Experts say

Dr. Tan Toh Lick

Obstetric & Gynaecology, Thomson Women's Clinic

Dr Tan graduated from King’s College London in 1997 and undertook his specialist training in London and Kent, UK. He worked in London as a consultant obstetrician and gynaecologist before relocating to Singapore in 2013. Dr Tan is on the UK’s General Medical Council and Singapore Medical Council’s specialist registers. He is also a Fellow of the Royal College of Obstetricians and Gynaecologists, and has RCOG special skills accreditation in minimally invasive surgery, gynaecological ultrasound, subfertility management and medical education. Apart from practicing, he enjoys teaching and currently runs medical education programmes for general practitioners and specialists.
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Erin Chen

Sexual Wellness Advocate, Sex & Relationship Counselor

Erin is an advocate for the inclusion of sexual wellness as part of everyday healthy living. She holds a Masters degree in Sexual Health Counselling from the University of Sydney, and helps people discover and confidently explore intimacy and pleasure within oneself or with another. Her career in sexual wellness began with the founding of Lila Sutra, a company that has disrupted sexual taboos in Singapore. In 2017, she launched SPARK – Asia’s first sexual wellness festival that brings together entrepreneurs, advocates and the general community to advance the modern conversation on intimacy, sexual health, and gender.
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Dr. Felix Li

Aesthetic Medicine, Dr Felix Li Thomson Wellth Clinic

Dr. Li earned his medical degree from the National University of Singapore, and is accredited by the Aesthetic Practice Oversight Committee of the Singapore Medical Council in aesthetic procedures. He regularly attends local and international conferences on aesthetic and anti-ageing medicine, as well as advanced anatomy workshops and masterclasses to keep abreast of the field’s rapid advances.
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What are common causes of dull skin on the face and body?
The appearance of dull skin is a result of poor light reflection off the skin. This is in turn due to uneven skin surface – rough or saggy skin, acne scars, prominent pores, fine lines and wrinkles; and/or uneven skin tone – blemishes, hyperpigmentation, blotchy or sensitive skin.

Healthy, hydrated, firm and clear skin reflects light evenly, giving the appearance of radiant and glowing skin. 

Dr. Felix Li
28 April 2019
What ingredients and claims should people with sensitive skin look out for in products?
Seeking a skincare range that is both effective and gentle can be a frustrating, expensive, or even painful process for individuals with sensitive skin. As a general rule, avoid products that contain ingredients that dry the skin – such as acids, retinols, and astringents; as well as ingredients that can irritate the skin – such as alcohol, fragrances, paraben, sulphates, and other chemical preservatives. If in doubt, seek your Doctor’s advice!

Dr. Felix Li
26 May 2019
How does activated charcoal detox the skin?
Activated charcoal draws dirt and other fine impurities to the surface of the skin, so that they may be cleansed off more effectively. Additionally, activated charcoal also has a mild anti-bacterial effect, which is helpful for acne prone skin.

Dr. Felix Li
28 April 2019
What is Palmitoyl Hexapeptide-36 and how it works on the skin?
Palmitoyl Hexapeptide-36 is a peptide, which is a specific chain of amino acids (protein fragments).

Peptides have wide ranging applications in skincare, as different peptides perform different functions. Peptides can act as cellular messengers to signal our cells to perform specific functions; transport specific molecules (Copper peptides) into skin; or influence neurotransmitters (Argireline, or “topical Botox”) or enzymes in the skin. Peptides work best in combination, and along with other building blocks of skincare.  

In the case of Palmitoyl Hexapeptide-36, it is a signalling peptide that influences cellular fibroblasts to synthesize new collagen, which in turn contributes to improvements in skin elasticity, skin texture, and the appearance of fine lines and wrinkles. 

Dr. Felix Li
9 April 2019
I’ve seen many products for dry skin that contains Sodium Hyaluronate, but in different concentrations and different molecular sizes. How should I select one that would work best on dry skin? Does the smallest molecule equate to the best?
Hyaluronic acid (HA) is a naturally occurring substance that promotes collagen synthesis in our skin. HA is well established as a cornerstone of skincare, due to its effect to help strengthen the collagen matrix of the skin, and improve the skin’s ability to retain moisture – which in turn improves skin elasticity, texture, and the appearance of fine lines.   

HA of different molecular weights penetrate the skin at different depths, and influence the inflammatory cascade at different points. The claim that low molecular weight HA penetrates the deepest and is therefore the most beneficial is essentially a marketing gimmick. For example, high molecular weight HA that does not penetrate the skin at all remains on the surface of skin, forming a protective barrier, and keeping the skin’s surface hydrated. Therefore, the ideal HA product contains a combination of HAs of different molecular weights, each selected for optimum benefit at the layer where it acts.

