Vaginal Discharge

Hello everyone, I hope you are all happy and well today.

You know, so many women are bothered by vaginal discharge and are often confused about what constitutes 'normal' changes.

A clear to whitish discharge from the vagina is normal and will fluctuate in consistency and amount throughout the menstrual cycle. It is actually a way by which your body gets rid of bacteria and dead cells in your vagina - keeping it clean and healthy. However, if you notice vaginal discharge that is unusual in color or odor, itching and burning in the vagina, or blood-stained discharge, it could indicate an infection or disease of the reproductive organs. Abnormal discharge always has an unusual odor or will cause swelling and itching in the vaginal area.

Urinary tract infections (UTIs) are common in women and are caused by bacteria which are usually either transmitted from the sexual partner or from the woman's anal area. The first symptoms of a UTI can be abnormal vaginal discharge, pain with sex or urination, and urinary odor. Sometimes there will even be vaginal and urinary bleeding.

The majority of women know that a UTI can cause a burning sensation while voiding and a constant urge to urinate, although only a few drops may be produced. The urine is usually cloudy and often strong smelling, but few women associate their abnormal discharge with a UTI.

As a doctor seeing a woman present with all these symptoms, it is hard for me to know which came first, the vaginal infection or the urinary tract infection. So, after we talk, I will check vaginal cultures and send a urine sample for testing at the lab. Most UTI's are caused by a bacteria known as E.Coli that comes from our rectal and anal area (lucky us that everything is so close together down there), as it is easy for that bacteria to get in the bladder and vaginal area from intercourse, and floss-type panties.

If you find that you are getting more than your fair share of these type of infections, it is good to know that they can be avoided by drinking lots of water and cranberry juice. Cranberry juice acidifies the urine, and bacteria don't like that. Do not use feminine hygiene sprays or douches, as they can make it worse. Also, urinating right before and after sex is an important habit in helping prevent infection.

I hope the next time you have abnormal vaginal discharge and urinary pain/pressure, that this information will help you.

Have a great week. Be safe and have fun.

Dr. Susan Boyd, MD

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What Is Emergency Contraception?

Contraception use is one of those ongoing controversies we, as women, face throughout our lifetime.

Surely, the weight of these decisions continue to be mainly in our court. Women now have more birth control options and, whether married, in a committed relationship or not, we are the ones who end up pregnant - we cannot just walk away once we are. Once we are pregnant, our bodies go through extreme changes, and whether we feel we want to continue the pregnancy or end it, we are left with the decision and consequences it brings. Even terminating a pregnancy causes irreversible changes to a woman's body- physically, chemically and emotionally - that are for a lifetime.

That is why planning pregnancy and preventing unwanted pregnancy is so important. Contraception choices have changed over the years, giving women safer options and more to choose from. Unfortunately, not everyone is so prepared or can have problems with condoms breaking (or slipping off)….. and then worry about what to do after the fact.

That is why 'Emergency Contraception' (EC) allows a woman the chance to decrease her risk of pregnancy after unprotected or under-protected intercourse. According to the National Institute of Health (NIH), nearly 50% of pregnancies in the United States are unintended. Of these 50% of pregnancies, 52% of women report no contraception use and 43% report inconsistent use. This is why EC has become such an important option of contraception for all women. It allows women the chance to decrease the risk of pregnancy.

EC is not an abortion pill, nor method, but rather a method of birth control that's been around since 1974. It can be used within 72 hours after having sex to prevent pregnancy by delaying ovulation. The original forms of EC started by a doctor by the name of Yupze, who used 2 to 3 birth control pills, 2 days in a row, within 72 hours of having unprotected sex, to delay ovulation and hopefully prevent unwanted pregnancy. The current method most of us are familiar with is "Plan B" and can be obtained at most pharmacies.

So even though now there are many forms of birth control to choose from, EC allows women another option that is safe to use for those scary situations. Babies are awesome, but there is nothing more terrifying to a woman than becoming pregnant when she is not prepared.

I hope you have a wonderful week. We will be discussing more on contraception in the future.

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What are the Signs and Symptoms of Perimenopause?

Menopause, which is the complete cessation of ovarian function usually happens around 51-52 years of age. The stage of a woman’s life leading up to menopause is called 'perimenopause', and it can begin in the late 30's, 10-15 years before menopause. Perimenopause can come and go until menopause begins, lasting from months to years in some women. It represents a decline of ovarian function and therefore, hormone imbalance.

