Understanding Vaginal Discharge

>> Friday, February 5, 2016

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Hello everyone I hope this finds you all well and healthy today.

It seems that I've been hearing from many due to your concerns over vaginal discharge. Some of you have noticed changes, and are asking whether it is normal. Some of you have been on birth control or recently delivered babies, had tubal sterilization and are now off oral contraceptives after many years. Some of you just feel that there have been changes since you have matured.

The basic function of you vagina, besides sexual pleasure, is to provide a clean, functional route from the outside of your body to your uterus and the rest of your internal reproductive system. The natural acid PH of the vagina, acts to prevent infections. The acidic nature of your vagina is caused by natural, bacteria produced by your body called lactobacilli. This is the same bacteria found in yogurt culture and that is why we always hear about women drinking or douching with yogurt to help prevent or cure infection. Unfortunately, it doesn't work well in the vagina, but can help as a 'probiotic' in the intestinal tract. When your vagina is healthy, the vagina keeps itself clean. We always joke that it is like a self-cleaning oven; it stays in a healthy state by producing the secretions of normal vaginal discharge. Many things may disrupt the natural balance of the vagina.

First it’s important to understand that all women have vaginal discharge. Glands in your vaginal and cervix produce small amounts of fluid that flows out of your vagina everyday taking with it old cells that line the vagina. Your normal vaginal discharge helps to clean the vagina, as well as keep it lubricated and free from infection and other germs. A normal vaginal discharge does not have a foul odor and usually has no odor at all. Normal vaginal discharge often appears clear or milky when it dries on your clothing; occasionally you may notice white spots or a normal vaginal discharge that is thin or stringy looking. This is all normal, and the sticky, stringy discharge indicates that you are ovulating. So if you have been on the pill for a long time you may not have seen it for awhile as you would not ovulate on the pill. The appearance may change due to sexual excitement, breastfeeding, ovulation, or diet. The consistency of your vaginal discharge or how thin or thick it is can be affected by your menstrual cycle, emotional stress, pregnancy, any prescription or OTC medications including hormones such as in the pill.

Other things that can upset the natural pH balance of your vagina and lead to vaginal infections include vaginal douches, feminine hygiene products, perfumed or deodorant soaps, antibiotics, pregnancy, diabetes, or infections. So we can all see that it is a highly sensitive area affected by many things, some obvious and some we would not expect. For example, having a head cold can cause and increase in vaginal discharge, strange huh? It is no wonder that douching with perfumed or homemade solutions can cause such recurrent or chronic odors and discharge. Although you can buy the douches at the local drug store, it this does not mean they offer help.

Your menstrual cycle has a significant affect on the type of vaginal discharge you experience throughout the month. Did you know you’re more likely to experience vaginal infections just before or during your period? This is because the pH balance of your vagina rises during your monthly cycle causing the pH of your vagina to be at its’ highest point a few days before and during your period. About halfway between your periods an increase in vaginal discharge that appears mucousy, sticky, and stretchy is normal. As stated above, this type of vaginal discharge is an indication of ovulation.

You may identify abnormal vaginal discharge and infection from the following signs:
- Changes in color, consistency, or amount
- Constant, increased vaginal discharge
- Presence of itching, discomfort, or any rash
- Vaginal burning during urination
- The presence of blood when it’s not your period time
- Cottage cheese-like vaginal discharge
- A foul odor accompanied by yellowish, greenish, or grayish white vaginal discharge

You are probably are aware of these signs or may have had them at some point. I recommend that you would go see you Ob/Gyn or family doctor when this happens and not just self-treat, unless it is something that you have had before and have already been seen for it. Vaginal discharge and infections are common and your doctor is used to seeing all types, so your doctor and the nurse may put you at ease. The anticipation of going and thinking about it is always worse.

The most common vaginal infection is bacterial vaginosis, as well as vaginal yeast infections and trichomoniasis. The most troublesome problem for some women are those who have recurrent or ongoing vaginal odor for no reason. This is a major issue and very embarrassing as they never feel clean, even though it has NOTHING to do with cleanliness. It is not from an infection and can be caused from any of the above we've already addressed.

