

These ladies were there to swim and have fun and they clearly thought that they look GOOD. And THEY DID! Their confidence shined brighter than the artificial indoor lighting, and I envied them. When you put on a two piece, that is not accidental. You have to rock it. I was totally feeling their swag.

I learned something this weekend about being comfortable in my own skin. I also have a few more Waterpark reflections.

More Waterpark Reflections

  1. Parents who don’t put their babies and toddlers in swim diapers are TRASH. I’m not sorry. <
  2. They don’t put clocks in the pool area on purpose- because the pool is a time warp that is designed to keep you there forever, like the Lotus Flower in ancient Greek mythology.
  3. Lazy Rivers and Wave Pools when you have children between 6 and 10 raise my blood pressure.
  4. They should sell Excedrin in vending machines or dispensers in the pool area. Or better yet, their should be Parent Recharge Stations like the ones on Marathon routes with shots of Gatorade and Espresso.
  5. Child locator wrist-bands need to be a thing. Kids are quick and slippery. And I have the fortune and curse of having some fearless ones.
  6. There MUST be a strain of Weed called Waterpark Lifeguard that keeps them alert enough to save lives, but cool enough to watch almost-tragedies occur every minute.
  7. Either I am growing, or these pool-only towels are shrinking. Issa Hand Towel**.
  8. I need 10 other moms to help me go Oceans Eleven on the adjacent Arcade. YOU’RE GONNA GIVE MY KID A PRIZE. Those toy-grabbing games and other lose-every-time games need a reckoning.
  9. Germs are good. Germs are good. Deep breath. Germs are good.
  10. I told you. My NERVES is BAD. (Still intentional grammar. See the translation below.)
  11. I know ONE thing. I’ll be strutting in my 2-piece the next time we go anywhere near water. You can believe that!

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    Photo by Juan Salamanca on

    * “My Nerves is bad” Translation: I am a nervous nelly around slippery floors, tall slides, and a bunch of fast moving children of all shapes and sizes not raised by ME.

    ** “Issa” is colloquial for “It’s a.” In different context it could also refer to Issa Rae, who I love.

    Don’t forget to subscribe above or below to The Gyneco-bLogic. Issa GREAT BLOG!

5 Things You Need To Know About Chlamydia

Chlamydia landed a role on this season of HBO’s Insecure and I was happy. Why? Well, because Lawrence was living that free, unprotected, and frankly reckless life, but not even TV Land could save him from the consequences. Props, Issa Rae (she’s the show’s creator.)

There are a lot of misconceptions about this infection out there. Who would we be here at The Gyneco-bLogic if we didn’t tackle myths, and reveal truths? Let’s get to it. This game is called…

Chlamydia True or False

You’ll know if you have Chlamydia.

False. For women, up to 85% of infections are asymptomatic. In men, up to 40% are without symptoms. How do most people find out? By getting periodic screening. The CDC recommends screening at regular intervals and especially if becoming intimate with a new partner.

If you treat Chlamydia, you are cured of any and all consequences.

False. While antibiotics will often eradicate the infection itself, the residual effects can still persist, like pelvic pain or fertility issues, especially in the setting of pelvic inflammatory disease, or PID.

A partner who has Chlamydia will absolutely pass the infection on to you.

False. However, if you find out that a partner has the infection, while it is important to get tested right away, we do treat women presumptively for the infection in hopes of shortening it’s duration and minimizing the risk of PID or fertility issues later on. Also if you are diagnosed with Gonorrhea, we treat presumptively for Chlamydia.

It takes up to 3 weeks for a repeat Chlamydia test to be negative AND a person can retest to make sure it is gone.

True. While treatment should be effective by 7 days from initiation (which is the minimum duration one should obstain from intercourse,) the bacteria can linger in the vagina/cervix for up to 3 weeks. Since many Chlamydia tests are DNA tests these days rather than cultures, that means that the repeat test would still be positive.

Also, a person CAN request a test-of-cure a week after about 3 weeks to make sure the infection is gone, however since the antibiotic treatment for chlamydia is 97% effective, a test of cure is not necessary. A RETEST IS generally performed 2-3 months after treatment to make sure the person was not re-infected. All partners should be informed and treated before resuming any sexual relationship. Don’t forget, a person can get chlamydia in their throat.

A nickname for Chlamydia is The Clap.

False. A common misconception, but The Clap is a reference to Gonorrhea rather than Chlamydia, though as I mentioned, the two can often go hand in hand. I propose the following nicknames for Chlamydia.

  1. The Wind- Because you can’t always feel it, even though it is there.
  2. The News- Because getting that diagnosis is news you can use.
  3. The Smackdown- Enough said.

I want to applaud Issa Rae and character Lawrence of Insecure on HBO for not only including the diagnosis in the storyline, but showing the uncomfortable, yet necessary process of informing his previous partners. Big Ups to owning up to THE SMACKDOWN.

Wear a condom next time, Lawrence.


Don’t forget to Like us on all things social and Subscribe to The Gyneco-bLogic above or below. We have that news you can use- wait, not Chlamydia.