Dr. Felix Li
18 April 2019
Ascorbyl Glucoside (Vitamin C) is best known for its antioxidant and brightening effect. How is the ingredient different from other forms of Vitamin C in brightening and adding a glow to the skin?

The benefits of Vitamin C on skin is well studied and clinically proven – its anti-oxidant effect cleans up free radicals from sun and environmental damage, protecting the skin from these stressors, and slowing down the process of skin aging – which in turn improves skin tone, skin texture, and the appearance of blemishes and hyperpigmentation.

Multiple forms of Vitamin C are used in skincare. Ascorbic acid is the original form of Vitamin C, while Ascobyl – or – Ascorbate are the esterified forms, which is essentially a compound added to slow the natural degradation of Ascorbic acid. The benefits of the various forms of Vitamin C are all the same. However, as Ascorbic acid is very unstable and degrade spontaneously, while the esterified forms, while more stable, still degrade over time, and especially when exposed to direct heat or light (notice how most of your Vitamin C products come in dark coloured bottles?), they tend to lose effectiveness over time.

A “second generation” Vitamin C product, or a Vitamin C precursor, that is stable in the bottle, and is converted into Ascorbic acid only when applied to the skin, is the best solution against the intrinsically unstable nature of Vitamin C.

Dr. Felix Li
9 April 2019

What are the common causes of dry skin and what’s the best way to treat it?
Dry skin is often a result of aging or damaged skin’s lack of ability to retain moisture. To make matters worse, dry skin is also more susceptible to sun and environmental damage, perpetuating the problem. Moisturisers address dry skin directly by trapping moisture in the skin, while treatments such as Rejuran – that increase new collagen production in the skin and strengthen the skin’s collagen matrix – help improve the skin’s ability to retain moisture, keeping it hydrated from within.  

Excessive use of or inappropriate skincare products is another common cause of dry skin, skin irritation, redness, and peeling. Common culprits include products containing acids, retinols, or hydroquinones. More is not always better – avoid complicated skincare regimes. And do give the products time to work. Multiple daily applications will not give faster results, but may increase the risks of side effects. Seek a Doctor’s advice if you are unsure which products are suitable for your skin, and tailor make a regime that is specific for you.   

Other simple tips - wash your face twice a day, and after sweating heavily. More frequent cleansing will only wash away the natural protective barrier of the skin. Apply spot treatment products such as pimple creams only over pimples, and de-pigmenting creams only over hyper pigmented areas – not the whole face.  

Dr. Felix Li
9 April 2019
Are there any preventive measures that can be taken to treat wrinkles?
An immediate and effective way to correct wrinkles is thorough Botox injections to relax those specific muscles. It is an effective way to reduce the appearance of dynamic wrinkles, and may also reduce the rate and severity of recurrence, especially in individuals who habitually have repetitive facial expressions, such as frowning.  

Try to keep the skin hydrated so as to improve the skin’s ability to retain moisture. Skin treatments including lasers, energy based devices, and skinboosters can help stimulate the body’s natural repair mechanisms and increase new collagen production in the skin, keeping our skin healthy and more resilient against extrinsic aging.

Dr. Felix Li
9 April 2019
What are wrinkles and what causes them?

Static lines, or fine lines that are visible on the surface of the skin at all times even without facial expression, is a result of dry and damaged skin, that has lost its intrinsic elasticity, and ability to retain moisture.

Dynamic wrinkles, or lines that appear with facial expression, such as frown lines, forehead lines, and crow’s feet, are due to over-activity of the small facial muscles responsible for the corresponding facial expressions.

Dr. Felix Li
9 April 2019

What is the best way we can prevent or delay our skin from aging?
While we cannot reverse “intrinsic aging”, or the natural process of aging; we can minimise the effects of “extrinsic aging” by reducing free radical and other external damage to the skin, while enhancing anti-oxidant and other repair mechanisms in the skin.

Sun protection – including oral and physical sunblock, sun avoidance – is key to minimise free radical damage to the skin. Stop smoking if you do, avoid second-hand smoke and polluted areas as much as possible. Regular exercise is a great way to improve blood circulation and enhance the body’s natural ability to repair. Maintain a balanced diet packed with antioxidants such as fruits and vegetables.

