Vaginal and Vulvar Health- 01

Vaginal Self-Exam
Foreign Body in the Vagina
Vaginal Infections
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Bacterial Vaginosis (BV)
Bartholin's Gland Cyst
Vaginal Cysts
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Douching: Helpful or Harmful?
Vaginal Discharge: What’s Abnormal?
Vaginal Dryness: Causes and Moisturizing Treatments
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Itching, Burning, and Irritation
Vaginal Fistula
What Is Vulvodynia?
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Vulvodynia: Causes, Symptoms, and Treatments
What Can I Do About Vulvodynia?
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Treatment for Vulvodynia
What Is Vulvovaginitis?
Vulvar Vestibulitis

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Vaginal Self-Exam

What Is a Vaginal Self-Exam?

You know it’s important to do regular breast self-exams to check for lumps or other changes. But did you know a vaginal self-exam can be just as important? It can help you find unusual changes earlier than if you waited for your regularly scheduled checkup. If you do find a problem, you can start treatment sooner, and you’ll more likely have a better outcome.

What to Look For

A self-exam isn’t as in-depth as a pelvic exam performed by your gynecologist. You should still have routine pelvic exams. These check for ovarian cysts, sexually transmitted diseases (STDs), uterine fibroids, early-stage cancer, and other signs of health problems.

But a self-exam may help you find signs of an STD or changes to your vulva (the outer part of your genitals) that could signal other health problems. Spots, sores, or bumps could be early signs of vulvar cancer and should be checked by your doctor. A more involved self-exam could also help you detect changes to your vaginal wall and possibly your cervix.

How Do I Do a Vaginal Self-Exam?

You can do it any time, but it’s best when you’re in between periods. Don’t use any vaginal creams or douches for at least 24 hours before doing the exam.

Here are some things that you can use that will help:

• A hand-held mirror
• A flashlight or other small light
• A detailed diagram of the genitals with all the parts labeled (so you'll know what you’re looking at)
• Pillows and a towel

Make sure your hands are clean or that you’re wearing sterile gloves. Be mindful of your fingernails.

Remove your clothes from the waist down. Sit on your bed or on a towel on the floor against a wall with your back propped up by pillows. Pull your feet toward your butt and spread your legs.

Relax your pelvic muscles. Then examine the parts of the vulva: the clitoris, and the outer and inner labia. Take note of the color and size of each part, so if anything changes you’ll notice it easily. You may need to pull back slightly on the hood of the clitoris. You might also have to spread apart your pubic hair to get a clear view of the area.

To do a more complete self-exam, gently spread the labia apart and angle the mirror and light so you can see into the vagina. The walls should be pinkish in color. If you’re comfortable, place your finger inside your vagina and feel along the vaginal wall. You may notice it feels a little like the roof of your mouth. If you push a little farther, you may feel your cervix. It feels like the tip of your nose.

If you’re not comfortable with this much probing, it’s OK. You can do a simple visual inspection. Just be sure you see your gynecologist for your regular pelvic exams. How often you have pelvic exams may depend on your age, health history, and other factors. Ask your doctor about what’s right for you.

When to Call a Doctor

If, during your vaginal self-exam, you see any genital warts, sores, bumps, spots, or unusual coloration, make an appointment to see your doctor. The same is true if you notice a smelly discharge. A small amount of non-smelly discharge is normal. It might be lighter or heavier, depending on where you are in your cycle.

If you do find a problem, remember: the earlier it’s diagnosed and treated, the sooner you’ll feel better and find peace of mind.

Foreign Body in the Vagina

Vaginal Foreign Bodies

Some objects are designed for use in a woman's vagina. These include tampons, vaginal suppositories, diaphrams, and medications delivered through the vagina. Others are not intended to be inserted and may be placed there accidentally or intentionally. Doctors referred to objects found in the vagina as "foreign bodies." These foreign bodies may produce symptoms or be asymptomatic for long periods of time.

Small objects inserted into the vagina do not generally cause pain. Unusual objects, generally those larger than the customary vaginal diameter, may cause pain because of distention. Other objects may cause pain due to sharp edges.

