‘Let’s Talk About Down There’ offers answers and advice from an OB-GYN

Portland OB-GYN Dr. Jennifer Lincoln has been trying to combat misinformation about sexual health on TikTok, Instagram and YouTube. Her videos on topics such as menstruation, birth control and the many questionable products marketed towards people with vaginas have been viewed hundreds of thousands of times. Lincoln joins us to tell us about her work on social media and her new book, “Let’s Talk About Down There.”

Jennifer Lincoln will be doing a virtual Powell’s Books event Tuesday, Sept. 14 at 5 p.m.

The following transcript was created by a computer and edited by a volunteer.

Dave Miller: Jen Lincoln spends her days as an OB/GYN at a hospital in Portland. She spent some of her evenings and weekends on social media combating misinformation about sexual health, on TikTok, Instagram and YouTube, where she has a combined 2.5 million followers and subscribers. She debunks myths that range from silly to dangerous and aims to destigmatize talking about reproductive health. Now she has taken that mission offline. Her new book is called Let’s Talk About Down There: An OB/GYN Answers All Your Burning Questions Without Making You Feel Embarrassed For Asking.

Miller: What did you see or hear that made you feel that this book was necessary?

Dr. Jennifer Lincoln: Despite having a lot of followers on social media there’s a lot more people who don’t use social media who are still lacking in all the information that I’ve covered in my book. And the great thing about social media is that you can go viral and you can have something be in front of millions of people very quickly. But just as quickly it can fade from the spotlight.

So I think it’s imperative that I was able to put some of my content in a real old fashioned book form that you could actually have on the shelf, that you could have in your house, that you could reference, that you could hand to your daughter when she’s going off to college and say, ‘hey, you know, I’m not so sure how much we really covered about this, but I want you to be safe and I want you to understand how your body works.’ And it just seemed like the next best step to meet people where they’re at and get the information where it needs to be.

Miller: What’s an example of the kind of misinformation that you want to correct?

Lincoln: In women’s health especially and in the OB/GYN field, we have so much misinformation when it comes to reproductive health, when it comes to birth control when it comes to what’s normal down there, just like the title of my book. In terms of discharge, infections, pain, women and those assigned female at birth are historically ignored when it comes to our complaints. And studies have shown that we are not taken as seriously. We have longer delays to care when we’re not taken care of. And so I wanted to address this because our field is really struggling and we see that people are not getting the kind of care that they need.

Miller: You were talking about the kind of misinformation that’s just broadly found in US society. I’m curious what you found in terms of gynecological myths when you joined Tiktok. In general, there may be some 90-year-olds who are on Tiktok, but in general, it’s a much younger audience?

Lincoln: Right. I never thought that I would be on TikTok. When I was doing my medical training and even when I started on Instagram where I found a really nice community of fellow healthcare provider moms who were then educating, I thought, you know, this would be fun. I love to write, I minored in English, this would be fun to do. But when TikTok started to get really big here in the United States just before the Pandemic, there were some friends of mine who were physicians who made the jump over and they told me, ‘Jen you need to be here. This is where your audience is demographically.’

And so I decided to hop on. It was really uncomfortable at first, but that’s truly what public health is. It’s about going to where your audience is, making your message in such a way that they will consume the content, understand it, and build that trust. Then empower them to want to take that further and really feel ownership about their bodies and now feel comfortable to go to their doctor and say, ‘hey, I have this concern’.

Miller: [What follows is a rerecording of] one of the TikToks that you put up. This one is in response to whether yogurt is good for vaginal health.

Lincoln: [previously recorded from TikTok] It’s time for tough love Wednesday with Dr. Jen. If I see one more person in my comment section or another health care provider who recommends eating yogurt for vaginal health, I’m going to scream! And I want you to stop it. Why? Because there is no good long-term data that shows that any sort of eating any kind of yogurt helps with long-term vaginal health. And I’m linking a reference here in the comments. And if you guys all like it, it’ll pop up to the top.

It reviews multiple studies and multiple professional society recommendations, only one of which says maybe it might help. But we don’t know and the rest say it’s inconclusive and why does this matter? Because you’re telling people with vaginas they have one more thing they’re supposed to do and there’s no evidence. And that is not fair. The probiotic industry is over a $35 billion dollar industry. That’s billions with a B. Why do you want to give them more money when you guys all hit the pharmaceutical industry when there’s actual data to help that. But yet the probiotic industry gets a pass. And if you are somebody who, up until today didn’t know, that’s okay. When we know better, we do better. But stop telling women that they have one more thing that they have to do when there’s no good data to do it. It’s not fair and it drives me bananas.

Miller: I watched a video a couple of times and edited this morning and I didn’t realize the first three times just how fast you talk. Um, you try to pack in a lot of words in 58 seconds or whatever it is. What kinds of responses do you get to your videos?