A good and complete skincare regime including antioxidants and moisturisers will help clean up free radicals, keep the skin hydrated, and improve the skin’s ability to retain moisture. Skin treatments including lasers, energy based devices, and skinboosters can help stimulate the body’s natural repair mechanisms and increase new collagen production in the skin, keeping our skin healthy and more resilient against extrinsic aging.

Dr. Felix Li
9 April 2019
Self-awareness and self-care starts from within, do you have any recommendations for the women who have just started their self-discovery journey or any encouragement for those who are afraid to make the first steps?
As I mentioned, something women can do is to try to make friends with it. We don’t usually take that context with our vulvas. So start by saying hi and having a look. You can do this exercise however way you want to – it doesn’t have to be a big deal. It can be a quick, 5 second peek or you can make it a whole occasion where you light candles, play music and really take your time. There’s no right way to do this exercise, it’s whatever you make it to be. The important part is to observe and pay attention to your thoughts and feelings, without judgment. I often encourage women to do this exercise regularly because it’s a great way to check in with your vulva and figure out its needs and wants.

Aside from this, general knowledge about vulvas and sexuality is always helpful in our sexual wellness journey; so a great book that I always suggest is “Come As You Are” by Emily Nagoski.

Erin Chen
5 April 2019
What are some of the things that women can do to care for their vulvas?
Caring for your vulva can feel quite confusing – where would you start?? In my experience, many women don’t have a very strong connection with their vulvas. So while we can care for our vulvas physically – don’t forget, there is also another part that goes into vulva care: how we feel about ours.

The starting point to that is to be honest with yourself about your feelings. It’s perfectly normal to feel shame towards your vulva (thanks, patriarchy), embarrassed by how it looks or smells. Perhaps you have an abundance of positive feelings, or maybe none at all. Whatever it may be, it is normal and okay. The starting point is just to notice how you feel about your vulva.

A way to uncover these feelings is to look at it! Take a mirror and take a peek. Observe what you see and the feelings and thoughts that surface.

From there, you can choose how you want to move forward. The more you get to know your vulva, the more you will naturally know what you can do to care for it. What your vulva care journey looks like is completely up to you!

Erin Chen
5 April 2019
What is your view on the subject of Labiaplasty or the notion of a “perfect” vulva?
Labiaplasty is surgery on the inner and outer lips of the vulva. It is often discussed in the media in a narrative similar to plastic surgery, where we think that women are getting Labiaplasty because they want a nice-looking or a “perfect” vulva that’s similar to what we see in porn. This might be the reason for some women, but according to recent research, many women have Labiaplasty for reasons others than aesthetics. Some do it because over time, their labia have elongated and are causing physical discomfort. For example, they might experience tugging during intercourse, find tight pants uncomfortable, experience twisting of the labia, and are nervous that their labia could become exposed in bathing suits. These physical factors can then impact how a woman feels in her body – she may feel more self-conscious or less attractive and less able to feel intimate with their partner.

While this recent research was done within small groups of women, it does show that the Labiaplasty procedure had a positive impact on their physical comfort, self esteem, sexual confidence and their sexual enjoyment. Many women who are choosing to have the surgery are not striving for the perfect vulva – they’re striving to make their lives easier, more comfortable and to feel better. Ultimately, it comes down to the individual woman’s reasons for wanting this surgery. And as with any elective surgery, informed consent and autonomy are important!

Erin Chen
18 April 2019
Women are often pressured by the perceptions set by media influences to have a “perfect-looking vulva”. Is there a difference between caring for your vulva and striving for the “perfect” vulva?

There’s definitely a difference between caring for your vulva and striving for the “perfect” vulva. Let’s take a moment and compare this to everyday wellness, where there’s also a difference between striving for the perfect body and caring for it.

The way we can differentiate between the two is to look at the actions, behaviours and feelings associated with each. When we’re striving for the perfect anything, there is usually a lot of comparison between what we have to an ideal state. And the feelings that usually come with striving and comparing tend to be more negative – lots of pressure, feeling inadequate, feeling like we need to do more, and to be different. You know that you’re striving for perfection when you’re starting to experience some of these feelings.

When we are caring for our own body, the actions, behaviours and feelings are different because you’re coming from a place of knowing what is best for you. For some people it feels more flexible, or creative, or lighter. It’s more of an internal exercise rather than looking outwards to achieve that perfect “it”.

Erin Chen
5 April 2019

Through your experience in working with so many women from different walks of life, what are the top 3 most common concerns when it comes to “vulva issues”?
In my experience, every woman and every case is different. While people might come to me with similar sexual challenges, what we end up working on varies a lot from person to person – that’s because everyone’s sexual history, experiences and circumstances are different.