While a variety of symptoms may result from a foreign body in the vagina, the most common symptoms are bleeding or foul-smelling vaginal discharge. Less common symptoms may include pain or urinary discomfort.

Perforation through the vagina into the abdominal cavity may also result in acute abdominal symptoms. Systemic infection can occur on rare occasion.

Causes of a Vaginal Foreign Body

The most common foreign body of the vagina in small children is small amounts of fibrous material from clothing and carpets, or most often, toilet paper. They may also place objects in their vagina at a time of self-exploration. The objects may be forgotten, or once placed in the vagina, unable to be removed by the child. Other common objects include marker caps or crayons. The objects found in children generally are small and do not cause pain from distention. Children will generally not place objects larger than the vaginal entrance due to discomfort.

Adolescent women may use tampons once their period begins. Occasionally, these tampons are forgotten and may not be removed for days. The breakage of a condom may also result in bits of latex or non-latex material being left in the vagina.

Adults may place foreign objects into the vagina as part of a sexual experience. Less commonly unusual objects may be placed in the vagina as the result of abuse. Adults may also experience forgotten tampons or bits of a condom.

While small objects placed in the vagina may remain for a period of time without symptoms, larger objects may produce pain or discomfort immediately, thus precipitating a visit to a doctor.

Symptoms of a Foreign Body in the Vagina

Common symptoms of a vaginal foreign body include the following:

• Vaginal discharge, generally foul-smelling and yellow, pink, or brown
• Vaginal bleeding, especially light bleeding
• Vaginal itching or foul odor
• Discomfort with urination
• Discomfort due to vaginal discharge producing skin irritation
• Abdominal or pelvic pain from placement of large objects or perforation of a foreign body into the abdominal cavity
• Skin redness
• Swelling of the vagina and its entrance
• Rash in the vaginal area

The presence of a vaginal foreign body may alter the normal bacterial flora of the vagina, thus resulting in repeated efforts to treat "vaginitis." The symptoms of a vaginal discharge may be interpreted as vaginitis, a sexually transmitted infection or even a yeast infection. Repeated use of antibiotics or other medications will not remove the symptoms if a foreign body remains present.

Objects left in the vagina very rarely lead to serious complications. However, the medical literature has had several case reports of pelvic abscess and subsequent scarring.

When to Seek Medical Care

A health care provider should be consulted when any change in vaginal discharge is present, particularly discharge which is foul-smelling or abnormal in color. The presence of a foreign body may cause abnormal vaginal bleeding.

If a foreign object was placed in the vagina and may still be there, the health care provider should be informed. Occasionally, an adult or adolescent woman may remember placing a tampon, but then be unable to remove it from the vagina.

Unusual objects may need to be removed using sedation or anesthesia in order to avoid pain. This may be particularly true of objects placed in the vagina of a small child or an adult who is unable to be cooperative with a vaginal exam. Some emergency departments allow sedation and removal in the emergency department without going to an operating room.

Exams and Tests for Vaginal Foreign Bodies

Vaginal foreign bodies are seen more commonly in children than in adolescent or adult women. Children may not be able to supply the history of an object placed in the vagina; however, some children will say that they have lost an object in their vagina. In addition to obtaining specific information about a possible vaginal foreign body, a health careprovider will perform a general history and physical exam as well.

It is appropriate for the health care provider to ask about questions related to sexual activity and sexual or physical abuse.

Methods for diagnosing and retrieving foreign bodies depend on the age of the female patient and sometimes the duration of time the object has been in the vagina.

For young girls, any visit to a doctor's office can be frightening. If a foreign object is suspected in a young girl, the physician may gently examine the vulva and vaginal entrance by separating the labia and glimpsing the foreign object. This may allow removal in the office through such techniques as warm water flushing of the vagina, but other larger objects may require sedation or examination under anesthesia for removal.

An adolescent patient may easily have a foreign body removed from the vagina in the outpatient setting. This may also hold true for adults. Visualization of the foreign body using a speculum and removal with a forceps may be the most efficient treatment.

