Vaginal and Vulvar Health- 03

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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Douching: Helpful or Harmful?

Vaginal Douching: Helpful or Harmful?

An estimated 20% to 40% of American women between ages 15 and 44 say they use a vaginal douche. Higher rates are seen in teens and African-American and Hispanic women. Besides making themselves feel fresher, women say they douche to get rid of unpleasant odors, wash away menstrual blood after their period, avoid getting sexually transmitted diseases, and prevent a pregnancyafter intercourse.

Yet, health experts say douching is not effective for any of these purposes. They also warn that it can actually increase the risk of infections, pregnancy complications, and other health problems.

What is douching?

The word ''douche'' is French for ''wash'' or ''soak.'' It is a method to wash out the vagina, usually with a mixture of water and vinegar. Douches that are sold in drugstores and supermarkets contain antiseptics and fragrances. A douche comes in a bottle or bag and is sprayed through a tube upward into the vagina

What are the advantages of douching?

Some women say douching makes them feel cleaner. There is, though, very little scientific evidence of benefit from douching.

What are the disadvantages of douching?

Overall, the risks of douching far outweigh the benefits. Here are just a few of the problems linked to douching:

• Vaginal infections (bacterial vaginosis). Douching upsets the natural balance of bacteria in the vagina (called vaginal flora). These changes make the environment more favorable for the growth of bacteria that cause infection. Studies have found that women who stopped douching were less likely to have bacterial vaginosis. Having bacterial vaginosis can increase the risk of preterm labor and sexually transmitted infections.
• Pelvic inflammatory disease (PID). PID is an infection of the uterus, fallopian tubes, and/or ovaries. Research has found that women who douche may have a 73% higher risk of getting PID.
• Pregnancy complications. Women who douche more than once a week have more difficulty getting pregnant than those who don't douche. Douching may also increase the risk of ectopic pregnancy by as much as 76%. With an ectopic pregnancy, the embryo implants outside the uterus. The more a woman douches, the greater the risk of having an ectopic pregnancy.
• Cervical cancer . Douching at least once a week has been linked to a possible increased chance of developing cervical cancer.

Should a woman douche?

According to health experts, including those at the American College of Obstetricians and Gynecologists (ACOG), you should avoid douching. Having some vaginal odor is normal. However, if you notice a very strong odor, it could be a sign of infection. The acidity of the vagina will naturally control bacteria, and simply washing the vagina with warm water and mild soap is enough to keep clean.

Vaginal Discharge: What’s Abnormal?

Vaginal Discharge: What’s Abnormal?

Vaginal discharge serves an important housekeeping function in the female reproductive system. Fluid made by glands inside the vagina and cervixcarries away dead cells and bacteria. This keeps the vaginaclean and helps prevent infection.

Most of the time, vaginal discharge is perfectly normal. The amount can vary, as can odor and hue (its color can range from clear to a milky white-ish), depending on the time in your menstrual cycle. For example, there will be more discharge if you are ovulating, breastfeeding, or are sexually aroused. The smell may be different if you are pregnant or you haven't been diligent about your personal hygiene.

None of those changes is cause for alarm. However, if the color, smell, or consistency seems significantly unusual, especially if it accompanied by vaginal itching or burning, you could be noticing an infection or other condition.

What causes abnormal discharge?

Any change in the vagina's balance of normal bacteria can affect the smell, color, or discharge texture. These are a few of the things that can upset that balance:

• Antibiotic or steroid use
• Bacterial vaginosis, a bacterial infection more common in pregnantwomen or women who have multiple sexual partners
• Birth control pills
• Cervical cancer
• Chlamydia or gonorrhea (STDs), sexually transmitted infections
• Diabetes
• Douches, scented soaps or lotions, bubble bath
• Pelvic infection after surgery
• Pelvic inflammatory disease (PID)
• Trichomoniasis, a parasitic infection typically contracted and caused by having unprotected sex
• Vaginal atrophy, the thinning and drying out of the vaginal walls during menopause
• Vaginitis, irritation in or around the vagina
• Yeast infections

See the chart below to learn more about what a particular type of discharge might mean.

How does the doctor diagnose abnormal discharge?

The doctor will start by taking a health history and asking about your symptoms. Questions may include:

• When did the abnormal discharge begin?
• What color is the discharge?
• Is there any smell?
• Do you have any itching, pain, or burning in or around the vagina?
• Do you have more than one sexual partner?
• Do you douche?

The doctor may take a sample of the discharge or do a Pap test to collect cells from your cervix for further examination.

How is abnormal discharge treated?