Symptoms can vary in severity and range, with some women experiencing physical symptoms like hot flashes, night sweats, feeling warm all the time and irregular periods. Some women experience sleeping disturbances, including difficulty falling asleep, staying asleep or multiple awakenings due to increased urination frequency that can occur due to decreased estrogen.

Perimenopause can also cause mood changes similar to what we see in PMS, only much more severe, with women suffering from anxiety, depression, irritability and fatigue. Hair loss, dry skin, decreased libido and vaginal dryness (causing pain with sex), can also occur.

With perimenopause, the symptoms of hormone imbalance can come and go for months or years. It can be very frustrating for women to experience many symptoms, have them go away, only to return again. The similarity of symptoms in perimenopause and menopause can be confusing, and therefore women usually seek out their for answers.

I hope this information helps you. If you have questions, always know I'm happy to answer them for you.

Have a great week,
Dr. Susan Boyd

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Can WaterWorks Help With Vaginal Discharge in Addition to Vaginal Odor?

This week the question is:

“I know WaterWorks helps with vaginal odor, but I have a lot of discharge, will it help me with that too?”

It seems kind of funny, but problems with vaginal odor and discharge seem way too embarrassing to bring up over lunch with the girls, even though in my experience, based on what I hear safely behind closed exam room doors, it's one of the most common problems women have. Maybe it would be good to know that the women closest to us suffer too.

Because vaginal odor can be caused by an imbalance of the normal bacterial flora in the vagina, odor and discharge often go hand in hand. Bacterial Vaginosis (BV) and yeast infections can both be culprits of recurrent odor and discharge.

Unlike store bought douches which contain chemicals that can make the situation worse by destroying that normal ecosystem WaterWorks uses of only tap water for vaginal cleansing, so it can be used every time you shower without causing any adverse effects. In fact, by using WaterWorks, a healthy balance can be created as the abnormal discharge and bacteria are removed and normal vaginal pH can be restored.

This is best seen by using WaterWorks to rinse out semen after sex. What is really happening has to do with the composition of the semen, which is a sugary, alkaline substance created to protect the sperm from the acidic environment of the vagina. If not for this, the sperm would die on contact with the vagina and no one would ever get pregnant. After sex, semen remains inside and if you have sex again within a day or two, it gives the vagina no time to restore the normal flora that creates the acidic environment. Once this happens there can be persistent discharge and odor that reoccurs.

So back to the question as to whether WaterWorks helps to eliminate vaginal discharge with the odor, the answer is yes. We have many women writing in and telling us how much they love WaterWorks. The WaterWorks system is a reusable vaginal cleansing system that has been FDA cleared for vaginal odor and it is the reaction of the stainless steel nozzle end that is designed to comfortably insert into the vagina, with ordinary tap water that eliminates or reduces the unpleasant odor.

The unique design and gentle sprinkling action will rinse unwanted discharge and semen from the vagina and help facilitate the natural healing process of your own body. No chemicals and no medications. What a wonderful gift to every woman.

Oh, and just for the sake of any curious readers, I do not receive commission from any of the WaterWorks that are sold, so there is no monetary incentive for me in telling you about it. I was just so excited when I discovered WaterWorks and met the inventor, because now women had a natural way to combat feminine odor and discharge without having to use chemicals or medications. All natural. What could be better than this?

I hope you stay safe this week.

I love hearing from you, thanks for all your emails,
Dr. Susan Boyd

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Vulvovaginal Atrophy & Menopause

Vaginal atrophy (atrophic vaginitis) is the thinning and inflammation of the vaginal walls due to a decline in estrogen. Vaginal atrophy occurs most often after menopause, but it can also develop during breast-feeding or at any time that your body's estrogen production is low, like during times of stress. Less circulating estrogen makes your vaginal tissues thinner, drier, less elastic and more fragile.

Vaginal atrophy due to menopause may begin to bother you during the years leading up to menopause (perimenopause), or it may not become a problem until several years into menopause. Regular sexual activity, with or without a partner, helps you maintain healthy vaginal tissues and can decrease problems associated with vaginal atrophy, as sexual activity enhances blood flow to your vagina.

There are some known factors that can accelerate vaginal atrophy due to their affect on hormone production and vaginal health. Cigarette smoking impairs blood circulation, depriving the vagina and other tissues of oxygen. Decreased blood flow to your vagina contributes to atrophic changes. Smoking also reduces the effects of naturally occurring estrogens in the body. In addition, women who smoke can have an earlier menopause. Also, women who never give birth vaginally are more prone to vaginal atrophy, as many hormones are released in response to vaginal stretching.