• Unusual objects or those that may disrupt to the vaginal wall may require sedation or anesthesia for removal, and to complete a thorough exam of the vagina and cervix.
• If an object has been present in the vagina for a long time, that object may cause erosion into the wall of the vagina. Acute placement of an unusual object in the vagina may cause perforation of the vaginal wall and secondary symptoms of an intra-abdominal infection.
• Although examination generally reveals the presence of a foreign body, some imaging techniques may also be helpful. These may include a CT (computerized tomography) scan or an abdominal X-ray. Ultrasonography may also assist in the location of a foreign body in the vagina or pelvis.

Medical Treatment

Bacterial infections or alteration in the normal bacterial flora of the vagina may be due to the presence of a foreign body altering the usual environment of the vagina. Removal may be performed with the forceps or with a warm water irrigation of the vagina. Once the foreign object is moved, antibiotics are generally not needed.

In children, vaginal lavage or irrigation is the method of choice to remove small bits of fibrous tissue. Removal of larger objects may be accomplished in the outpatient setting or may require sedation or evaluation in the operating room. Analgesia or anesthesia at the time of removal may make the procedure more comfortable.

Teenagers and older women may generally have foreign bodies removed in the outpatient setting; however, those patients who are unable to cooperate for an exam may also benefit from sedation or removal in the operating room.

Larger objects and those causing pain after placement in the vagina may require anesthesia for complete removal and inspection of the vaginal walls. These more complex procedures may require antibiotics.

Medications

Larger objects and objects causing painful infections will require anesthesia for pain and relaxation of vaginal muscles. Objects that have moved from the vagina to the abdomen or to other parts of the body will require surgery for removal.

Once the object is removed and antibiotics are given, infection, fever, pain, and vaginal discharge should soon clear up.

Next Steps

If symptoms of vaginal discharge, bleeding, abnormal odor, or urinary tract symptoms continue after an object has been removed, a repeat evaluation by a health care provider is recommended.

Follow-up

If symptoms resolve once a foreign body is removed, follow-up may not be necessary.

Repeat examination may be recommended if the health care provider is not certain the entire object has been removed or if any complexities, such as secondary infection is diagnosed at the time of removal of the foreign body.

Prevention

Prevention of infections related to foreign objects in the vagina begins with good vulvovaginal hygiene.

• In young children, parents should instruct perineal cleaning by wiping front to back. This will decrease the amount of bacteria and feces that may enter the vagina. Poor perineal hygiene may cause irritation of the vulva or vagina.
• Parents can also aid in the prevention of foreign bodies of the vagina by talking with children about their bodies and teaching them the proper names of their body parts, such as vagina, urethra, anus, and rectum. Knowing the correct names of body parts will allow children to better communicate any problems. For example, children may be able to describe these body parts to adults in instances of pain, discharge, or possible abuse.
• For older girls and women, good hygiene includes limiting the amount of time objects remain in the vagina. Tampons should be used no longer than six to eight hours.
• Sexual activities resulting in painful placement of objects in the vagina should be avoided.

Medications for vaginal infections or irritation should be used only when prescribed by a health care provider. Patients may commonly misdiagnose the reasons behind vaginal discharge. Douches or vaginal washes are not needed to clean the vagina. Douching may increase the risk of infection due to washing away the normal bacteria which help to fight infection. Showers and baths are satisfactory for cleaning the vaginal area.

Vaginal Infections

Vaginal Infections and Vaginitis

Most women have been there. You're distracted and squirming in your chair because it doesn't feel right down there. Perhaps there's a smell that's a little, well, funkier, than usual. You want to do something to make it stop, now.

Although it can be darned uncomfortable, it's not the end of the world. You could have an infection caused by bacteria, yeast, or viruses. Chemicals in soaps, sprays, or even clothing that come in contact with this area could be irritating the delicate skin and tissues.

It's not always easy to figure out what's going on, though. You'll probably need your doctor's help to sort it out and choose the right treatment.

