Chronic Vaginal Infections

>> Thursday, January 22, 2015

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Why is it that, no matter what we do, yeast and bacterial infections (and vaginal odor) keep returning over and over?

Many of you have probably used over-the-counter medicines, homemade concoctions and prescription medications from a doctor, yet still battle with chronic, recurrent yeast/bacterial infections that cause vaginal odor and irritation.

The bottom line is this: If the conditions that make us vulnerable to these issue are not corrected, unhealthy organisms, odors, and infections can continue to show up. So what can we do to create a healthy vaginal environment?

Many studies now show that restoring healthy probiotic flora significantly protects against chronic infections. Probiotics are healthy, disease-fighting bacteria that live in our colon, mouth and vagina. And, studies show that taking probiotics daily can help prevent recurrent, chronic infections. Once established, friendly bacteria (especially of the Lactobacillus genus) produce natural disinfectants that help maintain an optimal pH and a healthy balance of beneficial microorganisms in the vagina by excluding harmful bacteria and other pathogens.

For example, certain specific strains of Lactobacilli produce substances such as lactic acid, hydrogen peroxide, and bacteriocins, which inhibit the growth of bacteria implicated in bacterial vaginosis. Furthermore, these friendly acid-making bacteria may inhibit the adherence of harmful bacteria responsible for bacterial vaginosis.

Numerous factors may upset the delicate balance of friendly microflora. These include antibiotic therapy, dietary changes, cigarette smoking, sexual activity, and oscillating stress levels.

According to one report, there are more than 300 million cases of urinary tract infections, bacterial vaginosis, and yeast vaginitis worldwide every year. Yeast infections alone affect 75% of American women and 40-50% of these women will endure recurrent, chronic infections. So you are not alone.

Standard treatment for the common Candida yeast calls for antifungal therapy, either with an oral agent, such as fluconazole or vaginal creams and suppositories, which may require multiple applications. Bacterial vaginosis is commonly treated with an antibiotic, such as metronidazole or clindamycin.

Given the high prevalence of these infections, and the high rate of recurrence, it is clear that most adult women could benefit from preventive care and hygiene. Lactobacillus, when consumed orally daily, is especially effective at establishing and maintaining healthy vaginal microflora.

This is great news, because with the use of WaterWorks and probiotics, you could find that the recurrence of infections and odor will become less and less.

I hope this helped you.

Take care and be safe.
Dr. Susan Boyd, MD

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Strong Odor from Vaginal Discharge

>> Thursday, January 8, 2015

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Vaginal discharge is normal and it changes color and consistency throughout the month during the menstrual cycle. After our period it changes from thin and watery to thick and pasty, and during ovulation it becomes like mucous and very gooey, but not smelly or itchy.

It is naturally odorless and has the purpose of keeping the vagina clean and healthy. It fights off abnormal bacteria and supplies the perfect lubrication during sex. If we had no vaginal discharge, the vagina would feel dry and itchy (which is common in menopause or any times of hormone imbalance). Sex would be impossible or extremely painful because the vagina would not be able to stretch.

When vaginal discharge becomes odorous and itchy, it is usually caused from an imbalance of the vaginal pH. This change suppresses the healthy bacteria, called Lactobacillus, and it is unable to do its job of keeping the vagina clean and healthy. This imbalance causes an overgrowth of a variety of microorganisms such as yeast, bacteria and fungi - producing yeast and bacterial infections (BV). With these come odor and itching or burning.

Why does this happen? Many of us feel we did something wrong or we are dirty, so cleaning more will help. In fact, that will just make it worse - continuing the cycle of it feeling better for a day and then recurring, sometimes coming back even worse. Most of the time, excessive washing and douching is the cause of reoccurring infections and odors. Wearing tight or non-absorbent panties can also prevent healing.

