Yeast and BV (Bacterial Vaginosis)

I’ll do another post later on chlamydia and gonorrhea and other STDs–for now, let’s talk about the two most common problems women deal with!

YEAST and BACTERIAL VAGINOSIS

We use the term VAGINITIS (VAGh-in-eye-tis) to describe any inflammation, or vaginal infection (ITIS–means inflammation of ).

We ALL have bacteria in our vaginas–hundreds of bacteria live all over us—skin, mouth, bowels, vaginas.   Our bladders are sterile, and our internal organs–except bowels.  So, sometimes, we get a comment on a pap smear saying that some bacteria are seen.  We don’t have to treat bacteria just because they are seen–it is treated when when they “overgrow” and become a problem–causing discharge or a bad smell down there!

Most women ( 60%), will report that she has had a vaginal infection at some point, and many will self-diagnose, and treat with over the counter creams.  If you DO decide to self treat–and it doesn’t work, it is best to seek medical advice, and get an accurate diagnosis.

Women can get any of the following:

An increase in discharge, change of COLOUR of discharge, bad smell, spotting, pain, itching, pain with sex, redness, swelling.

It is NORMAL to have SOME vaginal discharge—about one teaspoon or less in 24 hours.  It is usually clear, or pale white. and there is no BAD smell to it.  The discharge can change depending on the time in your menstrual cycle–getting thicker and more sticky as you get closer to your period.  The vagina goes through many changes—sex, periods, childbirth, tampon use……

Some women have more discharge than others due to their cervix havng an “ectropion”.   This is a NORMAL variation of a cervix.  Just imagine your lips are turned out so the wet side is showing—you’d be drooling all the time.  Quite often, a cervix can be ‘turned out’–a “drooly cervix”.  This can be a royal pain, as it means you are always “wet”–and most women say they always get a dark bathing suit top, or a patterned suit–since a wet spot would show in their crotch if they wore something like a light colored plain pantie.

Cervical Ectropion–still a normal cervix–but you can see how it “drools”.

This is a cervix WITHOUT an ectropion—less likely to have that annoying drool.

http://www.drnick.net/img/cleaned%20images/1.11.13%20Exam_cleaned.JPG

cervic cautery ectropion

This is a cervix that bled every time the poor woman had sex.  There is no cancer or any infection, and her cervix bled just touching it.  We used little stick of silver nitrate to “chemically burn” the bleeding area–and the hope is it will heal so that it is not so bloody!

http://www.atozvetsupply.com/v/vspfiles/photos/71-SILVERN-SWAB-2.jpg

Usually you feel nothing but some mild cramping–that uterus –does it know how to do anything but cramp?  The cramping typically is mild, and lasts only a couple of minutes.  You may have some watery discharge for a few days as the area heals.

pH

The vagina has an “acid pH”.  You’ve heard of “acid rain” and “alkaline batteries” and “pH balanced”?  The healthy vagina has a pH of about 4-4.5.  The pH of your stomach is about 1.5-3.5–that’s why –when it comes up–it burns!

When the pH is normal, the healthy bacteria grow, and healthy bacteria actually produce HYDROGEN PEROXIDE—a well known cleaning solution–so when all is well–we actually have a self-cleaning system down there!

An infection can start when the pH balance gets fooled up–and the vagina becomes more alkaline.  Then those pesky, not so nice bacteria get going, and produce smelly gases–like dead fish!

There is treatment for BV.

Metronidazole gel or tablets (just don’t be drinking when on this stuff–it is like a cousin to Antabuse–the med we give to drinkers to stop them drinking–you will be sick as a dog!!!

Clindamycin tablets or gel

BORIC ACID–you can get this from Amazon!  A place called Herbie’s Herbs in Ontario sells medicinal boric acid–DO NOT USE THE COCKROACH KILLER–it has a pesticide in it!!

Click here for link to Herbie’s Herbs

Boric acid and can also treat yeast

DO NOT USE IF PREGNANT

I typically recommend you use 600 mg of Boric acid for one of two nights a week IF NEEDED!!!   Some teaching centers will say use it for two weelks straight–I hae NEVER had a patient  do this–it can burn your hoohah if you use it continuously–it is an acid!  Is it a 100% guarantee—no, but it works most of the time!

The thing with bacteria is that they create “biofilms”–it is like they surround themselves with “saran wrap” so that antibiotics don’t always work!  Treating some women with repeated infections can be very frustrating for the poor affected woman!

BACTERIAL VAGINOSIS (BV)

Why do some women get BV all the time, and others don’t–we have no idea!!  You can treat it and then it is back in a few weeks—-really annoying!!

BV has been linked to miscarriage–although it is NOT recommended that pregnant women get screened for this yet.  It also can cause infections after hysterectomy, preterm birth–and it seems like it can help other infections get more of a foot-hold.

Many women will  have some of the bacteria that cause BV seen at time of pap smear under the microscope–but that is not the same as BV INFECTION.  You need to have SYMPTOMS to be considered as infected.  There is still no evidence that screening, and treating BV in pregnancy makes any difference to prematurity rate–so we don’t screen.  We will treat IF SYMPTOMS.

So–yeast!

That can make you pretty red and sore–like you’re on fire–and not in a good way.  Sometimes, there is hardly any discharge at all!  Yeast is WAY more common in diabetics, and can be a chronic problem for diabetics.  The BEST way to get rid of yeast if you are diabetic is to get your sugars NORMAL—-not 8 or 9—NORMAL!!!

The other thing is that self diagnosis is not usually accurate–only ELEVEN percent of women who had never had a yeast infection correctly diagnosed themselves–35% if they had a previous history!

TREATMENT

ORAL med–fluconazole 150 mg–can take 2-3 days to work.  You can use Benadryl for itching.

Vaginal creamsImage result for yeast vulvitis

There are many creams out there–you doctor will prescribe something for you.

 

 

 

 

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