Monday, January 26, 2015

World War V(agina)






Any woman can attest, when there is disharmony within the cornucopia of microflora that is the vagina, the spectrum of afflictions can feel apocalyptic.

There is a  delicate balance that exists between the natives, yeast and bacteria. A balance that allows for the luxury of a ( relatively) odorless, well lubricated and supple vaginal oasis. A balance that can also be easily offset.


When this microbial civil war is in favor of yeast, symptoms can start off as a simple dryness or clumpy white discharge ( whimsically likened to cottage cheese) . If left unchecked, however, exfoliating with a Brillo pad can suddenly seem like a plausible solution to relieve the ghastly itch and public squirming. When the balance tips in favor of a rogue bacteria called Gardnerella, you can expect all the social life truncations that accompany fishy odor and grayish discharge.


What gives this deplorable duo a recurrent role in your vagina's monologue?


Believe it or not, your own hygiene practices might be the battle call. Contrary to prehistoric thought, your vagina need not be subject to the same cleaning practices as the back of your ears. So step away from your loofah and high endurance body wash; anything more than a thorough rinse with lukewarm water ( a mild soap can be permitted for the particularly exciting days), is overkill. Literally.


Another underrated tip that comes to mind (courtesy of the pumpkin spice latte scented tampons that were made available for those that were festively so inclined) keep things simple! Minimize the use of pantie liners, perfumed sanitary supplies and "warming" ( read: scalding) lubricants.  Avoid tight or restrictive undergarments. Using more cotton and even going commando in bed can help satisfy any troubled environment's " need to breathe" ( Side note- really good band).


Modifying your vaginal hygiene practices can not only save you some bucks on those only modestly helpful " pH replenishing" potions out there, but can even spare you some undesirable trips to stirrup central. Never the less, if you have started purchasing your monistat at Sam's Club because of how quickly you are "burning" through it, it might be time to utilize a different offensive strategy.


Case in point, I had a patient referred to me for " persistent discharge and itching". She mentioned that her primary care physician called in Diflucan ( treatment for yeast) based on what she described to be her symptoms over the phone. When the treatment didn't fix her symptoms , she had a topical steroidal cream ( treatment for vulvar dystrophy) called in instead. " I have had this several times before, but this time is the worst! " she wailed in agony.


(pause for dramatic effect)


Repeat after me:  I will not tele-treat my vagina.


Unfortunately, my patient was too embarrassed to mention the fresh catch odor that seemed to follow her everywhere (and was pathognomonic for bacterial vaginitis). Being treated over the phone with Diflucan only prolonged her infection. The worse the odor became, the more aggressively she washed herself in efforts of "cleansing it away"- further exacerbating the pH imbalance and making her more prone to persistent BV.  A simple vaginal swab shed light on this and she was started on Flagyl  (antibiotics). For added good measure, I suggested she eat plenty of yogurt ( live cultures of lactobacilli) while on treatment. In a few days, there was peace in paradise once again.


Prevention is always better then intervention. However,  if practicing the above basic hygiene principles isn't sufficient, or if you have recurrent encounters with yeast or  BV, consult your doctor to have further testing done. Conditions that can make you more prone to the aforementioned infections include uncontrolled diabetes, being immuno-compromised, or having a species that is resistant to the common first line treatments.


Please feel free to contact me with questions/comments/references.


Thanks for reading and as always,


Be happy, Be healthy!


ObGynKanobi OUT!



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