That said, the most common vulva concerns that people come to me with are usually about:
  • Painful sex
  • Wanting to increase their sex drive or sexual desire, and
  • Wanting to orgasm (more)

Erin Chen
5 April 2019

Do you think women are doing enough to care for themselves, specifically caring for their vulva?

I’d prefer not to generalise here because I’ve met and known many women who do amazingly with taking care of themselves and caring for their vulvas. That said, I do think there is a general lack of conversation and awareness in society about what vulva care is and what it could look like. So in that sense, it would be challenging for most women to practice vulva care if we don’t really know what it entails.

It’s also important to note that self-care and vulva care might look very different from women to women because it is something that’s unique to the individual. One interesting way to start exploring what vulva care might look like for you, at this moment, is to apply the five love languages to yourself. If you are not sure what the five love languages are, Google it . Once you know what your love language is, try it out in the context of caring for your vulva! You can get creative with this… what might vulva care be for you if your love language was physical touch? Or affirmation? Or quality time?

Remember that self-care and vulva care shouldn’t feel like pressure or increase your anxiety. So it’s not something you must do. It’s something that, even if it was just for one or five minutes, would give you a sense of joy or relief or whatever emotion it is that you are seeking that feels good for you.

Erin Chen
5 April 2019

What you think about Vulva Care? Do you think it is important?

For me, vulva care is a holistic matter. It’s not just about physical care, but the emotional connection and relationship we have with our vulvas. And it’s important, as part of vulva care, to have an understanding about them – much like how it’s important to have an understanding about the rest of our body and mind to be able to take care of ourselves.

So in that sense, I do think vulva care is important. It’s an essential and intimate area which carry a lot of meaning, energy and function for many vulva owners. In my experience, it’s also an area where many vulva owners don’t pay much attention to.

Erin Chen
5 April 2019

What do you think is the best way to open up the topic of vulva conversations? Do you think it’s best done from woman to woman?
I don’t think there is a “best” way to open up. For a lot of people, starting this conversation would most likely feel awkward and uncomfortable – which is completely normal when it’s something we’re not used to talking about! Here are a few suggestions that you can try to bring this topic up:

  • Share! If you come across an article, video, piece of art or anything that resonates with you – try sharing that with your friends or partner. Follow it up with something like, “What are your thoughts?” Articles are a great way to open conversations.
  • Be normal! Easier said than done, I know. This will take some practice – try to treat the conversation like a normal topic… there is no reason why we can’t talk about vulvas or sexual wellness the same way we talk about other parts of life – be it yoga, fashion, sports! A lot of the time, others feel awkward too when we’re awkward about it. So the more normal you are with the topic, the more space you provide for others around you to open up. Again, this takes practice – think of it as building your muscle memory for having authentic conversations.

From my experience, most women feel more comfortable discussing vulvas with other women; however, it’s really whoever you feel comfortable with that matters – the gender and their genitalia don’t really matter.

Erin Chen
5 April 2019
With an increasing openness in today's society about self-care, do you think that the conversation surrounding the vulva and vulva care is adequately discussed?

I think that the conversation on sexual wellness in general, let alone vulva care, is not adequately discussed in today’s society – probably because talking about anything sexual still feels taboo. We just haven’t had a lot of practice talking about sex, intimacy, our bodies and the feelings related to this area. Most people still refer to the vagina as “down there”, not knowing that they might actually mean the vulva! So no, there are not enough discussions about vulvas and vulva care at all!

And, I’m not sure if most people really know what it means to care for their vulvas. I’m guessing that for most, it likely brings to mind something sexual health-related, such as your annual Pap smear to make sure everything is okay or hygiene. On the flip side, some might think that it’s a cheeky way to refer to masturbation.

So we haven’t really had much thoughtful conversation around what vulva care could be or how one would go about defining vulva care for oneself!

Erin Chen
5 April 2019

The vagina has been known to be self-cleaning and also has a very specific PH-range that is required to prevent infections and other issues. Is it true that the Vulva is self-cleaning with a specific pH range too?
The vulva requires care to stay healthy. Keeping the vulva clean and dry is generally enough. However, do not douche, powder or use feminine sprays. Rinse the vulva, if necessary, with a perineal irrigation bottle, and dry the area by gentle patting rather than hair dryers. If there is mild vulva discomfort, soaking in warm water and using an emollient may be helpful. If the problem persists, or if there is any discharge, lesion or pain, then a review by a family doctor or gynaecologist is warranted.