We are lucky because if you check the WaterWorks Website you will find a wonderful device that 1000's of women are using today for daily feminine hygeine purposes, cleanliness after sex, and because of the unique FDA cleared design has cured many women of their vaginal odor problems. So no more embarrassing odors to worry about during sex, what a relief!

Please have the best, most wonderful week and be safe.

Dr. Susan Boyd, MD

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The Dilemma of Birth Control & Libido

>> Friday, January 15, 2016

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The question this week comes from Candace who writes:

I am twenty-nine years old and I have been on birth control since I was seventeen. The reason I was placed on it initially was to help regulate my period, which was becoming more and more of a problem. Instead of heavy flow for the first day of my cycle, I was bleeding heavy for four to five days and passing blood clots. This heavier flow also caused me to have severe cramps. When my ultrasound and blood tests came back normal I was placed on a birth control pill and, after a couple months, my symptoms went away and my periods returned to normal. Since that time, I have had no other problems. It really has been easy.

My concern now is that I have no sex drive and I feel that I am too young to be experiencing this. I read somewhere that the pill can interfere with hormone balance and cause this decreased libido or sex drive. Is that true? What can I do about it?

Unfortunately the answer is yes. The birth control pill has many side-effects. So many of them are positive (like regulating periods, decreasing of pain and cramps, controlling PMS, decreasing menstrual blood flow and clearing the complexion) that we rarely think of the negative effects.

Birth control pills combine estrogen and progesterone together in a specific way to prevent ovulation. Unfortunately, the very thing that causes this cycle control can also create a lack of sexual desire. You see, “the pill” is so effective at balancing hormones that it blocks the normal hormone fluctuations during the month which bring with them increased libido. Studies have shown that birth control pill users have a lower testosterone level than non-users because “the pill” can increase levels of sex binding globulin. This causes most of the estrogen and testosterone to be bound rather than circulating free in the blood stream, so less is available for use by the body.

So what can we do about it? First, we need to get a complete profile of lab tests, as this will give a snapshot of where hormone levels are on birth control. Once these levels are determined it is easy to see if estrogen or testosterone are low or both.

There have been several studies that show taking testosterone can improve sexual desire and function. In fact, low testosterone can not only cause hypoactive sexual desire, it can cause other diminished sense of well being, dysphoria (a mild depression), fatigue and loss of sexual pleasure.

Now, if estrogen and testosterone are low a woman can remain on her birth control with testosterone supplementation without compromising the pills' ability to prevent pregnancy. However, adding estrogen can compromise the contraceptive effectiveness.

Since sex is such an important part of a good relationship with your partner, and “the pill” is only one form of contraception, methods like the IUD (intra-uterine device) are becoming very popular, as it does not interfere with hormone balance. Most women who start using IUDs choose to stop taking “the pill” and, if the lack of sexual desire persists, then a hormone panel can be taken and re-evaluated by your doctor.

Isn't this fun? I am trying to keep it simple because it can get very complicated. Since we know low testosterone causes decreased sexual desire and pleasure, adding testosterone is the best place to start.

A healthy sexual relationship helps relieve stress and can heighten our sense of well being. This is important to understand as over 50% of office visits to health care professionals are from illness brought on or worsened by stress which can impact many aspects of our day to day life.

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Is a Yeast Infection Causing The "Fishy Smell"?

>> Friday, December 4, 2015

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So many of you are concerned about vaginal odor and come in for testing worried something may be seriously wrong. Others are just frustrated because they have an odor that never really goes away.

Yeast infection is not usually the culprit of "fishy”- type odors. Yeast infection can cause a change in the normal odor of your discharge. It may smell similar to the smell of bread or beer. This kind of odor is often described as a "sour" smell, rather than "fishy". Yeast infections are also mostly known for their intense itching and white discharge that is sometimes described as “cottage cheese”-like.

"Fishy" odors are associated with bacterial infections such as Bacterial Vaginosis ('BV'). You may have had one or both of these types of infections. They are very common and are not passed sexually. They are not STD's, although partners of women with yeast infection may notice external itchiness after sex (this is uncommon and will usually go away quickly without treatment).

