Treating vaginal infections

by Daphne R. Howland

A woman's healthy vagina is a moist place with a delicate balance of microorganisms. Subtle shifts can tip this balance, causing vaginitis (the general term for the variety of vaginal infections). At best, vaginitis can lead to a distracting level of discomfort, and at worst, serious health problems.

"The healthy vagina has an ecosystem that is a complex environment of microorganisms such as yeast and different kinds of bacteria," says Roxanne Guerriero, RNC, ANP, a nurse practitioner at the Spence Center for Women's Health in Cambridge, MA. "Vaginitis occurs because the ecosystem has been altered."

The types of vaginitis, the many causes, and the over-lapping symptoms have lead to much confusion for women. Certain classic signs of infection, like discharge or itching, may be nothing more than your menstrual cycle, a change in the weather, or a new laundry detergent. A woman's vagina changes with age, too, and the dryness that many experience after menopause can cause symptoms like itching and burning or painful intercourse.

Studies show that women's increased awareness of yeast infections, (in part due to advertising for medications now sold over the counter), has led to incorrect self-diagnosis and treatment. One study found that two-thirds of women who thought they had yeast infections didn't, while nearly half who didn't think their infections were yeast were wrong. Worse, a survey of gynecologists by the Institute for Epidemiological Research found that more than 40 percent of patients had incorrectly treated themselves with anti-yeast medicines. Such mistakes leave the actual infections untreated and could lead to severe complications such as pelvic inflammatory disease.

Many women really do know when they have a yeast infection. For them, a trip to the drugstore is the simplest, least expensive solution. But even they may not realize the variety of vaginal infections or the consequences of mistreating them. "I advocate self-treatment to some extent," says Cynthia Waldron, PA-C, a physician's assistant at Planned Parenthood of Greater Boston. "But there is a risk of delaying treatment for what you really have."

For most women with symptoms of vaginitis, a trip to the health care provider is the best way to deal with this confusion. Otherwise, mistakes in diagnosis or treatment could lead to serious complications. Below is some of the basic information on vaginitis that you may find useful.

Yeast infections

Contrary to common belief, yeast infections are the second most common vaginal infection, after bacterial vaginitis. Like bacterial infections, yeast infections are an imbalance of organisms naturally found in the vagina. Yeast, or candida, is a fungus that thrives in the moist warm environment the vagina provides and can overgrow for a variety of reasons, most commonly:

  • Antibiotics, which kill the friendly bacteria that keep candida in check.
  • Hormones, which change the vagina's makeup. The hormones of pregnancy and some birth control pills or steroids can affect yeast growth. Low-dose birth control pills and estrogen replacement therapy don't seem to affect yeast growth, however.
  • Heat and humidity, conditions in which yeast thrive. The weather can affect yeast growth, as can tight clothing or clothing that promotes heat.
  • Frequent intercourse (more than three times a week).
  • Decreased immunity. Women with HIV, for example, often suffer from severe and recurring yeast infections.
  • Diabetes, which can also make women prone to yeast infections.

These are the classic symptoms of yeast infection, although they can vary:

  • Discharge. Yeast infections produce a discharge that can range from watery to thick and cottage-cheese-like. The discharge is white, not yellow or green, and has an almost sweet odor, if it smells at all.
  • Itching. The itching and burning of a yeast infection, usually in the vulva or in the outer area of the vagina, can be severe.
  • Redness. Yeast infection can produce redness or red bumps around the vulva.

Vaginal yeast infections often go away on their own and there's no health risk to going without treatment. The itching is hard to live with, though. In general, yeast infections are easily cured by over-the-counter anti-fungal medications, which are available as creams, suppositories or oral medicine. Unless you're sure you have a yeast infection, it's best to see a health care provider because these medicines disrupt the vagina's balance of yeast and bacteria. Don't use vaginal creams or have intercourse at least 24 hours before your health care appointment, suggests the Spence Center's Guerriero. "Otherwise, when I take a specimen of the discharge, I can't see anything."

There is a lot of buzz about nutrition's role in controlling yeast infections, but little research. Many health care providers still recommend eating yogurt, taking acidophilus pills, or avoiding sugars. Simple sugars like those found in sweets, milk or fruits seem to provide fuel to out-of- hand yeast. Some say fermented foods like bread or wine also aggravate yeast infections.

