What Can I Do About Re-occurring Vaginitis?

Good morning everyone! Today is a good day, and it is even better when we can share it with those we love. In today's world we have to be so thankful for friends and family, and their health.

Today we will discuss the topic of re-occurring Vaginitis, which includes the most common form -- Bacterial Vaginosis (or BV). As you know from our previous discussions, BV is a condition in women where the normal balance of bacteria in the vagina is disrupted by an overgrowth of bacteria not normally present there except in very small amounts. In fact, there is a flip-flop of the bacterial balance due to a disruption of the pH, which causes the healthy, protective bacteria to be replaced by the unhealthy bacteria.

Because the pH of the vagina is normally on the acidic side of the scale, most bacteria and yeast won't grow in a healthy vagina. That is why the vagina is capable of self-cleansing, and why we emphasize to you over and over not to douche or clean inside your vagina with soaps and chemicals. Most cleansers and soaps are on the opposite side of the pH scale and will flip the pH from acidic to alkaline. So, instead of improving odors and discharge, using them will actually make it worse.

This is frustrating and brings fear to many women that the infection they have is much worse, or that it may even be an STD or cancer. It is amazing how our imagination can scare us like that. BV is not an STD (sexually transmitted disease), but having it can put a woman at higher risk for "catching" one -- such as HIV, Herpes, Chlamydia, Gonorrhea, Warts (Condyloma), HPV -- if she is exposed to it by her sexual partner.
Why is this? Because BV disrupts the normal acidic pH of the vagina that works as a protective barrier against disease. Most bacteria and viruses cannot survive in an acidic environment as they need a normal or more alkaline pH to thrive.

BV is the most common vaginal infection in women of childbearing age in the United States, and any woman can get it. But, the initial cause of BV is not fully understood. There are many unanswered questions about the role that harmful bacteria play in causing BV. We do know that some activities can upset the normal balance of bacteria in the vagina and put women at increased risk including:

• Having a new sex partner or multiple sex partners
• Douching
• Sexual activity in general can increase the incidence of re-occurrence because semen has an alkaline pH and is full of carbohydrates to feed the sperm and keep them healthy for their journey. It can recreate a vaginal environment that feeds the unhealthy bacteria.
• Note: Women do not get BV from toilet seats, bedding, swimming pools or from touching objects around them.
• Whether or not a woman has had sexual intercourse or is a virgin does not seem to make a difference in the ability to contract BV.
• Pregnant women are the most susceptible to BV due to the drastic hormone changes that cause large fluctuations in Vaginal pH. All pregnant women are screened and treated if positive because BV can put them at risk for pre-term labor and early delivery of their baby, resulting in possible complications.

So how do know if your vaginal troubles are normal, caused by BV, or maybe something worse? Well, it can be hard to tell. Even as a Doc, I can't tell by just looking. Many women have no symptoms at all. The concern to me as a doctor is that we know BV can increase a woman's susceptibility to other STDs. Of course, that is dependent on your being exposed to them by your sexual partner.

Women with BV will usually have an abnormal vaginal discharge with an unpleasant, even fishy, odor. Many women will experience an increase in the amount of discharge that requires the use of sanitary pads or panty-liners. The discharge is usually thin, white or gray, and it can burn and itch around the outside. Burning during urination can also occur, possibly as a result of chaffing caused from constant wetness and use of pads.

It can make you feel desperate to get rid of the odor, but nothing works -- shower after shower, cover-up sprays and lotions, but you still have the feeling that everyone around you can smell you. Douching, as we've said, will just destroy and damage the vaginal mucosa and natural bacterial environment that is needed to heal your vagina.

So how does one treat it and get rid of it so it stops coming back over and over again? This usually requires a diagnosis by your doctor and then a special prescription antibiotic (tablet or vaginal cream/gel) to destroy the bad bacteria and allow the healthy bacteria to replenish the vagina.

But how do we keep our vagina healthy so it doesn't re-occur over and over? The best way is to rinse the vagina to remove the semen right after sex. Think about it, what do the guys do? They jump up, go pee and rinse off their penis -- immediately, always. But, that is actually more important for us women to do, because our vagina is like a warm little incubator. After sex, it is full of sweet alkaline fluid that bacteria and yeast thrive upon.

Anything, even period blood, can change the normal healthy vaginal environment. So, if you have re-occurring BV it is essential for you to safely rinse with water. Never put anything, not even lemon juice or vinegar, inside your vagina.

We have talked about WaterWorks and how so many women are using it for just this reason. After your infection is cleared, WaterWorks is simply the best way to keep it away. WaterWorks is FDA cleared to eliminate vaginal odors, and for some of my patients that have struggled year after year with this, this has been the first method that has worked long-term. Plus it requires no chemicals and can be used daily for feminine hygiene maintenance.

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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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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.

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What Is Causing My Pain ‘Down There’?

Imagine vaginal burning and pain so severe you can’t sit comfortably, wear tight clothing or have sex. That’s the reality women with vulvodynia face, and although many of us would like to have a push-button answer to the problem, the human body does not function this way.

Why so many women suffer from pelvic pain during their cycles, during sex and some almost every day has puzzled many researchers and clinicians for years. There are a wide variety of reasons women can experience pain and problems.