Lincoln: Well thankfully I can talk slower now because now TikTok allows videos up to three minutes. Before that, you had to get it into 60 seconds and being from New York that’s very helpful. But it’s true. You are forced to take a very complicated conversation such as COVID vaccines or fertility or birth control side effects and get it down to small sound bites which of course is not going to be the whole conversation. But you have to reel people in in the first two seconds and kind of hook them in and then get that information out there. And then I’ll always put references where people can get more and can check in more.

But that’s the way we consume content these days. And that’s why I wrote the book the way that I did, which is in a Q&A format. I mean you could read an entire chapter and you can read the whole book in less than a day because that’s how we consume content these days. And that’s how we have to convey information if we want to get it across.

Miller: How did you decide on, for example, making a TikTok about yogurt? At what point does something you see rise to the level where you say, ‘I actually need to respond to this thing I’ve seen’?

Yes.

Lincoln: I’m sent TikToks to “review” every day. And if I responded to every single one, then I would have no time to parent or doctor or anything else. So usually, I will respond to one if I’m getting tagged multiple times, where something might be going viral and a lot of people have concerns. Or if it’s something particularly dangerous I’ve been sent or I’ve seen myself TilToks that advertise homemade abortions, which are completely not safe and very dangerous. When I feel compelled to respond, I’ll make one right away.

Miller: You said you can’t respond to everything. But the sense I’ve gotten looking through your various social media feeds is that you are a responsive content creator. It seems like you do look at some of the [literally hundreds of thousands of] comments that come for some of your videos. I get the sense that you must have to spend a lot of time, your own time, your own unpaid time, just going through this digital world?

Lincoln: It’s true. I mean some days, more than others and I find that, as a physician, I think it’s very important that if I put something out there, it needs to be very well researched. And sometimes that takes a lot of time and you can’t rush that. I’m also very dedicated to removing comments that are misinformation and not trying to leave the ones that I can find on my platforms.

Studies have shown that even if you debunk them [statements of misinformation], people still may think that they’re true if they’re left up. So I try to control the message and control my platforms as much as I can. Truly that’s why it was really nice writing this book because after doing all these things on social media and the filming and the editing and the mixing with the music. Writing a book is actually a lot easier.

Miller: What do you want cisgendered boys and men to learn from your work in this new book and from all of your social media work?

Lincoln: I really appreciate you asking that question because a lot of people assume that my content is just for women and those who have been assigned female at birth. And I truly believe that the way we advance reproductive and vaginal health care in this country is not only educat[ing] and expect[ing] only half the population to know what’s going on.

So it is imperative that everybody knows what’s normal and what’s not normal for both genders. And that’s because so much of why women and those assigned female at birth have internalized shame and come to my TikToks in my accounts is because they’ve been told by their male partner, ‘Hey, is it supposed to smell like that? Is it supposed to look like this? How come you don’t orgasm when we have sex?’ And they just think that something’s wrong with them and they think they’re broken because none of this was discussed in school.

And in their relationships, they are internalizing a lot of this - you SHOULD, it SHOULD be this way it SHOULD be that. We don’t know what’s normal because we don’t talk about it. So I would love for the cisgendered male who’s walking through Powell’s to pick up my book and say, ‘Hey, maybe I can learn something from this’ or maybe his girlfriend has it on the table and he picks it up and he can become a much more informed partner. And maybe one day he’ll be a father to two little girls and to be able to teach them and break the cycle of shame and stigma when it comes to our bodies.

Miller: This gets to something you talked about in a video about a year ago and I want to play a part of it. The video you put up on YouTube. It was to try to explain why one of your TikToks had gotten more than 70 million views. It was a simulation of a vaginal birth to explain to viewers what actually happens. And in this response video, you talked about the sum of literally hundreds of thousands of comments that have come in. [What follows is] the beginning of this response video.

Lincoln: Okay, here are some comments that I got - ‘Uh, so it just opens like that?’ 6,194 of you “like” that comment. Another one was - ‘I feel like it should not stretch that far’. So, so many comments were about feeling like this is how you have a baby, which really got me thinking you guys and girls [may be seeing this as] new information. And then I remembered we’re in America and we have some of the worst sex education in the world.

Miller: What is your educated understanding of what sex ed is like broadly in our country right now?

Lincoln: Oh, it’s a disaster. Practicing in Oregon, having children who are in the public school system in Oregon, sometimes I get into my bubble and I forget what it’s like. But being on social media and seeing something just like those responses, I remember exactly where we are. So in the United States, only 18 states are required to have sex education that is even medically accurate. Only 20 states and the District of Columbia even require that if we’re talking about sex education, that they cover contraception or birth control. So the vast majority of students are not being taught medically accurate sex education.

