How can I know if I have a Vaginal Infection !?
One of the most common complaints for women is “vaginal infections”. Patients present to our clinics reporting symptoms of a presumed infection. Occasionally these symptoms truly coincide with an existing pathology, but in many other instances the reported symptoms stem from a background of healthy cyclic physiologic (normal) changes.
A big number of women avoid
visiting the doctor for such a complaint, and prefer heading directly to the pharmacy
and buying over the counter medications in order to attend to their symptoms.
The purpose of today’s article, is to educate you about the different indicators of potential vaginal infections, and to instruct you about some behavioral modifications in order to aid in the management of existing and the prevention of future infections.
What is vaginal discharge?
Starting with vaginal discharge, it is the term doctors use to describe any fluid coming out of the vagina, regardless of its actual source (vagina, cervix, uterus…). This is actually one of the most common chief complaints for patients. This discharge can be completely normal. Actually, all pre-menopausal women will experience a small (2-5 millilitres) daily amount of clear/white mucus-like mostly odorless vaginal discharge.
This discharge fluctuates during the woman’s cycle (increases 1-2 weeks before the period) and differs from a woman to another; some experience minimal physiologic (normal) discharge, and others experience copious yet also normal discharge. This fluid actually is a marker of a healthy vagina! Because the more naturally lubricated the vagina is, the more likely is for you to see this physiologic discharge. In fact, after menopause (defined as 12 consecutive months without period) the vaginal mucosa (inner lining of the vagina) “dries out” secondary to the lack of hormonal stimulation, and thus the discharge decreases significantly.
Also, it is important for you to know that if you are on
birth control pills, or in case of pregnancy, the physiologic discharge is expected
to increase from baseline.
So, a small amount of clear/whitish non foul-smelling discharge
that fluctuates within a menstrual cycle is totally normal. Actually, this discharge
is beneficial because it helps in decreasing the risk of urinary and vaginal
infections as it contains “good” bacteria (collectively named: normal vaginal
flora)
When is vaginal discharge abnormal?
Before judging whether a discharge is normal or abnormal,
always know yourself! Because you know yourself better than anyone else, so any
dramatic change in the discharge should raise suspicion for a potential
infection. The first thing you should look at, is the discharge itself. As I previously
mentioned, a clear/white sparse discharge with no foul smell is
most likely normal and physiologic, so any change in the consistency, color or
smell of a discharge can signify an underlying infection.
So, a vaginal discharge is more likely to be associated with
an infection if:
- It has a bad smell
- It is green, yellow, grey or bloody in color
- It is more copious than usual
- It is thick, foamy and chunky (with big particles clumping together)
Besides the discharge itself, you should be totally aware of
other associated new symptoms such as:
- Painful intercourse (pain during sex, either from the outside or from the inside with deep penetration)
- Bleeding during or after sex
- Itching “down there”
- Burning sensation with or without urination
- Redness and\or swelling around the vagina
- Fever or chills
- Lower abdominal pain
In case you are suffering from any of the previously mentioned symptoms in addition to vaginal discharge, the probability for you to have a genital infection (vaginal, cervical or uterine) approaches 100%.
What can cause abnormal vaginal discharge?
So, it is clear by now that an underlying infection (bacterial,
fungal or parasitic) is the most probable cause for abnormal vaginal discharge.
However, sometimes this discharge occurs as a vaginal reaction to foreign
bodies. You might find that strange but sometimes women lose a condom or tampon
in their vaginas! And the first sign for such a foreign body is copious foul-smelling
discharge, so always keep this option in the back of your minds.
Also, another common reason for changes in the vaginal discharge
is a reaction to a new soap or other scented products (creams, powders, perfumes…) applied
in the vagina. This is also applicable to the products used in vaginal douching
(rinsing the insides of your vagina) which can cause more harm than benefit (will
be discussed later).
Most common infections causing vaginal discharge
Now we will go through the most common infectious reasons
for abnormal vaginal symptoms.