Vaginal odor may also worsen after sex, due to the mixing of semen, sweat, and vaginal fluids. Semen has a neutral pH of 7.4, which is the same as period blood. But the vagina has to maintain a lower pH than that of the rest of our body - somewhere around 7.2 - in order to kill the abnormal bacteria that would cause infections and odor. The normal/'healthy' Lactobacillus vaginal bacteria, likes a lower pH. When semen is deposited into the vagina, the vaginal flora can be disrupted as the pH rises. It is this rise of pH that allows the yeast and abnormal bacteria to grow and overpower the Lactobacillus. Then, abnormal bacteria and yeast produce odor and irritation.

So make it a habit to jump out of bed after sex and rinse the semen out of the vagina with plain water only. Do not ever let soap get into your vagina, as it is very alkaline and can bring on recurrent infections and odor. Soap should only be used to wash your skin and the outer part of the vagina - the labia, and the anal area.

WaterWorks makes feminine hygiene easy. It is FDA cleared to help reduce vaginal odor. It is reusable and uses just ordinary tap water only. The unique design helps us easily rinse inside the vagina, and it can be used daily. Most women use it every day and have overcome their recurrent odor and discharge problems.

Water alone is better than anything to rinse the vagina. We should never use dilute vinegar, lemon juice or other chemicals. WaterWorks is designed with a stainless steel nozzle that is inserted into the vagina, causing a reaction as it comes in contact with the vaginal mucosa to facilitate the removal of vaginal odor.

I hope this helps you all have a better understanding of how our bodies work and what keeps us healthy.

Have a safe and wonderful week,

Dr. Susan L. Boyd, MD

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Answers to Your HPV Questions

>> Thursday, December 11, 2014

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How many of you have gone to your ObGyn for your annual exam feeling good that you did the right thing, by being responsible and getting your annual checkup and Pap smear? Then, you find out that your pap came back positive for HPV?

Now you may start searching the Internet for all available information on HPV and what it means. Since its a sexually transmitted virus, and my last pap was negative, does this mean my partner cheated on me? Does it mean I'm going to get cervical cancer? There different types, so does it matter which kind I have? I've never had warts - does this mean I'm going to get warts since its a warty virus? Will it affect my chance to get pregnant? Can I give it to my baby during birth? If my partner has it and I get treated can he give it back to me? Can men be treated too so I don't have to worry about him giving it back to me? Could I have had this and given it to my partner? Do we need to use condoms so we don't pass it back and forth? Is it living in my blood stream and infecting my whole body? I read that it can cause oral and throat cancers from oral sex and anal cancer from anal sex or just the semen or penis touching the anal area - is this true?

I know there are so many questions. I get it, it is confusing and so is the information out there.

First, the reason women are urged to get Pap smears every year is to screen for cervical cancer. Almost all cervical cancers are caused by human papilloma virus (HPV). HPV is a common virus that can be passed from one person to another during sex. This means that you can become infected with it the very first time you have sex if your partner has had sex with someone before you. Likewise, if your current partner was a virgin when you met and you were not, you can pass it to him. That's why we say, "When we have sex with someone, it's like we are having sex with everyone they have had sex with." We are exposed to any and all viruses and STDs that they have been exposed to. Not a happy thought.

This can be distressing to women because, today, there is no way to treat men or even screen them like we do with Paps for women. And, if you are married and trying to get pregnant, condoms are not an option.

The good thing is, if you are good about getting your pap exams and following up if you get HPV or an abnormal result, then you can be treated. So, this can ease your worry about getting cancer.

HPV and the treatment will not interfere with your ability to get pregnant, but active, untreated forms can be transferred to your baby at birth.
Just remember, sex is sex. So, you can get HPV or any other type of STD with anal sex (anal cancer, anal warts, herpes, gonorrhea, chlamydia, etc.), oral sex (oral HPV, warts on your vocal chords or gums and tongue) and even by rubbing genitals together without penetration.