They’re not learning about birth or anything like that. They’re being told about abstinence-only education, which we know doesn’t work and has been proven and has been an enormous waste of our government’s money. So these young people grow up to be adults who then want to start their families. And I have seen countless couples and people who have not known when they should have sex to try to get pregnant. And then if they DO get pregnant, they are completely clueless on what happens even up to and including when they’re in active labor. And I am not placing any blame on them because it is a failure of our educational system. This Tiktok and the responses were just a reminder of them.

Miller: What kind of sex said did you get when you were growing up?

Lincoln: So I went to catholic schools up until I went to college. And in my high school years, I went to an all-girls catholic school. And so I was taught by a nun, of course, abstinence-only. The name of the class was called morality. So we were taught abstinence-only. We were told that if we had sex before marriage, we were tainted, we were decreasing our self-worth. We were never taught anything about birth control other than abstinence, which of course is one type of birth control, but not the whole story. We never covered consent. So basically I went to college completely blind.

Miller: What you’re describing is not actually sex ed. It’s almost the opposite of it. As you said, it was literally in a morality class. But I’m wondering how you think that experience informs the social media sex ed that you were practicing on a daily basis now?

Lincoln: I think it gives me the exact picture of what the majority of young people in this country experience. So I can say, ‘hey, I’m right there with you and I know exactly what you’re not getting in school and that’s why I want to tell you about what’s normal, what to expect and where to go for information.’ Because what happens nowadays, especially when they don’t get this information, they go online. They go to social media.

Americans spend 142 minutes a day on social media. And that includes people trying to get information about how periods work and birth control and pain with sex. So you might not be surprised, but there’s a lot of bad stuff out there too. And so I feel as health care providers, we need to be there to counteract that and to be reliable, trustworthy sources, especially for those people who feel they can’t ask their parents or are not getting the information from their schools.

Miller: You start your new book with a chapter, a big section on menstruation. Why start there?

Lincoln: That is just where it all begins. Traditionally when young girls and people uteruses and they have their first period, that’s when the parents say ‘we need to talk about this or you’re a woman now.’ And what does that mean? And since we don’t talk about it much in school, it’s the scary time that so many young people are not prepared for. So many of them do not know that it is not normal for your life to be taken over by your period, that you should not be missing work or school. It should not hurt that bad. And something I saw on social media were so many people saying, ‘but I was told it’s just your period and to just deal with it’. And I wanted to address all of the misinformation out there about periods.

Miller: Have you seen much of a societal change in terms of openness to talk about menstruation over the last few decades?

Lincoln: I feel that even just in the past couple of years, it’s very different. When I was in residency, I didn’t see a lot of my patients using menstrual cups for example. There were a couple and it seemed very out there and nowadays there’s multiple brands. It’s on the shelves at Target. You see the online ads and commercials and I really think that young people are starting to talk about it more and it’s not this secret. And I really feel like Gen Z is the generation that’s going to say ‘pay attention, I want this, I want this product’. Marketing companies understand that and they understand how much money there is to be made there for better or for worse.

So I do think it’s changing and I hope that it continues to change, especially as we’re seeing legislation in states about, for example, combating period poverty and having period products available at schools. So I think we’re going in the right direction, but I think that having people like me and many others on social media writing these books. This is how you break it down because you make, for example, my book just in somebody’s house. The fact that it’s there tells that 15-year-old that she can know about her body and she can speak up if she’s having a problem.

Miller: You talk about douches in a number of pages in the book. They seem to epitomize a lot of what you see as wrong with our culture’s approach to vaginal health. What kind of label would you put on boxes of dishes If you had complete control over the FDA?

Lincoln: I would say ‘Not fit for human consumption’ [with] one caveat. Douches actually are recommended for people who have surgically created neo vaginas in order to help with dilation and to prevent scarring. But that is a very tiny subset of people. And I’m telling you, we’re not recommending Summer’s Eve or Vagisil. These douches are the epitome of what’s wrong with society and how we frame what women should be like today because they have labels like Morning Roses and Tropical Sunset. I’m sorry, but your vagina is not supposed to smell like a tropical sunset.

It’s supposed to smell like a vagina. And maybe this is the most times somebody has said ‘vagina’ on your show. But I think it’s important that we destigmatize that word and understand that when you try to make something that’s very natural seem unnatural for the sole purpose of making money, you are completely insulting women. You are making us feel dirty and ashamed. And I would love that entire aisle to just be put in the garbage where it belongs.

Miller: One thing I wondered as I read your book is if you think that if we lived in a very different biological world and cisgender men had vaginas, do you think that we would douche with NASCAR-branded products or do you think that men wouldn’t do at all?

