Vaginitis, Why Do I Keep Getting It?

A range of infections can cause vaginal discharge, odor and itching. Bacterial vaginosis (BV) is the most common. Vaginal infections are commonly referred to as vaginitis and they can be caused by certain types of bacteria/fungus or by a sexually transmitted disease. But sometimes women can experience a constant feeling of irritation, swelling, discharge and odor, but no cause can be found. And, why do some women get cover and over, while other women seem to never be bothered with it?

A yeast infection is perhaps the most common cause of itching and swelling of the vagina. The vaginal discharge associated with yeast infections is typically thick and clumpy, and the itching is usually both internal and external. Most infections clear up with anti-fungal treatments of creams, suppositories or pills, either prescription or over-the-counter.

Bacterial vaginosis can also cause vaginal discharge and itching, but the discharge of a bacterial infection is much different from that of a yeast infection. It has a thin consistency, with a gray-white color, and an unpleasant, sour, fishy odor.

But what about when you have all the symptoms of BV or yeast infection but none of the vaginal cultures show that there is an infection? You may suffer symptoms like vaginal itching, vaginal burning, vaginal discharge and painful sex, but all the tests are negative!

This is what we call non-infectious vaginitis, which usually refers to vaginal irritation without an infection being present. It feels just like a vaginal yeast infection, or if it's external only with no discharge, what we call, "Lady" jock itch. Most often, this is caused by an allergic reaction to, or irritation from, vaginal sprays, condoms, douches, and spermicidal products, or a sensitivity to perfumed soaps, detergents or fabric softeners.

May I say that in Vegas, "Lady" jock itch is common, because we have extreme heat, which traps moisture against the body as we sweat or sit in wet bathing suits this time of year. So, day after day of sweating in the groin area creates moisture that is trapped by the clothing we wear - such as nylons, floss panties, non-cotton panties, tight jeans, shorts or dress pants.

With this type of heat, wetness issues and clothing drama, it prevents our bodies from breathing and instead functions like a perfect incubator for the growth of all the fungus and bacteria. And, it can just cause plain, old chapped, irritated skin.

So that's the definition of the Vegas "Lady" jock itch, :) which I'm sure all of you have where you live too…..you just didn't know what to call it.

The practice of rinsing out your vagina with a cleansing agent (douching) upsets the natural balance of your vaginal environment. This can lead to an overgrowth of anaerobic bacteria, which in turn can result in bacterial vaginosis, yeast infections or irritation. Since the vagina is self-cleaning, douching isn't necessary. But, you certainly can use WaterWorks, which uses normal tap water and a medical grade stainless steel nozzle to safely and effectively clean your vagina.

The link between sexual activity and bacterial vaginosis isn't entirely clear, but bacterial vaginosis occurs more often in women who have multiple sex partners or a new sex partner. Bacterial vaginosis also seems to occur more frequently in women who have sex with women.

For some reason that may be genetic, some women just have a lack of vagina lactobacilli. If your natural vaginal environment doesn't produce enough lactobacilli, you're more likely to develop bacterial vaginosis.

Precautions can be taken to prevent abnormal vaginal discharge and itching by limiting exposure to irritating chemicals and by avoiding perfumed feminine products, toilet paper and douches. The vaginal area should be kept clean and dry so that yeast or bacteria are less likely to grow and spread. Some women have also found that probiotics found in yogurt can be helpful. Also, wiping with baby wipes is a much better choice for women than toilet paper. They are inexpensive, non-irritating and clean all the creases much better. Some of you have the French type Bidets next to or attached to your toilet, which are also wonderful.

For those of you with stubborn, recurrent infections, you may want to try gently blow-drying the area on low heat after showering to make sure all the creases are dry before getting dressed.

For so many of you, I know it's a struggle. But hang in there and it will get better. It's best to treat any discharge or irritation immediately, before it has a chance to get worse.

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

Dear KnowYourV,
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.

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Is It Normal to Have Vaginal Discharge?

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.

Infections require medicated vaginal creams or antibiotic medications, but here are some tips for preventing vaginal infections that can lead to abnormal discharge:

• 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.

We are lucky enough to have WaterWorks, which is FDA cleared for feminine cleansing and to reduce vaginal odor problems. Everyone loves this, as it functions just like a douche, but isn't. It is made of medical grade stainless steel and uses no chemicals (only plain tap water) and it can safely remove vaginal odor with the first use.

