What Is Going On Down There?!

By Kaycee MacIntosh, PAC

 It is always unnerving to wake up and realize that part of your body is indicating that there is a problem, especially if that involves your reproductive system. At varying times during your life, you may experience vaginal itching, irritation, or vaginal discharge. Sometimes you might have painful urination, vaginal odor, or even painful intercourse. If you notice any of these symptoms, you likely have vaginitis.

Vaginitis is simply the inflammation of the vagina and vulva. The vagina is defined as the muscular tube leading from the external genitals to the cervix while the vulva is the external genitals. Vaginitis is one of the most common reasons that women see their ob-gynecologists. The three most common causes of vaginitis include bacterial vaginosis, yeast, and trichomoniasis. Other causes can include allergies to soap, spermicides, or when the body is in a lower estrogen state like menopause or while breastfeeding.

 Okay, so now we know what is likely to be going on. The next question is why? The vagina contains several organisms vital to the health of the vaginal tissues. An alteration in one of these organisms can cause an imbalance, causing an infection. Hormone alterations can lead to an imbalance of the vaginal PH, leading to vaginitis. Additionally, as mentioned previously, soaps or spermicides may upset the natural balance. 

 Bacterial vaginosis (BV) is an overgrowth of the bacteria found in the vagina. Symptoms include fishy-smelling vaginal discharge that might be worse during your period or after intercourse. The discharge can be dark, grey, or greenish in color. BV can also cause itching of the vagina and vulva. Antibiotics treat bacterial vaginosis and can be administered orally or with vaginal suppositories. Sex partners do not need treatment as this is not a sexually transmitted infection. If you get recurrent bacterial vaginosis, you may require more prolonged treatment. 

 Yeast infections occur when an organism called Candida, a normal fungus found in the vagina in small numbers, grows due to an imbalance in the normal bacteria. A person may experience thick, white discharge and have discomfort with urination or intercourse. The vulva, the tissue outside of the vagina, may be swollen and red. Antibiotics reduce all bacteria in the body, possibly leading to yeast infections. Diabetes mellitus increases the risk of yeast infections because elevated blood sugars promote yeast proliferation.

 Additionally, yeast infections can be more frequent in women with immune diseases such as HIV because the immune system, which protects the body from illness, is not functioning correctly. Pregnancy can also increase the risk of yeast infection due to hormone changes in the body. If you are experiencing these signs/symptoms, there are treatments including over-the-counter antifungal suppositories such as Monistat. Sometimes medical providers will prescribe oral antifungals for yeast infections if symptoms are severe or persistent.

Trichomonas is considered a sexually transmitted infection (STI). Trichomoniasis Vaginalis is a parasite that causes the condition. Women with this condition are at increased risk of other sexually transmitted infections. Symptoms of trichomonas include yellow, green, or grey discharge, vaginal pain, itching, redness, and sometimes painful urination. Healthcare providers treat trichomonas with an antibiotic called metronidazole or tinidazole taken by mouth. Sexual partners will need treatment since trichomonas is an STI, plus abstaining from sex until completion of the prescription. Other STIs such as gonorrhea and chlamydia can cause vaginitis and viral STIs, including herpes.

 Atrophic vaginitis is a thinning of vaginal tissue that occurs when vaginal tissue changes secondary to a lack of female hormones and is not related to infection. Atrophic vaginitis commonly occurs due to menopause. Symptoms of atrophic vaginitis include vaginal dryness, vaginal itching, burning sensation, and painful intercourse. Some women are concerned about infectious vaginitis when in reality they are experiencing vaginal atrophy. Treatment for atrophic vaginitis includes prescription topical estrogen applied vaginally in the form of a vaginal cream, tablet, or ring. Women with other menopausal symptoms such as hot flashes may take a prescribed estrogen which helps reduce symptoms of atrophic vaginitis. It may take a few weeks of treatment to notice an improvement in dryness and irritation. Some women note vaginal dryness while pregnant or breastfeeding. For women who note symptoms relating to reduction in estrogen due to menopause, pregnancy or breastfeeding, it may be helpful to use a water-based lubricant during intercourse to reduce discomfort (such as Good Clean Love or Slippery Stuff), and vaginal moisturizers may be considered (Good Clean Love brand or Hyalo-Gyn). These brands are available without a prescription.

 If you ever find yourself experiencing any of these symptoms, we hope you will schedule an appointment for an evaluation with your ob-gyn provider. Since the causes of your vaginal symptoms are not specific to one cause of vaginitis, it is helpful to have an exam by a licensed health care provider to get an accurate diagnosis. It is also not uncommon to have more than one cause of vaginal symptoms at a time, leading to improper treatment. I have treated patients with bacterial vaginosis, yeast infection, and urinary tract infections simultaneously. Signs of vaginitis, regardless of cause, can be similar to those of other STIs such as chlamydia and gonorrhea. If these illnesses are left untreated, they can lead to pelvic inflammatory disease, which can have serious consequences such as chronic pelvic pain, ectopic pregnancy, fallopian tube scarring, and infertility. 

An evaluation in the clinic will consist of your health care provider obtaining your health history, including your sexual health, and a vaginal examination. We test for bacterial vaginosis, yeast, and trichomoniasis with a vaginal swab that we evaluate in the clinic or send to the lab. The physical examination helps us determine if there are skin lesions or other clues that lead us to a diagnosis. STI and urine pregnancy testing will be performed as needed. 

Hopefully, you won’t ever experience a vaginal  infection, but to help keep your vaginal health in top-notch shape, here are some suggestions: 

Take probiotics if you are on antibiotics such as Align or Culturelle. 

• Managing your blood sugars if you have diabetes. 

• Use pH-neutral cleansers (Good Clean Love brand, Love Wellness pH balancing cleanser) and avoid cleansers with fragrance. 

• Avoid polyester-lined underwear, read labels to make sure underwear lining is 100% cotton. 

• Change pads or tampons regularly when on your period. 

• Avoid scented feminine hygiene products. 

• Avoid laundry detergents with perfume and avoid colored/scented toilet paper. 

• Change out of wet clothing after swimming or returning from the gym and avoid tight-fitting/poorly ventilating fabrics. 

• Use condoms during intercourse. There are latex-free condoms for those with latex allergies. 

• Avoid douching since it washes away the components that protect vaginal pH. 

• Remember that certain types of lubricants or spermicides may cause irritation for some people. If you have vaginal irritation, consider changing your brand. 

• When utilizing the internet for health care information, make sure to use reputable sources such as ACOG, (https://www.acog.org/womens-health), Mayo Clinic (https://www.mayoclinic.org/departments-centers/womens-health), etc. 

The most important aspect of health care is self-advocacy. It is easy to feel self-conscious about medical concerns relating to your reproductive system. Just realize that vaginitis is a prevalent condition, and most women, at one point or another, will experience a vaginal infection.

We are here to help. If you or someone you know needs an OB/Gyn, please call our office and we’ll get you scheduled for an appointment. We provide a safe, supportive, and non-judgmental environment and want you to get the answers you deserve. Call us at Kalispell OB/ GYN Monday-Friday at 406-752-5252. 

his article appears in 406 Woman magazine.