Lincoln: I love that question. No, we wouldn’t do it at all. It would be totally fine. We’d also get paid leave every time we had a period and we’d be off for a year after we had a baby. It would be completely different because we would see this as a normal part of our body. I mean, look at when Viagra came out right? Insurance covers it. It gets all this advertising. It’s completely accepted. But in the world of birth control access or abortion access, we’ve criminalized it and made it seem hush-hush and dirty. It’s very much a holdover from the patriarchal way of thinking when it comes to women’s health.

I mean you look at how we name things. Hysterical - the root word ‘hyster’ comes from the word uterus. It goes back to when we used to think that women lost their minds because their uteruses roamed around their bodies. And we still have that language permeating us today. So this is very deep-rooted. But I love how you’re asking that question because I do think that if roles were reversed we would be in a very different place when it comes to that aisle that I don’t like in the grocery store.

Miller: For a lot of the topics you cover, you structure the majority of your social media posts and videos upon questions. Often you answer them with the question right back, [such as] ‘who told you you should do that’ or ‘why would you think you should do that’ or ‘why do you think you need to do that’? What are you getting at with that first response before you go into the evidence-based answer?

Lincoln: I think it’s important because we need to step back and say why have you been made to feel this way? So for example, some of my questions, how do I may my vagina smell better? How do I lighten my labia? How do I change the appearance? It’s just it’s assumed that’s that’s the goal because that’s what the pornography industry has put out or that’s what we have been told is the quote-unquote ideal, stepping back and questioning that is the first way to take back your power and say,

[00:20:58.289]

hey, I don’t have to shave if I don’t want to do. There’s no medical reason. In fact, it’s better not to and it’s not too then speak down to people who might want to make those choices. I’m all for informed decision-making. But first stepping back and saying why is this important to you? And maybe it’s just because you’ve been made to feel that.

you have a section with the heading how do I start birth control without my parents knowing How do you navigate that as a doctor?

Yeah. And this is something that I have posted about this on my social media or when people who’ve read my book and have reviewed it. There was one very angry reviewer who said how could a doctor be doing this?

[00:21:38.190]

She should not be encouraging her patients to lie. And I hear you and I also have seen what happens when young people who have said, I didn’t want to get pregnant? But I’m having sex or you know, I didn’t get plan to get pregnant, but I was raped. And here’s what happened. I truly believe our young people deserve confidentiality. And I always always, in these situations, say it would be ideal if we could bring your parents in. You know, I I believe that honesty is the best policy. Can I help facilitate that conversation? But I also believe in autonomy and choice in keeping people safe.

[00:22:12.250]

And so I do believe, and unfortunately, access varies depending on what state you’re at. But if you are of the age where we can legally prescribe you birth control. And we have had an informed conversation. If you want to keep that private, I support that because I believe that it’s not always, again, as a parent, I can say, I want my child to disclose everything to me. But I also want them to feel that they have trusted adults that they can go to who can help prioritize their health and keep them safe.

Miller: So to go back to the alternate universe questions here, if you were designing sex-ed curricula, what would it be?

Lincoln: A lot of people have said, what do you hope to see in the future? And I’ve honestly said I hope that I become 100% irrelevant because I have been replaced by sex education and parental conversations that get people where they need to be. And so the sex ed that I would design starts, and this might blow some people’s mind, but it starts when your babies are babies. It’s using correct language and not naming things with silly names. It’s asking for consent and it’s teaching your kid that s/he doesn’t have to kiss grandma if they don’t want to. It’s teaching bodily respect and bodily autonomy and it’s age-appropriate as they get older.

I know some people push back and say why are kindergarteners being taught about masturbation? And that’s just a sensational way to hijack the conversation. But it’s about age appropriateness. It’s inclusive, it’s medically accurate. It’s culturally responsive and diverse and it’s an open facilitated conversation where young people feel that they have, not only their parents and teachers but also trusted, reliable evidence-based sources that they know that they can go to whenever they have questions. That includes going to their doctors and knowing they can ask questions without fear of judgment or shame.

Miller: We could have spent more than an hour on the next question I’m going to ask. So I preface it with a quick apology. You’ve recently been making videos in response to the new anti-abortion law in Texas. There are a lot of ways to think about this in terms of legal questions or societal implications. But how have you been thinking about it specifically from the perspective of a medical provider?

Lincoln: As an OB/GYN I’m not in Texas. But I have seen what happens when we try to get in the way of patient-provider care. Legislators have never cared for a dying pregnant person or somebody who has had a traumatic pregnancy and knows that their fetus will not live once they are born. To see legislators celebrating this law and knowing what it will do to the physical and mental health of pregnant people breaks my heart and I refuse to give up easily. We will continue to fight for this. I, 100%, believe that people can have the beliefs that they have about abortion. But we are not here to put our beliefs on other people or take away choice.

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