HPV is the most common sexually transmitted infection in the United States. There are over 100 types of HPV and they all belong to the condyloma or wart family. Many of them can cause genital warts. There are the 40 types can cause cervical or other genital cancers. The other 60 or so HPV types can cause infections and warts elsewhere on the body, even on the hands and face. They can infect the genital areas like the vulva (area outside the vagina), labia, and anus, and the linings of the vagina, cervix, and rectum. These types can also infect the lining of the mouth and throat. Some HPV types can cause changes on a woman’s cervix that can lead to cervical cancer. They are invisible unless the cervix is washed by a strong vinegar solution called acetic acid while other types can cause visible warts on the labia, anus, throat, vocal chords or skin.

HPV is so common that most people get it at some time in their lives. HPV usually causes no symptoms so you can't tell that you have it. For most women, HPV will go away on its own because our immune system can eventually kick it, especially in monogamous relationships. High risk behavior, such as having sex with many different partners on a regular basis, smoking, or having HIV or AIDS, or any disease like diabetes or autoimmune syndromes can also increase your chances of HPV because they weaken the immune system.

HPV types are often referred to as "low-risk" (wart-causing) or "high-risk" (cancer-causing), based on whether they put a person at risk for cancer. The International Agency for Research on Cancer found that 13 HPV types can cause cancer of the cervix; one of these types can cause cancers of the vulva, vagina, penis, anus, and certain head and neck cancers (specifically, the oropharynx, which includes the back of the throat, base of the tongue and tonsils). The types of HPV that can cause genital warts are not the same as the types that can cause cancer.

When the body's immune system can't get rid of a high-risk HPV infection, it can linger over time and turn normal cells into abnormal cells and then cancer. About 10% of women with high-risk HPV on their cervix will develop long-lasting HPV infections that put them at risk for cervical cancer.

When high-risk HPV lingers and infects the cells of the cervix, vulva, vagina, penis anus, or the oropharynx, it can cause cell changes called dysplasia, which is not a precancerous change. If ignored and untreated, they may eventually develop into cancer.

Using condoms can help prevent getting it. Using WaterWorks for famine hygiene immediately after sex can help clear the vagina of semen that could be infected with it. It is always easier to get any STD when having sex during our period so this is an especially important time to use WaterWorks. WaterWorks is not the same as douching because it uses only plain water with no chemicals and can be used every day if you want. It is FDA cleared for clearing vaginal odors and feminine hygiene.

I hope this helps you understand better.

Be safe and have some fun,
Dr. Susan Boyd, MD

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Pelvic Pain

>> Thursday, December 4, 2014

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Good morning. I am hope you are all looking forward to this beautiful holiday season with friends and family. Unfortunately, I know many of you may be smiling and laughing in between your episodes of pelvic pain. You have become so accustomed to it and even expect it by planning your holidays around it.

Pelvic pain is located in the lowest part of your abdomen, way down about half way between your pubic bone/pubic hairline and your belly button. Any pain that is at your belly button or higher is considered abdominal pain. It can be difficult to know for sure, because pain can radiate up from the pelvis to your belly button or ribs and back pain from your spine or tailbone can wrap around to the front. And, of course, abdominal pain can radiate down from your stomach, gallbladder or kidneys into the pelvis. It can be frustrating and scary!

Depending on its source, pelvic pain may be dull or sharp; it may be constant or intermittent; and it may be mild, moderate or severe. Pelvic pain can move around to your lower back, buttocks and shoot down your vagina and thighs. Pelvic pain can occur suddenly and sharply and last for just a few minutes 3-4 times a month. You my notice that it only hurts when you have sex, go to the restroom, have your period, or ovulate (about a week to 1 ½ weeks after your period).

Pelvic pain can be so complicated that it may have nothing to do with your uterus or ovaries. It may come from the muscles and connective tissue (ligaments) in the structures of the pelvic floor. This pain may be caused by irritation of nerves in the pelvis and can hurt when you exercise or walk your dog. There is no surgery for this -- not even a Total Hysterectomy with both ovaries removed will take away this type of pain.
There are many things that can cause pelvic pain. Some are chronic (which means it is a part of how your body was made and functions and can never be cured). The occasional or acute pain will come and go and is usually caused by something curable and temporary. Most women don't have chronic pain and all women have episodes of pelvic pain during their lifetimes.

