Factsheet

The Vagina - Common Vaginal Conditions

Date   01 July 2008

WHAT IS A NORMAL VAGINAL DISCHARGE?

• A healthy vaginal discharge is usually whitish, and dries yellow on underpants.
• It is sometimes heavier, sometimes lighter, and sometimes you won't notice it at all.
• It has a particular smell which is quite normal, and certainly isn't noticeable as long as you wash regularly.

All women have a vaginal discharge. The amount varies from woman to woman. Menopausal women often notice that they have less vaginal discharge. It also depends on where a woman is in her menstrual cycle and whether she is using hormonal contraception. The discharge is designed to keep the vagina healthy, but sometimes it changes in a way that causes problems.

HOW WOULD I KNOW IF I HAD AN INFECTION?

You might notice:

• Itching, burning or soreness around the vaginal area
• An increase in the amount vaginal discharge or an unusual or unpleasant smell
• Pain on passing urine
• Painful intercourse

If you have any of these symptoms you could have one of the vaginal conditions described below.

BACTERIAL VAGINOSIS

This is sometimes called B V or Gardnerella, and is an infection in the vagina caused by an imbalance in the bacteria that keep the vagina healthy. When this happens, the normal acidity of the vagina changes and some women will notice an unpleasant strong, fishy smell and a white or grey watery discharge. Usually there won't be any other symptoms, though the constant 'wet' feeling can sometimes cause some mild irritation. About half the women with bacterial vaginosis have no symptoms at all and usually do not need any treatment.

If a woman is pregnant and has bacterial vaginosis it is very important for her to be treated even if she has no symptoms. This is because having this condition during pregnancy can cause premature birth of the baby.

Bacterial vaginosis is not considered to be a sexually transmissible infection in heterosexual couples, and male sexual partners do not need to be treated. Bacterial vaginosis seems to be more common in women who have sex with women and there is some thought that it might be passed from one female partner to another.

Treatment

Usually four antibiotic tablets taken at once, or in more stubborn cases a doctor will prescribe a week-long course of antibiotic tablets. You will need to avoid alcohol while you are being treated as it can cause severe nausea or vomiting when combined with some of these treatments. There is also a more expensive option of using a prescription vaginal antibiotic cream.

Aci-Jel Therapeutic Vaginal Jelly® is an acidic jelly for the vagina, which is available from chemists without a prescription. It can be used to help correct the acid balance of the vagina. Some women find it useful in lessening the vaginal odour associated with this infection but it will not cure them of the infection.

THRUSH

This is also called Monilia or Candida and is a yeast that is found in the vagina, mouth and bowel. Usually it is kept in balance by a large number of other organisms that live normally in the body and on the skin, and it causes no problems. But sometimes the natural balance is upset and the amount of Thrush can increase.

This can be caused by pregnancy, diabetes, obesity or when a person is taking antibiotics, steroids or hormones like the Pill or Hormone Replacement Therapy (HRT).

About 10-20% of women who have Thrush have no symptoms at all. Those who do have symptoms usually have a cheesy, thick, white discharge that smells yeasty but not unpleasant. The area around the vagina is often red, itchy and sore, and sex can become very uncomfortable.

Because Thrush is normally carried by both men and women, it is not thought of as a sexually transmitted infection (STI). You do not have to have sex to get it, though sexual partners of people with Thrush sometimes develop symptoms as well.

Treatment

The most common treatments for Thrush are vaginal creams or pessaries that can be bought from the chemist without a prescription. Women who find that their symptoms don't settle with this simple treatment should see their doctor for further advice.

It is best not to use any vaginal treatment for a few days before you go to the doctor because these can make it more difficult to diagnose a vaginal infection. The doctor will check that the symptoms are in fact due to Thrush and not some other infection. They may also suggest an oral antifungal treatment available without a script from the chemist. Occasionally, sexual partners need treatment with an antifungal cream as well.

The use of plain yoghurt in the vagina is often promoted as a treatment for Thrush. Though it is certainly cool and soothing there is very little evidence that this treatment works, since it is unlikely that the bacteria in dairy products are able to survive long enough in the vagina to correct any imbalance.