How you are treated will depend on what’s causing the problem. For example, yeast infections are usually treated with antifungal medicationsinserted into the vagina in cream or gel form. Bacterial vaginosis is treated with antibiotic pills or creams. Trichomoniasis is usually treated with the drug metronidazole (Flagyl) or tinidazole (Tindamax).

Here are some tips for preventing vaginal infections that can lead to abnormal discharge:

• Keep the vagina clean by washing regularly with a gentle, mild soap and warm water.
• Never use scented soaps and feminine products or douche. Also avoid feminine sprays and bubble baths.
• After going to the bathroom, always wipe from front to back to prevent bacteria from getting into the vagina and causing an infection.
• Wear 100% cotton underpants, and avoid overly tight clothing.

Vaginal Dryness: Causes and Moisturizing Treatments

Vaginal Dryness: Causes and Moisturizing Treatments

During menopause, estrogenproduction slows and then stops. When that happens, a number of changes -- many of them unwelcome -- happen in a woman's body. Periods become irregular and then stop. You may have hot flashes, mood swings, a deeper voice, and an increase in facial hair.

Vaginal dryness is another common symptom of menopause -- and close to one out of every three women experiences it while going through "the change." And it becomes even more common after menopause. Vaginal dryness also can occur at any age from a number of different causes. It may seem like a minor irritation. But the lack of vaginal moisture can have a huge impact on your sex life. Fortunately, several treatments are available to relieve vaginal dryness.

What causes vaginal dryness?

Normally, the walls of the vagina stay lubricated with a thin layer of clear fluid. The hormone estrogen helps maintain that fluid and keeps the lining of the vagina healthy, thick, and elastic. During menopause, the drop in estrogen levels reduces the amount of moisture available. It also makes the vagina thinner and less elastic. This is called vaginal atrophy.

In addition to menopause, estrogen levels can drop from:

• Childbirth and breastfeeding
• Radiation or chemotherapy treatment for cancer
• Surgical removal of the ovaries
• Anti-estrogen medications used to treat uterine fibroids or endometriosis

Other causes of vaginal dryness include:

• Sjögren's syndrome (an autoimmune disorder that attacks cells in the body that produce moisture)
• Allergy and cold medications and certain antidepressants
• Douching
• Lack of enough foreplay before sexual intercourse

No matter what the cause, vaginal dryness can be extremely uncomfortable. It can lead to itching, burning, and painful intercourse.

How is vaginal dryness diagnosed?

Any burning, itching, or discomfort in the vaginal area warrants a call to your doctor or gynecologist. The doctor will take a health history and find out how long you've been experiencing symptoms and whether anything -- such as douching or taking medication -- seems to worsen them.

Your doctor will then do a pelvic exam, checking your vagina for any thinning or redness. The exam will help rule out other possible causes for your discomfort, including a vaginal or urinary tract infection. The doctor may also do a Pap test to remove and test cells from your vaginal wall or cervix.

How is vaginal dryness treated?

The most common treatment for vaginal dryness due to low estrogen levels is topical estrogen therapy. Topical estrogen replaces some of the hormone your body is no longer making. That helps relieve vaginal symptoms, but it doesn't put as much estrogen in your bloodstream as oral estrogen hormone therapy (HT).

Most women use one of three types of vaginal estrogen:

• Vaginal estrogen ring (Estring). You or your doctor inserts this soft, flexible ring into the vagina. There it releases a steady stream of estrogen directly to the vaginal tissues. The ring is replaced every three months.
• Vaginal estrogen tablet (Vagifem). You use a disposable applicator to insert a tablet into your vagina once a day for the first two weeks of treatment. Then you insert it twice a week until you no longer need it.
• Vaginal estrogen cream (Estrace, Premarin). You use an applicator to insert the cream into your vagina. You will typically apply the cream daily for one to two weeks then reduce the frequency to one to three times a week as directed by your doctor.

Any type of estrogen product can have side effects, such as vaginal bleeding and breast pain. Topical estrogen may not be recommended for women who:

• Have breast cancer, especially if they are taking an aromatase inhibitor
• To women with a history of endometrial cancer
• To women who have undiagnosed vaginal bleeding
• To pregnant or breastfeeding women

There isn't much research on the long-term use of topical estrogen, but doctors believe it is safe to use in the long term.

In order to keep the vagina more lubricated, try using a vaginal moisturizer (Replens), which you can buy at your local drugstore or supermarket. You can make intercourse more enjoyable by applying a water-based lubricant (Astroglide, K-Y) beforehand. Also take your time before having sex to make sure that you are fully relaxed and aroused.

Avoid using douches, bubble baths, scented soaps, and lotions around the sensitive vaginal area. These products can worsen dryness.