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 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


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


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. :)


Dr. Susan Boyd MD


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


Vaginal Discharge - What is Normal?

>> Friday, October 2, 2015

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Many of you are really struggling with an overabundance of vaginal discharge and write to me. You are concerned about whether it is normal, or perhaps due to some type of infection. It may go away for a week after the prescribed treatment, only to have it return again and again, sometimes only days later. I just want you to know, you are not alone. I see women in my office every day who struggle with this and feel that they are the only ones.

First, discharge is normal if you are a young adolescent or pre-menopausal female. It is secreted from special glands in the vagina that help keep us healthy by acidifying the vagina. This helps to fight off abnormal bacteria and yeast and provides moisture, so sex is not painful. Having no vaginal discharge would be like having no saliva in your mouth. Your teeth would decay, your tongue would stick to the top of your mouth, and you wouldn't be able to eat.

But some of you worry that you have too much discharge and actually need to use panty liners to stay dry. ‘Too much’ is not something I can determine, because what is normal for one woman may not be normal for another woman.

Vaginal discharge changes throughout our cycle, in both consistency (from thin and runny, to sticky and gooey, to thick and creamy). During ovulation it even has the consistency of mucous and a texture that is stretchy in nature. The changes correlate with hormone changes in our bodies. That's why the amount can change from woman to woman, as some women naturally have higher estrogen than others. We see this in pregnancy, and any woman who has been pregnant knows she had more discharge then, due to the higher hormone levels.

Besides making us feel 'wet' all the time when there is too much discharge, what you need to look for as abnormal is a sour or fishy odor, or itching that is uncontrollable. The first can be a sign of a bacterial infection (BV), and the second can be a sign of a yeast infection. Both are easily treated with prescription vaginal gels or tablets.

The odor can be exceptionally upsetting, as it lingers, and no amount of showers or baths will cure it because it is not from being unclean. Persistent discharge can also cause rashes and irritation, sort of like diaper rash in infants.

Recurrent yeast (candida) infections need to be checked out, as sometimes it can be a sign of a compromised immune system, like we see with diabetes, lupus, thyroid disorders, and HIV patients.

If you are struggling with constant yeast and bacterial infections, and feel you have way too much discharge, your gynecologist may prescribe Metrogel and Diflucan tablets to clear the infection. But for those of you who use the medications, only to find they return within a few days or a week, the best treatment is often to repeat the treatment 3-4 times back to back.

If you have an IUD, yeast and bacterial infections can happen more often, and it may take longer to normalize the vaginal pH to prevent recurrent infections.

I would also recommend purchasing and using a WaterWorks, as it is FDA cleared for vaginal cleansing and odor, and is all natural – with no harsh chemicals or perfumes.

As for surgery, like cryotherapy of the cervix for chronic cervicitis, or endometrial ablation, if you have no intentions of future pregnancy, it may help. But these need to be discussed with your gynecologist.

Dr. Susan Boyd, MD


Should I Use an IUD to Regulate My Periods?

>> Thursday, September 17, 2015

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“Dr. Boyd I’m 17 years old and I am active in many different sports like track, La Cross, biking and water sports. Every month my period comes very regular but it lasts for 6-8 days and it is very heavy and I pass clots for at least 3-4 days. I’ve heard birth control can help regulate periods and decrease bleeding. I have also seen commercials on TV that talk about the Mirena IUD and that it can do the same. The thing is I just don’t know if I am too young for an IUD or if I should use some other kind of birth control? I’ve heard if you are young, and have never had children, you should never use an IUD. Is that true?"

Thank you for your question Mimi. I know so many women of child-bearing age that have questions regarding birth control and IUDs (Intrauterine Devices). There are a lot of things to consider when deciding to start taking birth control. Things like; bleeding patterns, how much bleeding with each cycle, PMS, menstrual migraines, pain with periods, whether you have tried birth control before and had undesirable side effects, whether you want permanent or reversible birth control, etc. etc.

The trend today with so many women is to try to use more natural products and steer clear of products that artificially alter the body’s natural chemistry. That is why we are seeing a renewed interest in IUDs.

These 2nd generation IUDs are designed a little different than the IUDs of old, and these changes have really made all the difference. Let’s remember that “the pill” and other hormonal birth control have only been around for about 35-40 years for extensive use by the public. Prior to that, couples had few choices (such as condoms, spermicidal jellies, and IUDs). We’ve come a long way. So what are our choices for birth control today? Reversible types include; temperature chart or rhythm method, condoms, spermicidal jellies/ovules, several types of hormonal birth control ("the pill", the ring, the patch, the injection), IUDs (Mirena or Paragard). You can also choose from two permanent types: tubal ligation (laparoscopic or at time of cesarean section) or hysteroscopic tubal blockage like the ‘Essure’.

