Vaginal discharge is the one thing, other than the menstrual cycle, that women
notice and use to judge wellness in their bodies. If your cycles are
regular and on time, and your vaginal discharge is normal, you feel your
body is healthy, right? But, if a woman starts skipping her cycles or
having too many cycles or bleeding heavily, she knows something is not
right with her body. Okay.
Still, so many of you come in (most of you for other female problems) and I find out that you are constantly dealing with abnormal vaginal discharge or odor. You and your partner feel it is just 'normal' for women to have a fishy or strong odor all the time. Isn't that what all those tuna fish and fisherman's wharf jokes are all about? Men know it, and they talk about it, and think that's just the way it is – so, just grin and bear it.
Women don't know what to do. It's embarrassing, right? Three showers a day, and you still worry if everyone else can smell you. You can't wash it away, and that SUCKS because you know he's going to smell you during sex. But feminine sprays, lotion or soap and water do not help.
It is normal to have vaginal discharge. Some women produce more vaginal discharge than other women, and this is due to hormonal fluctuations. Teenagers and pregnant women both have higher than normal hormone levels which causes an increase in vaginal discharge. Women who are dry and lack discharge may have low hormone levels, like in menopause or during breastfeeding. You may also notice changes in the amount of vaginal discharge, changes in its consistency, (thick, thin, watery, sticky), and sometimes find it necessary to wear a pad or panty liner. Birth control pills will change vaginal discharge because it balances the female hormones and is a good therapy for women who feel too 'wet' all the time.
But, no matter the amount or consistency of discharge, it should never have a foul or fishy odor. At times, discharge may have a slight odor, due to hormonal changes during the month or during the final day of your cycle – due to pH changes from the menstrual blood. Normal discharge should not be accompanied by pain, itching, burning or redness.
Vaginal discharge is very important to the female reproductive system. Fluid made by glands inside the vagina and cervix carries away dead cells and bacteria. This keeps the vagina clean and helps prevent infection. A change in your normal vaginal discharge may be a symptom of a vaginal infection.
Most of the time, vaginal discharge is perfectly normal. The amount can vary, as can the odor, and the color can range from clear to a milky whitish, depending on the time of your cycle.
Important things to watch for to determine if there is an infection include the length of time you have had the abnormal discharge, the color/odor of the discharge and the presence of any itching, pain, or burning in or around the vagina. Different infections present with different types of discharge and symptoms:
- Chlamydia and gonorrhea are obvious, as there is a copious amount of cloudy, yellowish discharge, sort of like having a period of discharge, with an awful odor that is so different from the normal everyday discharge that it can alarm most women. In addition, they can cause urinary incontinence, painful sex, severe pelvic pain, bleeding and irregular cycles if not treated quickly. Also, they can be the cause of PID (pelvic inflammatory disease) which can cause severe illness, fevers, blockage of fallopian tubes and eventually lead to infertility.
- Trichamonas is a parasitic infection typically contracted and caused by having unprotected sex, with grayish frothy discharge.
- Yeast Infections can have two kinds of discharge: either thick and clumpy like cottage cheese or thin, whitish discharge that causes intense itching and swelling.
- Keep the outer vagina area clean by washing regularly with a gentle, mild soap and warm water. DO NOT WASH INSIDE THE VAGINA WITH SOAP. Never use scented soaps, feminine products or douche. Also avoid feminine sprays and bubble baths.
- After using the restroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection. It is a good idea to have baby wipes or other 'wet' wipes near the toilet as they work much better than toilet paper for feminine cleansing.
- Try to wear 100% cotton underpants; switch off wearing floss panties and regular panties; and avoid overly tight clothing all the time.
Have a safe and happy week,
Susan Boyd, MD
I’ve had a lot of questions from many of you about your irregular menstrual cycles. Shelly and Ciara just recently came in for a recheck because they are frustrated and searching for a solution. “I don’t understand Dr. Boyd, why my period will be normal for 2 or 3 months and then it will come so heavy that I pass clots, have cramps and soak 4 or more tampons in 30 minutes for the first couple days. Then I might skip a period or just spot for a few days, and then back to normal for a few months, then spotting or heavy it drives me crazy. Is something serious wrong with me? Will the pill help? What can I do?”