The risk of vaginal infections (vaginitis) can increase with vaginal atrophy. Atrophy leads to a change in the acidic environment of your vagina, making you more susceptible to infection from bacteria, yeast or other organisms.

Atrophic vaginal changes are also associated with changes in your urinary system, which can contribute to urinary problems. You might experience increased frequency, urgency or burning with urination. Some women experience more urinary tract infections or incontinence. Although stress incontinence is common among menopausal women, it doesn't appear to be caused by vaginal atrophy.

The symptoms can be varied, and some women have only one or two mild symptoms, while others can have many, sometimes more severe, symptoms. These can worsen the longer the body is estrogen-deficient. The most common symptoms include vaginal dryness and burning, spotting or even light bleeding after sex, discomfort and pain with sex, shortening of the vaginal canal and thinning of the vaginal walls, frequent urinary tract infections or urinary incontinence with burning and urgency.

Many of you may put off getting help because you feel you are experiencing a "natural" part of aging, and there is nothing that can be done about it. And some of you may be embarrassed about the changes that atrophy can cause, including uterine or bladder prolapse - which is where they begin to fall out of the vagina. Even though this is quite common and very uncomfortable, it's too embarrassing for some women to reach out for help.

Usually a simple pelvic exam and pap smear at your doctor's office is all that is needed to evaluate and diagnose vaginal atrophy or prolapse. If symptoms are bothersome, either vaginal or oral estrogen is effective in relieving vaginal dryness and itchiness, and improving vaginal elasticity. Vaginal estrogen may provide more direct relief of symptoms. You should experience noticeable improvements after a few weeks of estrogen therapy.

If you're experiencing vaginal dryness or irritation, adding back moisture with Replense, K-Y or Astroglide can help. The same is true for dryness with sex, so it is important to use a water-based lubricant, such as Astroglide or K-Y, to reduce discomfort during intercourse. Oils or petroleum-based products can make you more prone to infection.

Have a safe and happy week. :)

Dr. Susan Boyd, MD

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Struggling With Yeast Infections Since 5 Years Old. What Can I Do?

I recently received a letter with a question in which you may all have an interest. I'll post it here with my reply below. [Note: Please remember that my posts here are for informational purposes only. This is not medical advice, and should not be so construed or used - see this site's Terms of Use for additional information].

Dear Dr. Boyd,
I am a 31yr old woman; and since I was about 5yrs old I have been struggling with yeast infections (strawberry shortcake bubble bath caused it to start). They progressively have gotten worse with age.

They also have caused me to have medication prescribed (generic Diflucan) and a topical cream (Nystatin) over the last two years. But I can't seem to shake this infection or whatever it is.

I have been diagnosed with "trick" and given antibiotics and I haven't even had sex prior to this diagnosis. My "V" is discolored and wrinkly around the opening only on one side of my lip as if I have warts or something (which all my tests came back negative). When I use the Nystatin, it relieves the itching, swelling and discomfort (which helps) but nothing will heal the bubbly raw "scar" that keeps getting irritated - for whatever reason I'm not sure. It swells and itches and it's like the worst thing I have ever experienced.

Sex is out of the question because of it being raw and it's very unsightly. I have purchased WaterWorks and it really does help me get thru the day mainly because it's like an overproduction of yeast that greets me every morning or evening. Prior to WaterWorks, I had to swab out my "V" multiple times a day. I don't have medical insurance, so this is a financial pickle for me to keep going to the doctor with no resolution.

All of that being said, could my diet be preventing me from healing? Or could my bout of an eating disorder/depression (going days w/o eating, but drinking heavily, be the culprit? I'm at a loss here. I just don't know what else to do. Do you have any suggestions?
Sincerely,

Over It


Dear Over It,

I'm sorry to hear that you have been struggling so long. Bubble bath and soap can cause problems mainly because soap is alkaline, and the vagina stays healthy by remaining more acidic. So what we see with too much soap and bubble bath is rashes and allergies on the labia.

The Diflucan and Nystatin can help with both internal and external yeast infections, but only for a short time. Yeast and bacterial infections can always come back over and over. The medication is a treatment not a cure.

Trichamonas is passed sexually and can colonize or sit in the vagina for months if untreated. So there may be no way of knowing exactly when you got it.

Yeast infections can get better - as you have experienced - and you may feel OK for a few days, but then it can come right back. Why? Because anything that changes the pH of the vagina like sex, period blood, soap, hormone changes or feminine perfume sprays can bring them right back. That's why WaterWorks really helps, as it can be used to rinse out semen after sex, blood after a period and excess discharge. The plain water and medical grade stainless steel nozzle are very effective at healing the vagina and preventing reoccurrence.