The pH of different body parts is different, and this applies to the vulva too. However, this pH rises during menopause, reducing the antimicrobial defence of the vulva during menopause.

Dr. Tan Toh Lick
10 April 2019
Can hormonal changes / skin issues on vulva be treated by topical application of intimate care products? 
Some skin conditions can be treated using over-the-counter products. However, others may require prescription-only medications. It would be prudent to see a family doctor for an assessment before self-prescribing treatment.

Dr. Tan Toh Lick
1 May 2019
Can the vulva be affected by common skin issues such as folliculitis, dermatitis, dehydrated skin, scars & blemishes etc.?

Yes, the vulva can be complicated with common benign skin conditions such as eczema, psoriasis, and contact dermatitis. Like skin on other parts of the body, malignancy can also occur.

Dr. Tan Toh Lick
10 April 2019

Can hormonal changes in your body affect the health of the vulva (i.e. Menopause / pregnancy etc.)?

At puberty, fatty tissues deposit around the vulva increasing the size of the labia majora and mon pubis. In some girls, the pink labia minora may become darker. Pubic hair also starts to appear around this time. The vulva then remains similar until pregnancy.

During pregnancy, the vulva can become engorged and varicosities are common. Pigmentation of the vulva, as with other areas of the skin, can be significant. During a vaginal delivery, the muscles and ligaments supporting the vagina may be damaged. As the baby is delivered, perineal tears or episiotomies may further affect the appearance of the vulva. The return of the higher oestrogen hormone level after breastfeeding will generally improve the elasticity and lubrication of the area.

After menopause, the labia majora lose its substance and become less full. Like the skin on other parts of the body, it becomes thinner and loses its elasticity. Hair greying, loss and reduced growth are also observed.

Dr. Tan Toh Lick
10 April 2019

Is the skin of the Vulva the same as the skin of the rest of the body or is it more sensitive in comparison?
The skin of the labia majora and the perineum are covered with skin just like on the rest of the body. In contrast, the labia minora are lined with a mucous membrane, whose surface is kept moist by fluid secreted by specialised cells.

The area is often moist from normal vaginal discharge, sweating and in some women, incontinence. The combination of being close to the germs from the anus and being moist increases its risk of being infected. This is particularly so during the menopause when skin pH rises leading to less antimicrobial defence of the skin. Further, lipid production is reduced after the menopause which slows the healing process.

Dr. Tan Toh Lick
3 April 2019
Why is Vulva Care important, and how should I take care of my vulva?

Like the skin on other parts of the body, care for it is important to having a healthy vulva. Infections, skin conditions, chronic pain and scarring can affect the individual’s quality of life and self-image. Although rare, vulva cancer can be devastating and lethal. Persistent pain, soreness, tenderness, itch, raised thickened patches, lumps or moles should be reviewed by a doctor.

Dr. Tan Toh Lick
3 April 2019

I’ve always thought that the vagina and the vulva refer to the same area. Can you explain the anatomical difference between the two body parts and what is the specific function of the Vulva?

The vagina refers to the elastic muscular tube extending from the external genitals to the neck of the womb (cervix). It is a reproductive conduit connecting the external environment to the internal genitalia. During sexual intercourse, it receives the penis and allows the sperm to swim up into the womb. Conversely, it allows blood flow to be expelled from the womb during menstruation, and the baby during vaginal childbirth.

The vulva refers to the external female genital organs which are composed of the mons pubis, labia majora and minora, clitoris, urethral opening, vestibule and perineum.

The labia majora refers to the large, fleshy folds of tissue that enclose and protect the other external genital organs. The labia minora lie just inside the labia majora and surround the vestibule, which is the area around the openings to the vagina and urethra. A rich supply of blood vessels gives the labia minora a pink colour. The clitoris is a small protrusion at the upper end between the labia minora. The urethral opening allows the passage of urine. The perineum refers to the area between the vagina and anus.

Dr. Tan Toh Lick
3 April 2019

 

What are the specific functions of the clitoris, labia majora and labia minora?

The clitoris can be aroused and erect when sexually stimulated. This stimulation of the clitoris can cumulate into an orgasm.

The fleshy padded tissue of the labia majora protect the other external genital organs. They also contain sweat and sebaceous glands, which produce lubricating secretions particularly during sexual intercourse.

During sexual stimulation, the labia minora swell as their blood vessels become engorged with blood. This narrows the vaginal opening and makes them more sensitive to stimulation.

Dr. Tan Toh Lick
3 April 2019