So let’s take a look at how IUDs work because there is a lot of misunderstanding about this. Today’s IUDs are shaped like a capital letter ‘T’ with a string attached to the bottom of the ‘T’. It is placed during the menstrual cycle for two reasons; first, during the menstrual cycle the cervix is slightly open so the IUD can slide up into the uterus easier and second, because the cycle is a confirmation that there is not an early pregnancy. The string is there for easy removal, to monitor correct placement and insure that it is still in place and has not fallen out or migrated out of the uterus and up into the abdomen (which is extremely rare). The string is only seen on speculum exam by your doctor and does not hang out through the vagina like a tampon string.

Currently there are two types of IUDs, the Mirena and the Paragard. The Paragard is can be placed in the uterus for about 10 years and has been around longer than the Mirena. It is known as the “copper T” because the copper in the stem is what causes the cervical mucus to thicken, creating a barrier and preventing the sperm from passing through into the uterus and on to fertilize the egg. The Mirena IUD can be placed in the uterus for about 5 years. It releases progesterone from the stem to thicken the cervical mucus and thin the uterine lining. The abnormally thick mucus prevents the sperm from swimming through to reach the egg. The progesterone can also work to thin the uterine lining, which will prevent abnormal uterine bleeding and irregular menstrual periods. That is why sometimes the IUD is used instead of surgery to help treat irregular bleeding.

The main problem with the IUDs of the past was that they used a soft cotton string. This type of string acted like a wick to absorb the vaginal moisture and bacteria from the vagina and allowed it to travel up into the uterus. The use of these typed of IUDs caused many women to become infertile as the infections caused severe scaring of the fallopian tubes. The strings on the IUDs today feel like fishing line and are a monofilament type of substance which prevent bacteria from attaching and traveling up inside the uterus where the IUD is. The new IUDs are safe, and with the new type of string we no longer see these types of super infections.

So, Mimi, that is where the rumor started long ago that IUDs were not the best birth control for someone who has not had children. But now that is no longer the case. In fact, the Mirena would be a good choice for you as it lessens menstrual bleeding and cramping, and you don’t need to remember to take it. More women are choosing it as it doesn't artificially introduce hormones into our bodies to regulate menstrual cycles and it allows you to remain on a regular cycle and to ovulate, it just blocks the sperm from meeting the egg. So give your Gynecologist a call, this may be the right choice for you.

I hope you all have a wonderful week, and please keep writing in with your questions as we love to hear from you.

As always, stay safe,

Dr. Susan Boyd


Can Thongs Cause Infections?

>> Thursday, September 3, 2015

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There have been many articles in women's magazines, fashion magazines, and medical journals concerning this very question. But most women don’t even think about it being the cause of vaginal infection, irritation or urinary tract infections. Thong panties may look sexy, but they can bring health risks that don't feel too sexy. It is important that women are conscious about the health risks related to wearing thong panties, so here's what you need to know before you slip on another pair.

The way a thong is constructed makes it a perfect set-up for infection. This is because that thin band of material that fits so snuggly against your delicate areas works like a sponge for bacteria. This is especially concerning as fecal material from the anal area can make its way to the vagina and urethra creating ideal conditions for urinary tract or vaginal infections.

All it takes is for the thong to slide a little when you walk to send fecal bacteria like E. Coli and Beta-Strep where it's not supposed to be. Most non-thong panties don't cause this type of problem because they're looser and allow better air flow. They also don't slide in between the delicate tissues back and forth like a see-saw.

Another problem associated with thongs is the irritating effect of the tight material against the skin. When a woman walks around all day wearing thong panties, the material rubs against the urethra and outer vaginal area creating small tears which create a risk for infection. Thongs can also irritate hemorrhoids and even cause anal lacerations. Even more risky is wearing a thong during exercise, especially in hot weather. This is a set-up for vaginal yeast and bacterial infections.

Women’s urinary pain and/or vaginal irritation often lead women to worry whether they 'caught' something from their partner like an STD/STI. By the time I see them in my office, they have often tried over-the-counter medications and douching to clean the vaginal area.

I have had my patients worry so much about cleaning the vaginal area that they will use disposable douches 3-4xs a day. They will reuse the disposable douche bottles and refill them with their own recipes like vinegar solutions, soap and water, shampoo, mouthwash, lemon juice, or plain water. I’ve even had women who have used a shower nozzle inserted into their vaginal area to clean out the discharge and infection. I have had other women tell me they simply use their fingers to reach up and clean inside their vagina with soap and water. All of these methods can be very harmful and can lead to more infections by continually removing all the 'good' vaginal bacterial or flora that is there to balance and fight infection.

That is why, if you haven't already looked into purchasing the WaterWorks Vaginal Cleansing System, you should.

It is a wonderful way to feel clean, and be able to safely clean inside your vagina without destroying the 'good' bacteria and vaginal flora that is supposed to be there. It is FDA approved and reusable so you never have to re-buy anything. It is made of medical grade stainless steel and is sturdy and well-made.

WaterWorks uses no chemicals - only plain tap water for cleansing. It is the reaction of the stainless steel with the water and the vaginal mucosa that creates the natural chemical reaction to remove unwanted odors. And unlike a traditional douche, the soft downward sprinkling action completely and safely removes unwanted discharge. What a wonderful combination for women today to have to ensure personal hygiene without the worry of creating more infection.

Dr. Susan


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