Your body, GI tract and vagina naturally have bacteria and yeast living in them. They are there for a purpose - to create a balance. The problems (infections/odors) come when the vaginal ecosystem gets imbalanced, which allows the 'bad' bacteria to take over. Normally the 'good' bacteria are in abundance, which is what is needed to maintain a low, acidic environment. This is the vagina's defense against infections and unpleasant odors.

I think the greatest concern is how we keep everything in balance to keep the 'bad' bacteria from taking over, and causing unwanted odors, BV and yeast infections. Sex, your menstrual cycle, medications, birth control pills, hormone changes in pregnancy or menopause and over-the-counter treatments (especially douching with over the counter (OTC) douches) can all upset the vaginal balance.

I know by the time patients come and talk to me about unpleasant fishy odor, it has become a very embarrassing problem that can interfere with intimacy. Some women worry that it is a hygiene problem and somehow they are not staying clean enough. Many women find temporary relief, but the odor returns no matter how many times they shower or try to rinse out their vagina. Most of the time this just makes it worse, because all this cleaning and douching is only destroying the 'good' bacteria with the 'bad', leaving your vagina defenseless. So everything rebounds back, over and over, causing fear and frustration.

But it is not a hygiene problem; rather the pH and normal flora balance just need to be restored. WaterWorks Feminine Cleansing System is used for so many women for odor without infection(s). WaterWorks is all-natural and you don't need to turn to pharmaceuticals to rid yourself of this recurrent odor problem. Many women are using it daily to clean their vagina and find that it is perfect for rinsing out semen after sex and residue of blood from their cycle. As I said above, it’s the semen and blood from your menstrual cycle that can create the imbalance in the vaginal ecosystem and raise the pH, causing the unpleasant odor.

WaterWorks is the only FDA cleared vaginal cleansing system that uses only tap water flowing through a stainless steel nozzle that gently rinses and cleanses the vagina. It is the reaction of running water with stainless steel contacting the vaginal walls that removes the odor. The best thing is, it is reusable and comes with a water reservoir and tubing that connects to the stainless steel nozzle for insertion. You do not have to continue to buy OTC douching products that don't work or pay co-pays on prescribed medications that only work temporarily.

WaterWorks has been the only product to work for so many women to eliminate unpleasant odor, and so many have had results the first time they used. It can help you to keep infection away, maintain a healthy vaginal ecosystem, and allow you to feel more confident. I truly hope this has answered your question and helped you this week.

Have a great week,

Dr. Susan Boyd.

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Is it Safe to Douche to Remove Vaginal Discharge or Odors?

>> Friday, November 20, 2015

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This is probably one of the most confusing decisions that women make about their personal hygiene.

Just go to the corner drug store and see how many feminine hygiene products are available. You’ll find many packages of premixed, disposable douches of various types and scents. I was asked today by a patient who had just had a c-section a few weeks ago when I felt it would be OK for her to start douching again! But the majority of women won't even ask their doctor about douching because they know that most gynecologists are against it altogether.

For many girls in their early teens, douching is taught as part of their personal hygiene by their mothers or older siblings. The applicators and empty boxes are seen discarded in the wastebasket just like pads and tampon wrappers. Most girls don’t consider that douching could in any way be an unhealthy practice. They think, “Why would stores sell them if they were not safe to use?” Some women feel unfinished or unclean if they are unable to douche after their monthly cycle or intercourse. Others incorporate it into their daily bathing routine.

Unfortunately, these same women who are hoping to clean their vaginal area with douches can actually completely disrupt the natural vaginal pH and flora, setting the vagina up for odors, discharge and recurrent yeast and bacterial infections. The normal vaginal pH is about 4.0, and it is this acidic environment that prevents the overgrowth of unfriendly bacteria as seen in bacterial vaginosis or recurrent yeast infections. Changing the vaginal pH with douching can invite overgrowth and infections.

Vaginal discharge is normal, and should only cause concern if it has a very strong, unusual odor or is causing irritation, itching or burning during urination. If this happens, it is important to get examined by your doctor.

It is estimated by ACOG (American College of Obstetricians and Gynecologists) that 20 - 40 percent of women age 15 - 44 douche at least once a week to remove blood, discharge and odors. Clearly, there is much confusion among women who are struggling with recurrent infections and odors. The vagina, if left alone is usually able to maintain a low pH and clean itself. But many of you are continually struggling with unwanted vaginal odors and recurrent yeast and bacterial infections. Because of this, you are prescribed oral medications, antibiotics, and vaginal creams over and over. And the temptation to douche is still there, because the odors keep coming back.