If you are prescribed antibiotics for ay other infection, ask the doctor about also using something to help prevent Thrush - especially if you have had problems with Thrush in the past.

TRICHOMONIASIS

This infection is caused by a small parasite called Trichomonas. It can be carried by both men and women and is almost always sexually transmitted. It may also be possible to pick it up from objects contaminated with semen or vaginal mucous (eg shared sex toys). Most men, and about half the women who carry this infection, have no symptoms at all.

When women have symptoms they may notice a thin, frothy vaginal discharge, with an unpleasant fishy smell. The vagina may be sore and itchy, and some women notice a burning sensation when they pass urine (pee). The infection is usually diagnosed by finding the parasites in the vaginal discharge when it is examined under a microscope, or occasionally on a Pap test.

Treatment

The most common treatment is usually tablets prescribed by a doctor. It is important that all sexual partners are treated at the same time to avoid re-infection. You should avoid alcohol while you are being treated since it can cause severe nausea or vomiting when combined with this treatment. A more expensive treatment is the use of a prescription vaginal antibiotic cream.

DERMATITIS

Dermatitis is a very common cause for irritation around the vagina. The main symptom is usually itching, but if a woman scratches the area the skin can tear or split and this can cause burning and stinging as well.

Dermatitis can be caused by anything that irritates the sensitive skin around the vagina eg the detergents used to wash underwear, panty liners, perfumed toilet papers and pads, soaps, perfumes, bubble baths, shower gels, vaginal deodorants, lubricants and spermicides.

Dermatitis can also be caused by an allergy, perhaps to the rubber in condoms or diaphragms, to tea-tree oil, or to one of the ingredients in vaginal creams or pessaries. Often the woman will have had other allergies like asthma, hay fever or eczema.

Treatment

Usually a weak cortisone ointment is used to treat mild symptoms. Ointments are a bit messier to use than creams but doctors prefer women to use them around the vaginal area, because they cause less irritation than creams or lotions, and are longer lasting.

Sometimes stronger cortisone preparations are needed for a short time when symptoms are more severe. It is important not to use these stronger cortisone preparations long-term as they can damage the skin and cause symptoms to get even worse when you stop using them.

Cold compresses can help to relieve the symptoms and antihistamine tablets can be useful when the cause is an allergy. A gentle moisturiser may be prescribed by your doctor to stop any splits in the skin.

WHAT CAN I DO TO KEEP MY VAGINA HEALTHY?

There are a number of simple things you can do.

• Wear cotton or silk underwear rather than synthetics and change daily. Wear pantyhose for as short a time as possible.
• Wash underwear in hot water and pure soap and double rinse to make sure any irritants are removed before you wear them.
• Change out of damp swimming costumes or sports clothes as soon as possible after swimming or exercise.
• Change pads and tampons regularly (at least every three to four hours), but don't get into the habit of wearing day pads or panty liners during the day as they increase your risk of vaginal irritation. Avoid using perfumed or deodorised pads and tampons.
• Avoid tight fitting clothes such as jeans as this creates a moist, warm environment that encourages the overgrowth of bacteria and yeasts
• Never douche - except if it is specifically prescribed by a doctor to treat an infection. Douching increases your risk of vaginal irritation. A healthy vagina does not need a vaginal deodorant
• Avoid using soaps, bubble baths, bath salts, perfumes and perfumed talcs around the vaginal area. And never ever use anything harsh such as disinfectants - even diluted, near your vagina.
• Always wipe from the front to the back after going to the toilet since this stops bowel organisms being swept into the vagina. Don't use perfumed toilet paper because it can cause irritation.
• Keep your immune system healthy. Eat a healthy, well-balanced diet, get plenty of sleep, exercise regularly and don't smoke. If you can, avoid things that make you feel tense, and try to manage your stress levels in whatever way works best for you eg with massage, yoga, or meditation etc.

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For further information

Contact the Healthline on 1300 658 886.