Vaginal and Vulvar Health- 02

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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Bacterial Vaginosis (BV)

What Is Bacterial Vaginosis?

Both "good" and "bad" bacteria live in your vagina. If the delicate balance between them is upset, you can get an infection called bacterial vaginosis, or BV for short. You may not have symptoms, and you may not need treatment.

Most of the time, BV doesn't cause any other health problems. But it can lead to other issues, especially when you're pregnantor trying to get pregnant.

Causes

A type of bacteria called lactobacillus keeps your vagina slightly acidic so bad types of bacteria don't grow well. If your lactobacillus levels drop, more bad bacteria move in, and you get BV.

Any woman can get BV, but some things raise your odds, including:

• Smoking
• Sexual activity
• Douching

You'd think that keeping your lady bits clean would stop BV, but when you wash out your vagina by douching, you upset the natural balance of bacteria. Scented soaps, bubble baths, and vaginal deodorants have a similar effect.

A new sex partner, or having more than one, makes it more likely that you'll get BV. The reason why isn't clear, but women who have female partners are most at risk. You can also get BV from oral and anal sex.

An IUD birth control device, which fits inside your uterus, has been linked to BV -- especially if you have irregular bleeding. But we need more studies to know if it's really a cause.

You might have heard that you can get vaginal infections like BV from swimming pools or public toilet seats, but that's not true.

Symptoms

Around half of all women with BV show no symptoms. But if you do, you could notice a:

• Thin white, gray, or green discharge
• Burning feeling when you pee
• Fishy smell that gets stronger after sex

It's not the same as a yeast infection. Those often itch, have a thick, white discharge, and don't smell.

Diagnosis

You'll need to check with your primary care doctor or gynecologist. She'll ask about your symptoms and do a vaginal exam. She may use a cotton swab to take a sample of your discharge to check under a microscope for BV.

Taking a sample can also help your doctor or a lab rule out other sexually transmitted infections (STIs) like gonorrhea or trichomoniasis, which share some symptoms.

Treatment

If you don't have any symptoms and aren't pregnant, you may not need treatment. Your BV may go away on its own.

When you do have symptoms, your doctor can prescribe antibiotics to get rid of your infection. This could be a tablet you take by mouth or a cream or gel you apply to your vagina. You'll need to take most treatments for 5 to 7 days. And you should finish all of your medicine, even if your symptoms go away. If you stop early, your infection could come back.

Since BV could be spread through sex, avoid all sexual contact until you're better. If your partner is another woman, she may want to see her doctor so she can be treated, too.

If you use an IUD and BV keeps coming back (recurrent BV), you may want to talk to your doctor about a different type of birth control instead.

Even after BV is treated and goes away, it's common for it to return. If that happens, you'll probably need to take antibiotics again for a longer time.

Other Infections

Having BV makes it easier for you to get an STI like herpes, chlamydia, or gonorrhea. If you already have HIV, BV raises your chances of passing it on to your partner.

If you have BV when you get a hysterectomy or other surgery on your female organs, you're more likely to come down with a bacterial infectionafterward.

Some of the same things that cause BV can also lead to pelvic inflammatory disease (PID), an infection of your uterus, fallopian tubes, and ovaries.

Pregnancy

When you're going through fertility treatments like in vitro fertilization(IVF), you may have less success if you have BV.

Pregnant women with BV have had babies who were born premature (before the 37th week) or with a low birth weight (less than 5.5 pounds). Since there's a chance BV could be the cause, you should get it treated.

Prevention

To lower your chances of getting BV, use only water – not even soap -- when you wash your genital area. Don't douche. When you go to the bathroom, wipe from front to back, from your vagina toward your anus.

Put a condom on before his penis touches your vagina, mouth, or anus. Clean sex toys after every use.

Limit the number of sex partners you have. Get tested for STIs, and have your partners get tested, too.

Bartholin's Gland Cyst

What Is a Bartholin's Gland Cyst?

The Bartholin’s glands are located on each side of the vaginal opening. They’re about the size of a pea. They produce fluid that keeps the vagina moist.

The fluid travels to the vaginathrough ducts (tubes). If they become blocked, fluid can back up into them. This forms a swelling -- a cyst. Doctors call these Bartholin’s gland cysts. Most of the time, they don’t hurt. They’re almost always benign, or non-cancerous.

What Causes It?

Doctors aren’t sure why the glands sometimes become blocked. In rare cases, it may be due to a sexually transmitted infection (STI) like gonorrheaor chlamydia.

About two out of 10 women can expect to get a Bartholin’s gland cyst at some point. It typically happens in your 20s. They’re less likely to develop as you age.

What Are the Symptoms?

You may not have any, unless the cyst is large or becomes infected. If infection sets in (doctors call this an “abscess”), you’ll likely have extreme pain at the site of the cyst. Sex -- and even walking -- may hurt. If the cyst is large, it can make one side of your labia majora (the large folds of skin on the outside of your vagina) hang lower than the other.

You might also have fever and an unusual vaginal discharge.

How Do I Know If I Have a Bartholin’s Cyst?

Only your doctor can tell you for sure. He’ll do a physical exam. He’ll also likely take a sample of your vaginal discharge and look at it under a microscope. This will reveal whether you have an STI. If you have an abscess, he’ll take a culture of it and send it to a lab.

If you’re under 40, he may do a biopsy (sample of tissue from the cyst) to rule out vulvar cancer. That’s a disease that affects the lips that surround your vagina.

What’s the Treatment?