Bacterial Vaginosis (BV)
This is the most common cause of abnormal vaginal discharge in women. There are different bacterial strains that can cause BV, but the main reason behind it is a reduction in the normal vaginal flora (beneficial vaginal bacteria) and thus an increase in the number of pathological bacteria.
Symptoms include a foul smell that is typically described as “fishy smell”,
especially more noticeable after sex. Also, the discharge is typically off-white
and thin. Affected women are less likely to experience pain, burning sensation,
redness, swelling, fever or chills.
Even though bacterial vaginosis is not classified as a
sexually transmitted infection, yet one of its commonly reported risk factors
is having multiple or new sexual partners. Also, women who have sex with women
are at an increased risk for bacterial vaginosis compared to heterosexual
women. Moreover, smoking and vaginal douching are recognized as important risk
factors for this infection, because they both alter the normal protective
vaginal flora.
The diagnosis should be made by your clinician! A home-based
diagnosis is not accurate and thus you should follow with your gynecologist in
case of any of the above-mentioned symptoms. It is always advisable to never
self-medicate in case of any suspected vaginal infection, as you may make
things worse! The treatment is simple, either oral or vaginal (cream or gel)
antibiotics. If symptoms improve after treatment course, a follow up visit is
not necessary.
I will not go through the names and doses of the antibiotics that can be used,
but you should know that in case you were prescribed the famous Flagyl pills (metronidazole)
avoid Alcohol consumption as these two strongly interact.
Male partners treatment is not indicated, but female partners treatment is
usually indicated especially in the setting of symptoms in the female partner.
Avoid sex during the treatment period.
Vaginal Yeast Infection (Candida)
Also, a common reason for vaginal infection is Candida. Patients usually present with burning sensation “down there” exacerbated by urination,
in addition to itching and irritation along with copious thick white cottage
cheese like (curd-like) discharge. The most famous causative agent is Candida
which is considered part of the normal vaginal flora, however, in the setting of
altered environment it can overgrow and cause symptoms.
The main risks for developing yeast infections are, diabetes, weak immune
system (HIV, chemotherapy, steroid use…), pregnancy, vaginal douching, recent
intake of antibiotics for any reason and estrogen containing birth control methods.
Here again, Candida is NOT a sexually transmitted infection, but
it is more commonly seen in women who are sexually active.
The diagnosis should be made by your clinician! Also, women are discouraged from self-medicating with over the counter anti-fungal
creams or pills. Actually, a study showed than only 11% of women in the States
accurately diagnosed their infections! So, self-diagnosis and self-treatment
will most likely waste your time, money and efforts, and may even worsen your
symptoms.
Once the diagnosis is made, treatment can be introduced with the use of either vaginal
or oral anti-fungal medications. You are expected to notice a positive effect in
few days after treatment initiation. Treatment of your partner (male or female)
is NOT indicated (unless the female partner has symptoms). Again, avoid sex
during the treatment period.
Some patients ask about diet changes and the use of supplements to treat and prevent vaginal yeast infections, but the fact is that there are no strong studies to advocate for such practices. Actually, the use of probiotics, garlic or other food supplements to decrease the risk of vaginal thrush is not proven yet. The only clear benefit was seen after implementing a healthier diet for better blood sugar control in the setting of diabetes.
Trichomoniasis or Trich!
Trichomoniasis is a sexually transmitted infection that can
cause symptoms in both males and females. Most men do not have any symptoms,
yet women tend to show symptoms more often than men. In women, the most
commonly reported symptoms are:
- Foul smelling foamy greenish-yellow discharge
- Itching and burning of the vagina and area around the vagina
- Minimal bleeding (spotting) after sex
- Pain during sex
- Pain or burning during urination
In men, the reported symptoms are, pain or burning during
urination in addition to abnormal penile discharge.
The most important risk factor for this infection is having
new or multiple sexual partners as it is a sexually transmitted infection.