So far, the studies on the benefits of yogurt has produced conflicting results. Still, many women swear that eating plain yogurt, with live cultures, helps. Because low-fat yogurt is such a healthy food, there is no harm in this belief, and science may yet prove them right.

Bacterial infections

An overgrowth of the low-level bacteria naturally found in the vagina, are the most common cause of vaginal infections. Failing to treat bacterial vaginitis can lead to serious complications like pelvic inflammatory disease, which can lead to infertility, endometriosis, and fertility problems.

It's not understood what causes a bacterial infection. Although sexual activity may be a factor, bacterial vaginitis is also common in women who have never had sex or are monogamous. Douching is a common cause of bacterial infection. Women already suffering from bacterial vaginitis may be tempted to use douches or sprays to hide the characteristic foul odor, but they only make things worse.

Although women often mistake bacterial vaginitis for yeast vaginitis, the symptoms are different

  • Discharge. Bacterial infection causes a discolored discharge that is watery, whitish or greyish, with an unpleasant odor.
  • Itching and burning. Sometimes, no symptoms at all.
Bacterial infections are treated with oral prescription medications, making a trip to the health care provider or clinic necessary. Some studies also suggest that eating yogurt with live cultures helps ease bacterial infections.

Trichomoniasis

Trichomoniasis is another common vaginal infection, usually sexually transmitted. Men are asymptomatic and even monogamous couples may pass the parasite. For that reason, when one partner is infected, both should be treated with an antibiotic. The Trichomoniasis parasite can also be transmitted by wet towels, washcloths or bathing suits. "Trich" can lead to urinary tract infection, but doesn't affect fertility.

The symptoms of "trich" are:

  • Discharge. A frothy yellowish, greenish or grayish discharge with a particularly unpleasant odor.
  • Light bleeding.
  • Itching and burning.
  • Redness of the vagina.
  • Painful urination or intercourse.
  • Swelling in the abdomen.

Chlamydia

Chlamydia is a sexually transmitted cervical infection. Because there are often no symptoms of chlamydia and because it can lead to fertility problems, women are now often routinely tested.

Although most people with chlamydia have no symptoms, possible signs include:

  • Slight bleeding, especially after intercourse.
  • Painful urination.
  • More-than-usual discharge.

Chlamydia is treated with an antibiotic and both partners are treated when one is found to be infected.

Preventing vaginitis

Along with many other factors, your menstrual cycle affects the vagina's environment. Many women find that symptoms of their vaginal infection get better once menstruation starts. "If you're period is coming up, wait a few days before you take any medicine or see your provider," says Roxanne Guerriero, RNC, ANP, a nurse practitioner at the Spence Center for Women's Health in Cambridge, MA. "Having your period will often restore that balance you need in the vagina."

To maintain vaginal health, which helps prevent vaginitis, follow these good habits

  • Wash your genital area daily, using only mild soaps, like Dove. DON'T use antibacterial soaps.
  • Douches, powder, harsh soaps, bubble bathes, and similar chemicals are highly disruptive to the vagina's delicate balance of "good" bacteria and yeast. Don't use them!
  • If you do take a bubble bath, rinse your genital area.
  • Use clean dry towels after your shower and never use someone else's.
  • To keep the "humidity" level as low as possible, wear cotton underwear and loose clothing. Sleep without underwear. Panty liners every day can also help, but avoid ones that contain perfumes.
  • Change your underwear every day.
  • Use laundry soap without perfumes or dyes.
  • Always wipe yourself from front to back. If you're prone to infections, you may want to rinse off with water whenever you go to the bathroom.
  • Change out of your gym clothes or wet swimsuit as soon as possible. Invest in workout wear that wicks away moisture.
  • Insist that your sexual partner washes his genitals before intercourse, especially if he isn't circumcised. (Uncircumcised men are more prone to bacteria or yeast infections themselves.)
  • Condoms help prevent sexually transmitted vaginitis, but some women have allergic reactions to latex condoms. Spermicides can also lead to infections in some women. Talk to your health care provider about alternatives.
  • Sleep well and find ways to manage stress. Some experts believe lack of sleep and stress can trigger bacterial and yeast infections.