Luckily a remarkable new product I have discovered along with my patients, called WaterWorks, has absolutely changed the lives of so many women. It is a special, reusable vaginal cleansing system that uses just plain tap water. It is used in the shower, and what makes it so special is the stainless steel nozzle that sprinkles water out gently. It is the reaction of the stainless steel with the water and vaginal mucosa that eliminates (not covers up) odor. Odor can be eliminated the first time it is used! The system does not change vaginal pH, nor does it destroy the good bacteria and natural flora.

If you haven't checked it out, now is the time. Just go to WaterWorkshealth.com and see what you're missing. Leave the old douches behind, and start on a journey of refreshment and healing.

Until next week, Dr. Susan

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HPV Virus and What Can be Done About It

>> Friday, November 6, 2015

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Many of you have questions about the HPV virus and what can be done if you have a pap smear with a positive result.  HPV (Human Papilloma Virus) are little organisms that can infect the skin and the lining of some of the body's passageways and internal organs.  There have been more than 100 types of HPV identified.  Some types of HPV cause no known health problems.  Others can cause warts to grow on the infected areas (skin, perineum, vocal cords and in the vagina), and a few types can cause cancer.  It is because of this that we want you to have pap smears every year, as they screen for cervical cancer and HPV virus.


HPV is very common, and it is estimated that greater than 75% of people worldwide are infected.  In fact, HPV is the most common STD in the U.S., especially among young people.  That means that if you are sexually active, you have a very high chance of contracting it.  One partner could be a virgin at the onset of the relationship, and if their partner has been with even one other person and got the virus from that person, he/she can pass it to the other.  Only if both partners are virgins and truly have never been with another person sexually (in any way - anally, orally, etc.) will they remain free of the HPV.

That is why if your current partner is your first partner, but you are not his, and you suddenly have an abnormal pap smear that is positive for HPV, it does not mean he has been unfaithful.  The HPV virus can lay dormant, hiding in your cervical cells for many years, never showing any symptoms, and suddenly begin to replicate and become active again.

Women who get yearly pap smears are more likely to have the virus detected and prevent any serious consequences like cancer.  HPV has high and low risk types.  It is the high risk types that are covered in the HPV (gardasil) vaccination which is now available for boys and girls.  

We know that, with early detection, any signs of progression to cancer can be caught early and treated.  HPV can affect the oral mucosa - causing mouth and throat cancer, and the anus - causing anal cancer.  With a healthy immune system, most people who contract HPV when they are young will eventually destroy the virus on their own with no lasting health problems. Risk factors that can interfere with your body's ability to do this and which put a person at risk for cancer are: cigarette smoking, being infected with another STD at the same time, and a weakened immune system from having another medical illness like diabetes, HIV, or autoimmune illnesses.

Once again, safe sexual practices and using condoms seems to be very important, as well as not having multiple sexual partners at the same time.  These are ways to help yourself.  

I know I discussed this before, but many of my patients love the WaterWorks device for this reason.  Immediately after sex, you can get up and use it to rinse out the semen.  The longer the semen stays inside of you, the more likely you are to get HPV and other STDs.  The guys always jump up and rinse off and pee, right?  So this is a woman's way of doing the same.  Get the semen out, and let WaterWorks gently cleanse your vagina.  You will feel cleaner and have peace of mind.  It uses only warm, clean water and no chemicals, so what could be better?

Hope you stay cool and your summer is fabulous.  It is almost over, so if you haven't done something fun for yourself, it doesn't have to be expensive, but do it this week.
          
Be safe and take care, all of you.

Dr. Susan Boyd, MD


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Causes of Vaginal Bleeding or “Spotting” Between Periods

>> Friday, October 23, 2015

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Our topic of the week, vaginal bleeding or “spotting” between periods,  is just one of those common problems that women experience at different times for many reasons. What worries most of us does not know why we are bleeding or how long it will last. And let’s face it, it's just plain messy and inconvenient to have unexpected bleeding over and over.