Female reproductive system related: It may be caused by female conditions like Adenomyosis, Endometriosis, Menstrual cramps (dysmenorrhea), Ectopic pregnancy (or other pregnancy-related conditions), Miscarriage (before the 20th week), intrauterine fetal death, Mittelschmerz (ovulation pain), Ovarian cysts, Pelvic inflammatory disease (PID) or Uterine fibroids.

Pain from non female related organs: Include Appendicitis, Colon cancer, Chronic constipation, Crohn's disease, Diverticulitis, Fibromyalgia, Inguinal hernia Interstitial cystitis (also called painful bladder syndrome), Irritable bowel syndrome, Kidney stones, Past physical or sexual abuse, Pelvic floor muscle spasms, Ulcerative colitis or Urinary tract infections.

If you suddenly develop severe pelvic pain, it may be a medical emergency like a ruptured ectopic (tubal) pregnancy or a ruptured cyst that is causing internal bleeding. You should seek medical attention promptly as these are life threatening.

I hope you all have a wonderful week and stay safe during the holidays.

Sincerely,
Dr. Susan Boyd, MD

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Could Changes in My Cycle be a Sign of Cancer?

>> Thursday, November 20, 2014

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Good morning to all of you. I hope you are looking forward to the upcoming holidays, even if it's just a time of rest.

In my last blog, I discussed the frustration and worry of abnormal vaginal bleeding. Nothing is more frustrating than unpredictable vaginal bleeding that keeps happening over and over. I have discussed extensively in prior blogs the different reasons for abnormal bleeding, both serious and not serious. I have also discussed that the major concern for most of us is that the abnormal bleeding could relate to cancer or some other life-threatening illness.

Women use monthly cycles to monitor our overall health. This means that when our periods are regular, we assume our bodies are healthy. When we start having irregular, heavy or prolonged bleeding or no bleeding at all, it can be alarming. The most common thing I hear is, "My cycles are so regular, I can calculate not just the day, but almost the hour my period will start."

This puts it into perspective why it can be so scary when there is a change. Many of you logon to the Internet for an immediate explanation or an answer. Of course, this only increases anxiety because the first thing you may read about is uterine, cervical or other female cancer.

While that can be one cause, cancer is a rare reason for abnormal periods. There are so many more common reasons for abnormal bleeding than cancer. I'm not saying I would ignore it and not check for cancer, but I would be checking for everything from ovarian cysts to hormone imbalance. I mentioned many of these disorders in the last blog but did not go into detail as I've done that in past blogs and will do it again.

What is important is that non-cancerous causes are just that, non cancerous. They won't just magically change into a malignant cancerous situation.

Please, if you are experiencing changes in your periods, go to your doctor first, not the Internet. I know it's hard, but negative information can cause stress and anxiety and can actually worsen the bleeding and irregularity.

Don't forget to write in if you have questions. Have a wonderful week and please check out our WaterWorks for help with feminine hygiene and to stop recurrent vaginal odor.

Dr. Susan Boyd, MD

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What Can I Do About Abnormal Vaginal Bleeding?

>> Thursday, November 13, 2014

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There is absolutely nothing more frustrating than abnormal vaginal bleeding and not knowing when your period is coming.  For many of you, this is a common occurrence.  Just when you think, 'Yay!!  I'm so happy that period is gone!', and you can stop wearing a panty liner…..then, here comes more bleeding and spotting.  And forget planning a romantic evening when there is bleeding, spotting or pinkish and gooey brown discharge.  And, as if the bleeding isn't bad enough, there is the battle with horrible odor from blood that causes a rise in vaginal pH.