I am finding that more women than ever seem to be having problems with abnormal uterine bleeding, that presents younger as women (pre-teens) are menstruating at a younger age. Teens and young women are struggling with weight more now than ever and much of it has to do with the hormones that have been introduced into our food supply in greater and greater amounts over the past few years.
Ingesting excess hormones every day via dairy and meat products has been shown in several studies to affect growth (size, weight, and height) in children and possibly sexual development, fertility and menstrual irregularities. This becomes more of a concern as we continue to see childhood obesity increase and weight changes in women (up or down), can cause abnormal uterine bleeding and infertility. The thyroid gland is also important in menstrual regulation and can be affected by the hormone overload caused from animal sourced food products, pesticides, chemicals and plastics in our environment.
One way to gain understanding is to review the ‘normal’ menstrual cycle, then we can compare it to Shelly’s and Ciara’s problems next week and maybe see what is going on. Menstruation usually starts at about age 12 or 13. One study, however, has indicated that girls may be starting puberty earlier than in the past. By the age of eight, 48% of African-American girls and 15% of white girls were showing pubic hair and developing breasts. It had previously been thought that only 1% of girls exhibited such changes at that age. Alternatively, a study done in England found that the average age for the onset of menstruation has changed very little since the 1950s, with the median age being 13 years.
The uterus is a pear-shaped organ located between the bladder and lower intestine. It consists of two parts, the body and the cervix. When we are not pregnant the body of the uterus is about the size of a fist, with its walls collapsed and flattened against each other. During pregnancy the walls of the uterus are pushed apart as the fetus grows. The cervix is the lower third of the uterus. It has a canal opening into the vagina this opening is called the os which allows menstrual blood to flow out of the uterus into the vagina.
Leading off each side of the body of the uterus are two tubes known as the fallopian tubes. Near the end of each tube is an ovary. Ovaries are egg-producing organs that hold between 200,000 and 400,000 follicles that contain the genetic material for producing babies. The inner lining of the uterus is called the endometrium and during pregnancy it thickens and becomes enriched with blood vessels to house and support the growing fetus. If pregnancy does not occur, the endometrium is released as your period. The hypothalamus (an area in the brain) and the pituitary gland regulate the reproductive hormones. The pituitary gland is often referred to as the master gland because of its important role in many vital functions, many of which require hormones. In women, six key hormones serve as chemical messengers that regulate the reproductive system.
The hypothalamus first releases the gonadatropin-releasing hormone (GNRH)>
This chemical, in turn, stimulates the pituitary gland to produce follicular stimulating hormone (FSH) and Lutinizing Hormone (LH).
Estrogen, progesterone and testosterone are secreted by the ovaries at the command of FSH and LH and complete the hormonal group necessary for reproductive health.
The menstrual cycle reflects the changes that occur in the endometrium, the inner lining of the uterus. Layers of the endometrium are shed at the end of the cycle as part of menstrual flow. The menstrual cycle is generally divided into phases; the follicular phase, ovulation phase and the luteal (or secretory) phase.
For a clear picture of the process it is important to understand how to count days in a menstrual cycle. Day one is generally considered to be the first day of bleeding. The follicular phase includes menstrual bleeding followed by proliferation (growth and thickening) of the endometrium, uusually lasting from day 1 to day 14. The following processes occur during this time.
At the end of the menstrual flow, the proliferative phase begins, and the endometrium starts to grow and thicken. FSH levels rise and stimulate several ovarian follicles to mature over a two-week period until their eggs nearly triple in size. During this period, FSH also signals the ovaries to produce estrogen, which, in turn, stimulates a great surge of LH around day 14.
The surge of LH at the end of the follicular phase triggers ovulation by causing the largest follicle to burst and release its egg into one of the two fallopian tubes. At ovulation (usually day 14 in a 28-day cycle), the proliferative stage ends and the luteal (secretory) phase begins. The luteal (secretory) phase lasts about 14 days.
Finally, the endometrial lining sloughs off and is shed during menstruation. It’s amazing how complicated our cycles can be it really makes you wonder how things go right most of the time. Next week we can take a look at what goes wrong now that we know how things should function.
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
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.
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.
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