Vulvodynia is a debilitating, difficult to treat, often incurable problem that causes extreme sensitivity of the vulva and vaginal labia. Possible contributors include injury to nerves in the vulva, hypersensitivity to candida (yeast) or other fungal and bacterial infections At times, the pelvic floor muscles spasm, causing throbbing and sensitivity to the slightest touch or pressure.

Some partially successful treatments have included the use of tricyclic antidepressants (to block pain receptors in the vulva), topical estrogen or lidocaine gel, and even surgery. Surgery is an extremely radical approach and requires removal of vulvar tissue in hopes the grafted tissue will cure the pain Capsaicin cream is a newer treatment that has to be specially compounded (and which contains the active ingredient in chili peppers), but has been shown to dramatically reduce symptoms.

If a woman’s condition is flared by a candida (yeast) hypersensitivity -- to which even a slight imbalance can cause itching and burning -- weekly doses of an oral antifungal medication over several weeks or months can help alleviate symptoms.

Some treatments for painful sex in women do not require medical intervention and can be treated safely at home - by using personal lubricants with intercourse, allowing injuries & surgical incisions to heal completely after surgery or childbirth, and simple patience and rest. Sometimes with vaginal pain due to menopause, excessive dryness after childbirth, or infections like yeast or bacteria, it may require a prescription from your physician. And, there are actually physical therapists that specialize in pelvic floor muscles that can help to alleviate the pain of pelvic organ prolapse.

Another condition, vaginitis, is caused from a disruption in the natural balance of bacteria that live in every healthy vagina. Vaginitis usually refers to bacterial vaginosis and yeast infections that can cause unbearable itching, burning, pain and/or odor for many women. It can re-occur several times per year.

There is no single cause for vaginitis, and it is not considered sexually transmitted. Common causes may include hormonal changes due to birth control, menopause or pregnancy, as well as chronic medical conditions, such as HIV and diabetes, which weaken the immune system. Frequent sex can also be a big cause of recurrent vaginitis, due to the sugary, alkaline solution surrounding the sperm which disrupts the acidic environment of the vagina. This creates a perfect environment for bacteria and yeast to flourish. Recurrent infections can cause chronic pain in women. Treatment is painless and easy - most women simply insert a prescribed cream at night or take a prescription oral antifungal or antibacterial.

Atrophic vaginitis is thought to be a problem of menopause. The term describes the dryness, vaginal wall thinning and shrinkage, and paleness of tissue due to lack of estrogen. Urinary incontinence can go hand in hand with this. Many of you have experienced this with childbirth and breastfeeding, due to the hormone changes which are similar to menopause. This condition can feel like an infection, with burning, itching, and pain, but no active fungus or bacteria is found. Treatments such as estrogen creams or oral estrogen therapy can help.

Some women suffer from another condition called lichen dermatoses, which is a condition that can lighten and stiffen the tissue in the vulva and can cause severe itching and scar formation. A mix of topical steroids with a tiny dab of estrogen can help heal the damage to the vulvar tissue and decrease symptoms.

Vaginismus is a rare condition (affecting fewer than 2% of women in the United States) in which the muscles surrounding the vagina involuntarily spasm so tightly that you can’t have sexual intercourse or even insert a tampon. The specific cause of vaginismus is unknown, but, as with vulvodynia, physical therapy can be a successful treatment.

Physical therapists who specialize in pelvic floor disorders can correct structural abnormalities and design a manual therapy and exercise program that will retrain pelvic muscles that are too tight or too weak, depending on the condition. Their efforts can dramatically reduce symptoms without the side effects of medication. They also teach women the proper way to perform techniques at home, with dilators and their own fingers, to gently stretch and massage the muscles. If a woman’s symptoms persist despite physical therapy, a doctor can inject Botox to paralyze muscles and prevent the spasms for up to six months. Other (older) treatments that have been successful for vaginismus include sex therapy medications such as Valium and hypnotherapy.

Fibroids affect about 77% of women, but most don’t realize they have them. In some cases, there are no symptoms, but some women can develop cramping, excessive bleeding during menstruation, and painful intercourse. The growth and development of these uterine tumors are rarely cancerous, in fact less than 0.01% of the time. Fibroids may shrink naturally after menopause. Treatment options vary and usually have a lot to do with a woman's age and desire for future childbearing.

Hysterectomy is one option, but if you have a desire for future fertility, it is possible to have only the fibroids removed, leaving the uterus and ovaries intact. There is also a procedure called uterine artery embolization, which cuts off the blood supply and forces the fibroid to shrink, however this may compromise future ability to have children, as it compromises blood flow to the uterus.

Genital Herpes is a disease caused by the herpes simplex virus (HSV), of which there are two types. Type 1 (HSV-1) usually causes oral herpes, an infection of the lips and mouth. Symptoms are commonly known as cold sores or fever blisters. In the past, HSV-1 was not known to cause genital lesions, but that is changing, and we now know oral herpes can be passed to the genital area via oral sex. Genital herpes is caused by the second type of herpes virus (HSV-2) and reoccurs more often - causing more distress to the person who has it. Chronic herpes infections can be a cause of persistent pelvic pain and painful intercourse.

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