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Summer Heat and Recurrent Yeast Infections

Summer time with all the excess sweating, can bring a handful of problems.   Athletic wear has come a long way to help allow the body to breath better while it heats up during exercise.   It is built to wick away some of the excess moisture.  Undergarments have used some of this same technology with good success in reducing common recurring infections.

I see some women a lot more often when the weather heats up, because common infections like yeast, bacterial vaginosis, beta-strep and external genital fungal infections are much more frequent.  This can be extremely frustrating and I know many of you even worry about underlying causes like a weakened immune system, diabetes, liver disease, thyroid disorders, or other chronic illnesses.  All of these concerns are valid and are great reasons to see your doctor to have all the appropriate tests taken and evaluated.  This way, your care can be individualized for you. 

Many of you, just like me, would like to know if there are "natural" ways to treat these reoccurring, benign vaginal infections.  It gets tiring buying and re-buying the same medications as these infections always seem to reoccur.

Set aside the notion of 'sexually transmitted' for a minute, as a lot of you are in stable, monogamous sexual relationships, and have been for many years.  You may be having over-the-top, satisfying sex, because like a fine wine, it just gets better with time, right?  Better (if we can use that word to describe it) and more comfortable - which leads to more imaginative play and fun positions and a desire to try more and more adventurous experiences together.  But, a lot of you wonder if it is possible for your husband (or partner) and you to  pass this  back and forth over and over again. The answer to this is, 'no.'

Recurrent infections and irritations can be so frustrating!  Even though you may feel like the only woman with this problem, it is so common.  Most of you have been given the standard treatments like fluconazole for recurrent vaginal yeast infections and its external vulvar and anal itching. 

Fluconazole works great most of the time, but you may wonder whether there is any way to just heal this and get better.  The good news is that several trials and comparisons are showing that probiotics are making a huge difference, when combined with traditional treatment and a healthy lifestyle that encourages a healthy immune system.  Why is this?  Probiotics are composed of the natural bacteria that colonize our bodies like lactobacillus and bifidobacteri. These bacteria release a surfactant that prevents the candida or other forms of yeast from adhering to the tissues like the vagina.  In addition, probiotics compete with the yeast and will  secrete antibiotic substances to destroy the competition.

Studies indicate that women with recurrent infections who took a capsule of lactobacilli and L. fermentum had a significant decrease of yeast after 4 weeks.  When combined with fluconazole and taken for 28 days, many women were cured of vulvovaginitis.  This is great news and encouraging for all of you who have seen your doctor and had cultures and know it is not from a chronic, underlying illness.

One more piece of help from me is that those of you using the WaterWorks system 3-4 times a week or daily will have added benefit.            

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Recurrent Vaginal Yeast and Bacterial Infections.

These type of infections are common, and they tend to increase in frequency and recurrence as the weather warms up. Several of you have had these off and on for awhile, but are now coming in because of "little cuts" that you are noticing around the labia and vaginal opening.

The skin around the genital area is so sensitive and delicate that it is common to see areas of breakdown associated with constant infections and moisture. Clothing can trap moisture against our skin, preventing it from breathing, and cause a yeast-based rash to occur externally. This can occur over the mons pubis (where most of the pubic hair grows), down around the labia and vaginal opening, groin & leg creases, under arms, breasts and tummy folds.

These rashes can cause extreme irritation and itching called genital puritis, and this can lead to skin breakdown and little cuts forming where clothing rubs or skin stress occurs during intercourse. These are not serious and will heal with time as the vaginal infections clear. There are wonderful creams that can be used to help facilitate healing and relieve the itching and temptation to scratch that area.

In extreme cases, it can be beneficial to wear underwear similar to men's boxers so that the elastic bands do not continue to rub and injure the skin. Keeping the area as dry as possible helps, as can using a blow dryer on medium heat to gently dry all the creases after showering and before putting any creams or medications on the area. This can also help to clear boils, ingrown hair follicles, and sebaceous cysts that pop up in that area.

It sounds silly to do all this, but we take so much care to keep the skin on our face clear and healthy, yet forget that a little extra care in the vaginal area can prevent recurrent problems. It can be a source of embarrassment to have "blemishes" all over the labia and upper thighs, and it can interfere with intimacy and confidence with our partners.

It is such a common problem, but with a just a little care, it can be completely cleared. I hope this saves you from a little worry and helps you to know how common this problem is. You are not alone, as so many women struggle with this. My next blog will continue to provide more information on this problem so we can continue to learn more and more.

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