Types of Vaginitis

Doctors refer to the various conditions that cause an infection or inflammation of the vagina as "vaginitis." The most common kinds are:

• Bacterial vaginosis
• Candida or "yeast" infections
• Chlamydia
• Gonorrhea
• Reactions or allergies (non-infectious vaginitis)
• Trichomoniasis
• Viral vaginitis

Although they may have different symptoms, a diagnosis can be tricky even for an experienced doctor. Part of the problem is that you could have more than one at the same time.

You could also have an infection without any symptoms.

What's Normal? What Symptoms Aren't?

A woman's vagina makes discharge that's usually clear or slightly cloudy. In part, it's how the vagina cleans itself.

It doesn't really have a smell or make you itch. How much of it and exactly what it looks and feels like can vary during your menstrual cycle. At one point, you may have only a small amount of a very thin or watery discharge, and at another time of the month, it's thicker and there's more of it. That's all normal.

When discharge has a very noticeable odor, or burns or itches, that's likely a problem. You might feel an irritation any time of the day, but it's most often bothersome at night. Having sex can make some symptoms worse.

You should call your doctor when:

• Your vaginal discharge changes color, is heavier, or smells different.
• You notice itching, burning, swelling, or soreness around or outside of your vagina.
• It burns when you pee.
• Sex is uncomfortable.

Yeast Infection or Bacterial Vaginosis?

Two of the most common causes are related to organisms that live in your vagina. They can have very similar symptoms. Yeast infections are an overgrowth of the yeast that you normally have in your body. Bacterial vaginosis happens when the balance of bacteria is thrown off. With both conditions, you may notice white or grayish discharge.

How can you tell them apart? If there's a fishy smell, bacterial vaginosis is a better guess. If your discharge looks like cottage cheese, a yeast infectionmay be to blame. That's also more likely to cause itching and burning, though bacterial vaginosis might make you itchy, too.

And you could have both at the same time.

Spread Through Sex

You can get vaginal infections through sexual contact, too:

• Chlamydia
• Gonorrhea
• Herpes simplex virus
• Human papilloma virus (HPV) or genital warts
• Trichomoniasis

Women may not have obvious symptoms of these STDs. If you're sexually active (especially if you have multiple partners), you should talk to your doctor about getting tested for them at your annual checkup.

If left untreated, some of these can permanently damage your reproductive organs or cause other health problems. You could also pass them to a partner.

Non-Infectious Vaginitis

Sometimes itching, burning, and even discharge happen without an infection. Most often, it's an allergic reaction to or irritation from products such as:

• Detergents
• Douches
• Fabric softeners
• Perfumed soaps
• Spermicides
• Vaginal sprays

It could also be from a lower level of hormones because of menopause or because you've had your ovaries removed. This can make your vagina dry, a condition called atrophic vaginitis. Sexual intercourse could be painful, and you may notice vaginal itching and burning.

Treatment

The key to treating vaginal infections effectively is getting the right diagnosis.

Pay close attention to exactly which symptoms you have and when. Be ready to describe the color, texture, smell, and amount of discharge. Don't douche before your office or clinic visit; it will make accurate testing hard or impossible. Some doctors will ask you to not have sex during the 24-48 hours before your appointment.

It's better to see your doctor before you try over-the-counter medications, even if you're pretty sure you know what you have.

You treat non-infectious vaginitis by dealing with the probable cause. Consider what products you're using that could be irritating your sensitive skin. For hormonal changes, your doctor may prescribe estrogen to ease symptoms.

Prevent Vaginitis

Keep yourself clean and dry. But doctors don't recommend vaginal sprays or heavily perfumed soaps for this area. Douching may cause irritation, too, and more importantly, could hide or spread an infection. It also removes the healthy bacteria that do the housekeeping in your vagina. Douching is never recommended. 

Avoid clothes that hold in heat and moisture. Nylon underwear, tight jeans, non-breathable gym shorts and leggings, and pantyhose without a cotton panel can lead to yeast infections.

Eating yogurt with active cultures (check the label) might help you get fewer infections.

Condoms are the best way to prevent passing infections between sexual partners.

Get a complete gynecologic exam every year, including a Pap smear if your doctor recommends it.