Two patients came in this week who has been struggling with recurrent vaginal bleeding. When a woman comes into my office for vaginal bleeding that is not part of a regular menstrual cycle, it begins a whole investigative process.

Rarely would I able to discover immediately on physical exam, or by looking into your vagina with a speculum, the reason for abnormal vaginal bleeding, because the cause of most vaginal bleeding originates way up inside where I can't see. That's why we need ultrasounds and CT scans to look deep inside your body, and blood tests to make sure all your hormones are in check. We need to be sure that the other organs in your body are functioning properly.

A woman's body is so sensitively balanced and intricately put together that simple things like diet and exercise can affect and disrupt the entire system. Especially because so many of our meats and dairy products are full of growth hormones and antibiotics they give to the livestock.

So what is considered abnormal bleeding?

• When you are not expecting your menstrual period.
• When your menstrual flow is lighter or heavier than what is normal for you.
• At a time in life when it is not expected, such as before age 10, when you are pregnant, or after menopause.
• Bleeding with pregnancy is always scary, and is something that always needs to be checked out by your doctor. Spotting to minimal bleeding may be normal in pregnancy. But, heavy vaginal bleeding or bleeding that occurs before 12 weeks may mean a serious problem like possible miscarriage or ectopic pregnancy. Heavy vaginal bleeding or bleeding that occurs after 12 weeks also may mean a serious problem, such as placenta previa.

Non-pregnancy causes of bleeding:

• Ovulation can cause mid-cycle bleeding.
• PCOs (polycystic ovarian syndrome) is a hormone imbalance that interferes with normal ovulation – it can cause abnormal bleeding.
• Medicines that interfere with hormones.
• An IUD also may increase your chances of spotting or heavy bleeding.
• Infection of the vagina, cervix, uterus, fallopian tubes, or ovaries may cause vaginal bleeding, after intercourse or douching.
• Sexually transmitted infections (STIs) are often the cause of bleeding.
• Pelvic inflammatory disease (PID) causes inflammation or infection of the uterus, fallopian tubes, or ovaries, which can cause abnormal bleeding.
• Sexual Abuse or rough sex.
• An object in the vagina.
• Uterine fibroids which are a common cause of heavy periods
• Structural problems, such as uterine prolapse or polyps.
• Cancer of the vagina, cervix, or ovaries.

So, as you can see, there are so many different reasons for abnormal bleeding that it is important to check with your doctor to make sure your body is functioning properly.

I hope you all have a wonderful week and stay safe. :)

Sincerely,

Dr. Susan Boyd MD

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Are Oral and Hormonal Contraceptives Safe?

>> Friday, October 16, 2015

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Good Morning, I hope all is well this week.

As we all know, contraception is an important women’s health issue. It seems to be a regular part of the daily routine for many of us. A question I am frequently asked about is whether oral or hormonal contraceptives are safe, especially in women over 35 or who have medical conditions.

Besides preventing pregnancy, women gain some real non-contraceptive benefits from combined hormonal contraceptives or CHCs. Some of these could be decrease of dysmenorrhea and menorrhagia (painful periods and heavy bleeding), regulation of timing and cycle length, decrease in problems with anemia or iron deficiency or improvement of symptoms of PMS and breast tenderness.

Women with PCOS, the most common hormone imbalance in younger women, may see benefits and find improvement in their acne and weight. Pills containing progestins such as drospirenone help with antiandrogen and antimineralcorticoid activity that may reduce water retention and hirsutism (abnormal hair growth). CHCs have been found to be safe in non-smoking women with well controlled hypertension, uncomplicated diabetes, migraines without aura, uncomplicated liver disease and connective tissue disorders such as rheumatoid arthritis without antibodies and lupus erythematosus.

There are options of non-hormonal contraception like the IUD, condoms, diaphrams, cervical caps, and spermicides. If used properly they are effective to prevent pregnancy. For women who have other health issues, you may feel more comfortable using these methods.

So this should make a lot of women happy to know that birth control is safe and can be beneficial in some ways. There are lots of options, so don’t get caught pregnant, wishing you would of done something sooner.

Hope you all have a wonderful weekend, be safe and take care.

Dr. Susan Boyd,MD

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