Here again, you should never start any over the counter medication
without consulting with your physician, as the diagnosis is only made on clinical
grounds by a specialist. Once the diagnosis is confirmed, treatment is usually initiated
with oral pills (no vaginal therapy for this infection).
All your sexual partners for the past 60 days should be treated
as well.
Also bear in mind that if you were diagnosed with trichomoniasis,
screening for all other sexually transmitted infections becomes warranted (HIV,
Gonorrhea, Chlamydia, hepatitis B)
Chlamydia and Gonorrhea
Finally, one of the most commonly seen infections causing
abnormal vaginal discharge are Chlamydia and Gonorrhea. Both are sexually
transmitted infections and can cause abnormal foul smelling greenish discharge,
in addition to abnormal vaginal bleeding, abdominal pain, pain during sex,
burning upon urination and fever or chills.
The diagnosis should be made by a specialized clinician as
it is crucial to know whether the infection is localized to the vagina and
cervix or has spread to the uterus (known as pelvic inflammatory disease). Antibiotics
are the mainstay of therapy and you should abstain from sex for at least 7 days
after initiation of therapy.
Here similarly, all your partners for the past 60 days should
be treated and should abstain as well.
Again, you should be tested for other sexually transmitted
infections in case of a positive result for either Chlamydia or Gonorrhea.
What to do?
So, in a nutshell, in case you have any changes in your
vaginal discharge patterns, in terms of amount, smell, color and consistency
you should seek medical advice.
Also in case you have associated, abdominal pain, fever,
chills, itching, burning sensation, pain during sex or abnormal bleeding patters, consult with your physician.
You are not advised to self-diagnose and self-medicate
without seeking a professional opinion.
In the setting of sexually transmitted infections, you and all
your partners (males and females) for the past 60 days should be tested and treated, and you
will have to do a full STI panel screening.
Some infections cannot be managed with vaginal creams or ovules,
as you might need oral therapy (follow with your physician)
How to prevent?
The key in the prevention of unwanted vaginal infections, is
to avoid certain habits and implement healthier practices.
You should AVOID the following:
- Vaginal douches (rinsing the insides of your vagina)
- Wearing pantyliners/pads every day
- Scented vaginal sprays, powders, perfumes or washes
- Bubble baths or other scented bath products
- Wearing tight synthetic clothing (especially in hot climates)
- Taking invalidated anti-fungal and anti-bacterial medications
- Having sex when you have any of the previously-mentioned symptoms of infection
- Unprotected non-monogamous sexual intercourse
You should IMPLEMENT the following:
- Use water or unscented cleanser to wash the genital area (use warm water and your hand instead of hot water and a cloth)
- In case of a foul smell, do not douche to get rid of the smell, instead see a health care provider
- Wear cotton underwear
- Rinse genitals with water and/or pat dry after toileting instead of using baby wipes or scented toilet papers.
- Have better control of your chronic medical condition (diabetes, low immune state…)
- Use barrier contraception (such as condoms)
- Change out of wet and tight clothing as soon as possible (avoid hanging out in your wet swimwear)
In conclusion, not all vaginal discharges are abnormal, but
any change in your usual discharge, and any new associated symptoms should
raise suspicion for a potential underlying infection and should incite you to seek
professional medical advice.
Karam
Disclaimer: This article mainly applies to pre-menopausal women in their reproductive age. In the setting of abnormal vaginal discharge in young girls (before any period) and older ladies (after the age of menopause) the differential diagnosis changes totally, so always follow with a specialist!
Hello,
ReplyDeleteMy Grandma taught me that I should always put a finger in my vaginal (not too deep) just a around the walls, to bring out the whitish discharge and wash afterwards. And with water only.
This has helped to prevent my panties from discharges expect for during my periods.
Is this harmful or Not.
Hello,
DeleteEven if it is done just using water without any chemicals, I would still advise against such a routine practice, as on the long run your normal vaginal flora might be perturbed and you may become prone to fungal and bacterial infections