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Vaginal Infections

Knowing the difference between normal discharge and infections.

The Healthy Vagina

The vagina serves as a passageway between the outside of the body and the inner reproductive organs. The pH balance of the vagina is acidic, which discourages infections from occurring. This acidic environment is created by normally-occurring bacteria. A healthy vagina produces secretions to cleanse and regulate itself, similar to how saliva cleanses and regulates the environment of the mouth. These vaginal secretions are normal vaginal discharge. Any interference with the delicate balance of vaginal secretions sets up an environment conducive to infection.

Normal Vaginal Discharge

All women have some vaginal discharge. Normal discharge may appear clear, cloudy white, and/or yellowish when dry on clothing. It may also contain white flecks and at times may be thin and stringy. Changes in normal discharge can occur for many reasons, including menstrual cycle, emotional stressors, nutritional status, pregnancy, usage of medications - including birth control pills, and sexual arousal.

Effects of the Menstrual Cycle

The menstrual cycle affects the vaginal environment. You may notice increased wetness and clear discharge around mid-cycle. The pH balance of the vagina fluctuates during the cycle and is the least acidic on the days just prior to and during menstruation. Infections, therefore, are most common at this time.

Signs of Abnormal Discharge

Any changes in color or amount of discharge may be a sign of a vaginal infection. Vaginal infections are very common; most women will experience some form of a vaginal infection in their lifetime. If you experience any of the symptoms below, this may be a sign of vaginal infection:

  • Discharge accompanied by itching, rash or soreness
  • Persistent, increased discharge
  • Burning on skin during urination
  • White, clumpy discharge (somewhat like cottage cheese)
  • Grey/white or yellow/green discharge with a foul odor

Outlined below is basic information on three common vaginal infections

Bacterial Vaginosis

The exact cause of bacterial vaginosis is unknown. Similar to a yeast infection, there is an overgrowth of bacteria, and the delicate balance of the vaginal environment is upset when these bacteria occur in increased amounts. Recurrence of bacterial vaginosis is common and bacterial vaginosis can coexist with other vaginal infections.

Signs and Symptoms:

  • Increased amount of discharge
  • Grey/white, thin, watery discharge
  • Foul/fishy odor with discharge
  • Increased odor to discharge immediately after intercourse

Nearly half of the women with bacterial vaginosis don't display any symptoms.

Treatment: There is no over-the-counter treatment available. There are two treatment options with metronidazole (Flagyl) - an oral antibiotic or a topical antibiotic cream. Metronidazole can cause nausea and darkening of urine. Alcohol consumption should be avoided while on this medication, and for 48 hours after treatment, due to possible alcohol intolerance, which can result in nausea and vomiting. If you are using the vaginal antibiotic cream, it must be used daily for five days.

Trichomoniasis

This infection is caused by a one-celled protozoan organism. Trichomoniasis is almost always spread through sexual contact. However, the protozoan organism can survive for up to twenty-four hours in a moist environment, making wet towels or bathing suits possible instruments of transmission from someone with the infection.

Signs and Symptoms: Most men and some women don't display any symptoms, but may include:

  • Yellow/green, frothy, discharge
  • Foul odor with discharge
  • Increased amount of discharge
  • Inflammation of vulva/vagina
  • Increased frequency of urination
  • Itching

Treatment:

The treatment used is the oral antibiotic, metronidazole. Remember - no alcohol consumption when taking the medication and for 48 hours after treatment! It is recommended that both partners be treated at the same time to avoid recurrent infections. Partners should be treated even if they aren't displaying any symptoms. Avoid intercourse until treatment is completed.

Monilia (Yeast) Infection

There is normally a small amount of yeast (Candida albicans) present in the vagina. A yeast infection occurs when there is an overabundance of yeast, often caused by a change in the pH balance of the vagina. Yeast infections are not usually sexually transmitted.

Some Factors That May Increase Susceptibility to Yeast Infections:

  • Increased stress
  • Use of oral contraceptives
  • Diabetes
  • Pregnancy
  • Use of antibiotics (protective bacteria are destroyed by antibiotics, allowing yeast overgrowth)

Signs and Symptoms:

  • Increased amount of discharge
  • White, clumpy (cottage cheese-like), discharge
  • Redness, itching, burning in vaginal/vulvar area

Treatment: Since yeast is normally present in the vagina, it is unrealistic to try to eliminate all yeast. Therefore, the goal of treatment is to reduce the overgrowth of yeast organisms and return the vagina to a healthy balance. Treatment consists of antifungal agents in the form of tablets, vaginal creams or suppositories. Over-the-counter treatments are available. However, if you are pregnant, always be sure to have any medications approved by a health care provider. Partners are not usually treated unless they are displaying symptoms such as itching or irritation in the genital area. Treatment for male partners consists of the use of fungicidal cream on the penis.

Prevention and Treatment Guidelines for Vaginal Infections

  • Have new partners wear condoms during sexual intercourse.
  • Stay healthy; eat well, get enough sleep, drink enough fluids.
  • Keep vaginal area clean and dry.
  • Wear cotton underwear.
  • Wipe from front to back after urination or bowel movement.
  • Avoid using deodorant pads or tampons.
  • Don't use petroleum jelly or other oils for lubricants.
  • Don't douche.
  • Use medication as long as directed.
  • Avoid sexual intercourse until treatment is completed and you are symptom free.
  • Don't scratch infected or inflamed areas; it can cause further irritation.
  • If using medication inside the vagina, use it during the menstrual period.
  • During an infection, use pads rather than tampons if menstruation occurs.
  • Avoid vulvovaginal irritants, including perfumed or deodorant soaps/body washes.
  • If symptoms persist after completing the treatment, an exam is indicated. Call for an appointment, and please use nothing in the vagina for 48 hours prior to your exam.