Vaginal Infections

Although this subject is not discussed openly at bookclub, it is unlikely that many of the members would not have experienced some form of vaginal infection or discomfort in their lives. By taking note of the symptoms and appearance of the discharge it can be self diagnosed and even treated at home with over-the-counter medication, but the more serious cases should be seen and treated by a healthcare practitioner.

Causes 

The vagina creates its own environment which maintains a certain balance among the normal bacteria found there and the monthly hormonal changes in a woman’s body. When this system is upset as a result of fluctuating hormones, antibiotics or oral contraceptive use, douches, vaginal medication, sexual intercourse, other disease and stress factors, an infection results which is physically and emotionally distressing.

The three most common infections are:

-       bacterial vaginosis

-       vaginal yeast infection (thrush)

-       trichomoniasis.

The causes and treatment of all three are very different and this is another reason why they should be correctly diagnosed for best results.

Bacterial vaginosis accounts for about 50% of vaginal infections which is caused by an imbalance in the types of bacteria normally found in the vagina and is an overgrowth of Garnderella vaginalis.

The cause could be pregnancy or an intrauterine device or  frequent douching and is associated with sexual activity. Women who are not sexually active are rarely affected. It is also a myth that it can be ‘caught’ from toilet seats, bedding or swimming pools!

Yeast infections or thrush is caused mainly by a fungus called Candida albicans.  It is an overgrowth of the normal fungi in the vagina which is usually kept under control by the normal bacteria in the body. It is thought to be caused by:

-       the use of antibiotics (it destroys protective bacteria as well as bad bacteria)

-       diabetes and pregnancy as both can raise the sugar content (pH balance) of the vagina and increase the risk of a yeast infection

-       oral contraceptives can change hormonal levels and normal ovulation and even menopause can result in an infection.

-       wearing very tight underwear or non-cotton panties can increase temperature, moisture and local irritation.

 This fungus can spread to other parts of the body including skin, mucous membranes, heart valves, oesophagus and other areas, and can cause life threatening systemic infections in people with weakened immune systems such as during pregnancy, HIV positive people, those with diabetes or if a person is taking steroids. It is estimated that at least one in four women will have at least one yeast infection in their lifetime, but many will have recurrent infections over time.

Trichomoniasis is a sexually transmitted disease caused by Trichomonas vaginalis and is primarily an infection of the urinary and genital tract, but for women the vagina is the most common site of infection. It can also be caused by allergies to spermicides, vaginal hygiene products, detergents and fabric softeners.

Symptoms

Vaginal discharge is normal for women in their reproductive years as the cervical glands produce a clear mucous that drains downward and this is mixed with bacteria and discarded cells. This discharge could be whitish in colour and turn yellow when exposed to air. If the discharge has a different colour and smell, as well as symptoms of itching and burning, an infection is more than likely present.

Bacterial vaginosis causes an abnormal discharge with an unpleasant odour and some women report a strong fishlike smell, especially after intercourse. The discharge is white or grey and there is burning during urination, accompanied by itching around the outside of the vagina.

Thrush causes a thick, whitish, ‘cottage cheese’ type of discharge and may be extremely itchy. Urination could be painful. But it is also common not to have much in the way of symptoms.

Trichomoniasis causes a malodorous, yellow-green or grey, frothy discharge, and there is itching and irritation of the genitals and burning when urinating. Because it is a sexually-transmitted disease, symptoms may appear within 4-20 days after exposure.

Treatment

If this is a type of infection that the woman has experienced previously, such as a yeast infection, she should be able to self-diagnose and treat the condition.

If the infection is accompanied by more severe symptoms such as severe pain, fever, vomiting, abdominal pain or abnormal bleeding outside the menstrual period, see a doctor as soon as possible.

Bacterial vaginosis and trichomoniasis will not go away with over-the-counter medications and require antibiotics. Treatment will probably include metronidazole (Flagyl) or clindamycin, but the doctor will decide the best course of action. If metronidazole is prescribed, avoid drinking alcohol during this time as it will cause nausea and vomiting.

Yeast infections or thrush can be treated with over the counter medicine such as Canesten or   any other clotrimazole products on the market, but Canesten does have a once-off cream treatment or a pessary which is easier than using a cream for seven days. Gyno-Daktarin has a similar once only treatment as well. Home treatment is not always 100% effective and it is safer to see the doctor for more severe infections in which case fluconazole (Diflucan) or itraconazole (Sporanox) could be prescribed. Both of these can be taken orally as a single dose.

Other home cures such as vinegar douche, or inserting yoghurt has not been proven effective and is not recommended.

Prevention

During treatment keep the genital area clean and dry and a shower instead of a bath is recommended. Don’t douche or use feminine sprays and avoid sexual intercourse until treatment is completed and symptoms are gone.

As stated above, the chemical balance in the vagina is very sensitive, and the body knows best how to clean itself there. Best method is warm water and gentle, unscented soap and no hard scrubbing!

To prevent recurrence of yeast infections:

-       Tight and synthetic underwear should be avoided.

-       Pantyhose could cause a problem in sensitive individuals

-       Women should be taught from small to wipe front to back after using the toilet as this avoids potential contamination.

-       Walking around in wet swim wear is not recommended, and  wearing a wet suit on a hot day is sure to cause problems.

Trichomoniasis can be prevented by having safe sex with condoms, and if infected, the partner should be treated as well. It is well known that multiple partners is not a good idea under any circumstance and should be avoided.

Summary

A woman should always be aware of personal hygiene and look after herself. This does not mean that the genital area must be scrubbed clean with harsh soaps or anything like that! Gentle daily cleansing, wearing comfortable cotton underwear and avoiding feminine sprays or chemicals will go a long way towards preventing an infection, especially thrush. However, if an infection occurs, diagnose as soon as possible or seek treatment, and the duration of the infection won’t be long and distressful. Ignoring it won’t help, treatment will.

Frieda Kilian Dip Mkt (IMM), BA Hons (Psych)