Unfortunately, you have probably been told different things from different doctors and still don't know why you don't have regular bleeding once a month like everyone else.  You may have heard of Dysfunctional uterine bleeding (DUB), Abnormal uterine bleeding (AUB), thyroid or metabolic disorders, Polycystic ovarian syndrome (PCOs), Hypermenorrhea or Polymenorrhea, Anovulation, Chronic cervicitis or endometritis, polyps, fibroids, and even hormone imbalance. 

So what does it all mean?  I know you just want it to stop, and you worry about it being harmful to your body or becoming cancer.  You wonder if you can get pregnant or if you are infertile.  You want to know how to determine when you are ovulating, if you need surgery, if it's something you're doing wrong, like eating the wrong diet or exercising too much or too little.   You wonder if it is a hormone issue, and, if so, can they be fixed?  Will you always struggle with this?  There are just so many questions!

The medical definition is AUB or Abnormal uterine bleeding, which is irregular bleeding from the uterus for unknown reason.  For example, you may get your period more often than every 21 days or farther apart than 35 days.  Some women will skip for 3 months and then bleed for several days or weeks.  Your period may last longer than 7 days.   Abnormal uterine bleeding has also been called dysfunctional uterine bleeding (DUB).  It is usually not serious, but it can be annoying and can definitely disrupt your life.

Normally one of your ovaries releases an egg during your menstrual cycle - called ovulation.  Abnormal uterine bleeding is often triggered when women don't ovulate.  This causes abnormal changes in hormone levels and in some cases can lead to unexpected vaginal bleeding.  When we don't ovulate, it puts our entire cycle into dysfunction and causes us to go into unsynchronized phases.

Of course it's just not that simple because we can ovulate and have normal hormone balance and still have AUB.  Women always judge their overall health by the regularity of their monthly cycles, so any changes in how long they last, how many we get in a month, or how much we bleed triggers concern.  Some of you have never experienced a normal, monthly cycle that lasts 4-5 days with one or two days of moderate to heavy bleeding.

In order to rule out all other causes of AUB, there are certain tests that can be done that will check your blood for thyroid disease, hormone imbalance, bleeding and clotting disorders, anemia and kidney or liver disease.  Ultrasound or CT scans can help check for physical and anatomic abnormalities.  It sounds scary, for sure, but even brain tumors, usually benign and located in the pituitary gland, can be a reason and would require a brain MRI.  It is also important to have your doctor look over all your current medicines, vitamins and herbs, as they can cause a profound effect on periods and bleeding patterns.

Once you are evaluated, a plan can be initiated between you and your doctor as to the best way to regulate the bleeding.  The increased yeast and bacterial infection (which can cause vaginal odor and irritation) can also be worked on.  There are combination medicines that include pills, vaginal creams and gels that can be used.  But, it is common for it to take several treatments to get things back in balance.

Douching is tempting, as it is normal to want to rinse out the smelly, brownish or bloody discharge.  But, douching is a temporary fix, because all the chemicals, vinegar etc., will just contribute to the imbalance and will rinse out the healthy bacteria with the abnormal bacteria and yeast.  So this process just goes on and on.
Hopefully you have checked out "WaterWorks", as it is a reusable FDA-cleared feminine cleansing system.  It is great for daily use to clean out blood, discharge and semen.  It uses plain water (no chemicals), and can be used over and over.  All parts are replaceable, so it has no negative effect on the environment.  The best part is that, after the first use, you will have no more vaginal odor.  So, when the bleeding slows or calms way down, you can enjoy sex with confidence that the odor is gone.  Yay!! 

So go get your tests done, and if you have questions write to me.  

I hope you learned a little more about your body and that it helps you feel better and less scared about getting things checked out. 

Have a happy week and have fun.