If your exam shows that you have an STI, or if your cyst is infected, your doctor will prescribe an antibiotic. He may also prescribe topical medications.If you’re under 40 and your cyst isn’t causing problems, you probably won’t need treatment. A simple sitz bath may help the cyst go away on its own. Simply fill a tub with 3 to 4 inches of water (enough to cover your vulva), and gently sit. Do this several times a day for three or four days. The cyst may burst and drain on its own.

If the Bartholin’s cyst is causing problems -- or if it’s turned into an abscess -- you’ll need to see your doctor. He’ll treat it in one of three ways:

Surgical drainage. Your doctor will make a small cut in the cyst. He’ll then place a small rubber tube (catheter) into the opening to allow it to drain. It can stay in place for up to 6 weeks. You’ll feel better right away after the fluid has been drained. But you may need to take oral pain medication for several days afterwards. Keep in mind that a Bartholin's cyst or abscess may come back and need treatment again.

Side effects include pain or discomfort -- especially during sex. You might also have swelling of the labia (lips around the vagina), infection, bleeding, or scarring.

Marsupialization. If cysts bother you or come back, this procedure may help. Your doctor cuts the cyst to open it. He then stitches the skin around the cyst to form a small pouch. This allows the fluid to drain out. He packs the area with special gauze to soak up the fluid and any blood. The whole process takes less than half an hour, and you can go home the same day.

Your doctor may prescribe painkillers afterward. There’s also a risk of infection, bleeding, and the abscess coming back.

Removal of the gland. Your doctor might recommend this option if others haven’t worked or you keep getting Bartholin’s cysts and abscesses. This surgery takes about an hour and you’ll receive anesthesia so you’re not awake for it. Many patients are able to go home after the procedure.

Some possible problems include bleeding, bruising, and infection.

Vaginal Cysts

Vaginal Cysts

The human body isn't perfectly smooth. It's prone to developing various lumps and bumps. Cysts are just one type of growth many people get. These sac-like lumps are filled with fluid, air, or other materials. They're not usually harmful or painful.

Some cysts are so small that they can't be seen with the naked eye. Others can grow to the size of an orange.

You can find cysts just about anywhere on the body, including the vagina. A vaginal cyst is usually located on or under the lining of the vagina.

There are several different types of vaginal cysts:

• Inclusion cysts are one of the most common types of vaginal cysts. They are usually very small and located in the lower back of the vaginal wall.
• Bartholin's gland cysts are fluid-filled cysts that form on the Bartholin's glands. These glands sit on either side of the opening to the vagina and produce the fluid that lubricates the vaginal lips (labia).
• Gartner's duct cysts occur when ducts in a developing embryo don't disappear as they are supposed to after the baby is born. These remaining ducts can form vaginal cysts later in life.
• Müllerian cysts are another common type of vaginal cyst that form from structures left behind when a baby develops. These cysts can grow anywhere on the vaginal walls and they often contain mucus.

Vaginal Cyst Causes

Vaginal cysts usually form when a gland or duct becomes clogged, causing liquid or another material to collect inside. The cause of a vaginal cyst depends on its type.

Inclusion cysts are caused by trauma to the vaginal walls. For example, women may get an inclusion cyst after they have an episiotomy (a surgical cut used to enlarge the vaginal opening during childbirth) or when they have surgery that damages the lining of the vagina.

Bartholin's gland cysts are caused when the opening to the Bartholin's gland becomes blocked -- such as by a flap of skin -- creating a fluid-filled growth. An abscess can result from a number of bacteria including those that cause sexually transmitted diseases such as gonorrhea or chlamydia. Bacteria normally found in the intestinal tract, such as E. coli, can also lead to Bartholin's abscesses.

Vaginal Cyst Symptoms

Vaginal cysts usually don't cause symptoms. If you have one of these cysts, you might feel a small lump along the vaginal wall or on the lips. Often, your gynecologist will discover the lump during your annual exam. The cyst might stay the same size or grow larger.

The cyst shouldn't be painful. However, some larger cysts -- especially Bartholin's gland cysts -- can cause discomfort when you walk, have sex, or insert a tampon.

Cysts are more likely to cause pain when they get infected. Vaginal cysts can become infected by the normal bacteria found on the skin or by a sexually transmitted infection. Infected vaginal cysts can form an abscess -- a pus-filled lump that can be very painful.

Vaginal Cyst Treatments

Vaginal cysts usually don't need to be treated. Often they will remain small and not cause any problems. Your health care provider may just want to monitor the cyst's growth during routine exams.

You might need to have a biopsy of the cyst to rule out cancer. During a biopsy, your health care provider removes a piece of tissue from the cyst. That piece of tissue is examined under a microscope to see if it is cancerous.

To relieve any discomfort you're having from a vaginal cyst, sit in a bathtub filled with a few inches of warm water (called a sitz bath) several times a day for three or four days.

To treat an infected vaginal cyst, you may need to take antibiotics.

If a vaginal cyst is large and filled with fluid (like a Bartholin's cyst), your health care provider can insert a small tube called a catheter to drain it. You will have to keep the catheter in place for about four to six weeks. You could also have a procedure in which a small incision is made in the cyst to drain the fluid (called marsupialization).

It's also possible to have surgery to remove the entire cyst if you're very uncomfortable or the cyst keeps returning. Some health care providers recommend that women over age 40 have surgery to remove certain types of vaginal cysts because of the possibility they might be cancerous. Cysts that are treated with surgery usually don't come back.