I'm sorry I'm not there to look at the area on the one side of your vaginal opening-lip area to know what it is and biopsy it, but you need to see your gynecologist and have this done. Your doctor will want to determine what it is (including ruling out cancer or lichen sclerosis - as many lesions can cause ongoing, reoccurring, itching and swelling). Even reoccurring yeast infections can cause lesions like this that are raised, swollen and bumpy. They can make the normal vaginal tissue feel bumpy and look worse than normal. It is good sign that misstating helps, and it is possible that you just need to use it much longer or try a prescription antifungal/cortisone cream combination.

The opening of the vagina and the vaginal walls are "bumpy" naturally. This is called rugations and often women worry that they are warts. The rugations are a sign that a women's hormones are still working and that the vagina still has it's stretchability. As women age and go through menopause they stop producing hormones, and if they are not on hormone replacement, the vaginal walls will thin and shrink and lose their ability to stretch so vaginal sex can become very painful, or even impossible.

I hope this helps you to understand your body better and prompts you to see your gynecologist about the one side that is not healing. Hopefully (s)he can give you refills, so you can fill your meds and treat the infection as soon as you feel it coming back. Continue your daily use of WaterWorks as well.

Thank you for your letter,

Please write again if you have any further questions,

Dr. Susan Boyd, MD

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HPV - Human Papillomavirus: What You Need to Know

I know many of you are worried when you are sent to me from your primary care doctor (or return after a pap I have done showing abnormal results) with dysplasia or Human papillomavirus - HPV. HPV is the name for a group of more than 100 types of viruses; more than 40 types of HPV can be passed through sexual contact.

We may feel like we are the only ones who have such a thing when we get it, but HPV is so easy to get and so common that over 70% of sexually active people will have HPV at some point in their lives. In fact, HPV is the most common STD in America, with well over 25 million cases and rising. Some people will never know they even have it because they never break out with warts or never have an abnormal pap test. HPV usually has no symptoms, but can have periods of flaring up and then hibernating. Most of the time there are no signs of infection or "flare ups" (such as abnormal discharge or itching) to alert us of a problem.

The pap test is designed to detect abnormalities of cervical cells and also HPV infections. The pap test will focus on High Risk abnormalities, as these types are known to cause cervical cancer. Low Risk types can cause genital warts - which are obvious when they are present and which can be removed. The HPV that causes cancer cannot be seen visibly when your doctor looks at your cervix or anal area. HPV is a flat warty virus that is invisible to the naked eye. The vaccine focuses on preventing only the top High Risk types of HPV.

If you have an abnormal pap test it is important to follow-up for further testing by your doctor to determine the reason for it. Sometimes yeast or bacterial infections, cervical irritation or hormone changes can be the cause. An abnormal pap does not always mean HPV infection or cervical cancer. A colposcopy is often done to help your doctor see the abnormal tissue on the cervix. It is a lot like getting a pap smear except a special magnifying scope can be used with a strong iodine solution or acetic acid solution that causes the HPV to show up white. This helps your doctor know where to do a biopsy to send a sample to pathology for further evaluation. Some colposcopies are being done with colpo biopsy brushes which are much faster and less painful.

If you do have HPV, there are different ways it can be treated right in your doctor's office. Using Cryosurgery, abnormal tissue is frozen off. The Loop Electrosurgical Excision procedure (LEEP) uses a hot wire loop to remove tissue. Laser treatment uses a beam of light to destroy abnormal tissue.

Cone biopsy, where a cone-shaped sample of abnormal tissue is removed from the cervix and looked at under the microscope, is done in the operating room and reserved for instances when biopsies show early signs of cancer. This biopsy also can serve as a treatment if all the abnormal tissue is removed.

If you have had the HPV vaccine, it does not mean you do not need to worry about HPV or about getting a pap test. HPV can lay dormant for years, and even undetected HPV can show up after the vaccine because the vaccine does not cure HPV. It simply prevents us from getting infected or reinfected.

Being in an exclusive relationship is the best way to prevent HPV infection or reinfection. Note, condoms don’t always protect you from HPV. But, they may reduce your risk of getting genital warts and other STDs.

Just remember, the best thing is to follow up with your doctor and get your annual pap smears, so you know you are healthy. Encourage your partner to visit the doctor as well.

Have a safe and happy week,

Dr. Susan Boyd, MD

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