Dr. Susan Boyd, MD



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Treatment Options for Heavy or Prolonged Menstrual Periods

>> Thursday, October 30, 2014

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Heavy or prolonged menstrual periods, or menorrhagia, is the most common type of abnormal bleeding that women experience.  Periods are considered heavy if there is enough blood to soak a pad or tampon every hour for several consecutive hours.  Sometimes, it's nighttime bleeding that requires getting up to change pads or tampons or passing large blood clots.  And, when our periods last longer than 7 days with heavy bleeding, not spotting.  All of this can interfere with sleep and daily activities and lead to anemia, causing symptoms such as fatigue and shortness of breath.

As we have discussed, a balance between estrogen and progesterone regulates the buildup of the endometrial lining of the uterus, which is shed during menstruation.  If a hormone imbalance occurs, this lining can thicken too much, causing many menstrual irregularities.

Certain drugs, including anti-inflammatory medications like aspirin, and anticoagulants or blood thinners can contribute to heavy or prolonged menstrual bleeding.  Also, if someone has a blood coagulation disorder from birth, such as Von Willebrand's disease, the blood doesn't clot well.  There are other inherited disorders as well that can cause abnormal menstrual bleeding. The good thing is these are usually identified at the same time as the first period, because it will be very heavy.

There are a number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, that may be associated with menorrhagia.  Also, fibroids, polyps or other noncancerous tumors of the uterus, and things like Adenomyosis, which is a condition that causes the glands from the lining of the uterus to become imbedded in the muscular wall of the uterus.  Of course, the worst case scenario would be some kind of female cancer like uterine, ovarian, or cervical cancer.  These are rare, but possible, causes of heavy menstrual bleeding.  Other medical conditions can prevent normal blood clotting, including liver, kidney, or thyroid disease, and bleeding or platelet disorders.

Treatment for menorrhagia once you have identified the reason, may include one or more of the following things:

  • The nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can reduce the amount of blood loss and help with pain.
  • Lysteda (tranexamic acid), a non-hormonal medication that can also be prescribed to you because it promotes blood clotting and will significantly decrease blood loss.
  • Birth control pills or hormone therapy is a common method used to stabilize the endometrial lining of the uterus, regulate menstrual cycles, or correct hormonal imbalances.
  • The IUD Mirena is used for heavy bleeding and also prevents pregnancy.  It works by local progesterone absorption, not systemic absorption.  That means no hormone goes into the blood stream, so it doesn't affect or change our own hormone balance.  In fact women continue to ovulate and have their own natural hormone fluctuations.  Because this local absorption thins the lining of the uterus (endometrium), it makes periods very light, or absent.  This makes it a wonderful method for helping with heavy or irregular menstrual bleeding.  It is also effective in preventing pregnancy because it thickens the cervical mucus, or discharge, so much that the sperm cannot pass through the cervix to fertilize the egg.  This is a good choice for women who do not want surgery or who cannot or don't want to take hormones.

Many women have chosen more permanent procedures when they are done having children.  Endometrial ablation can be done in several ways like freezing, hot thermal balloon ablation, electro-cautery, and hot water.  This effectively cauterizes the endometrial lining so it won't build up monthly any more.  It can last 3-5 years and occasionally can be permanent.  It is considered a semi-permanent way to stop heavy menstrual or frequent/continuous vaginal bleeding.
Hysterectomy, which is complete removal of the uterus, as it is the uterus that bleeds.  Ovaries produce all the female hormones and can be removed, but if there is no pain problems, it is best to leave them for hormone support. 

Many women who have continuous or irregular bleeding can also have odor problems.  This happens because the vagina maintains health by being slightly acidic.  Blood is a higher, physiological pH and this will cause a rise in vaginal pH.  When this happens, yeast and abnormal vaginal bacteria overgrows and this brings abnormal odors and could lead to yeast or bacterial infections.

UsingWaterWorks during this time to rinse out the excess blood would help keep away unwanted orders.  It is safe to use daily, uses no chemicals and is FDA cleared to help with vaginal odor. :)

I hope you have a wonderful week and stay safe!

Dr. Susan L. Boyd, MD


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