A quick word about vaginal infections…

In the past few weeks as I’ve been plotting my podcasts (and writing them up, if not actually recording), I’ve gotten three calls about vaginal infections. So here are a few things it’s helpful to know.

First of all – having some vaginal discharge (liquid that flows from the vagina) is normal and expected. A healthy vagina makes a clear or slightly cloudy discharge to clean itself. At different parts of a woman’s menstrual cycle, discharge gets thicker and thinner, heavier or lighter. (Many women reliably use this to track ovulation – more on that later!) Some women have more discharge than others, more of a baseline odor to their discharge than others, etc. etc. “Variations of normal” is a big theme in gynecology. 🙂

That being said, there are a few causes of vaginitis (aka “vaginal inflammation”) that are not caught from someone else and experienced more often by frum women than the others you may see on a longer list.

• Bacterial vaginosis
• Candida or “yeast infections”
• Reactions or allergies

Bacterial Vaginosis (“BV”) vs Candida (“Yeast Infection”)

Interestingly, both are caused by organisms (what we usually call “germ buggies” in this house) that are normally found in the vagina. Vaginas aren’t sterile – they are colonized (lived in) by a mix of bacteria and yeast. (I know that sounds kind of gross, but skin is colonized too, and we try not to think about it, right?) When everything stays balanced, this is a healthy and protective thing. The different organisms keep each other in check. However, when something throws off the balance one way or the other, a woman can end up with a symptomatic (bothersome) vaginal infection.

Both BV and yeast infections can cause a white or grayish discharge (and it’s actually possible to have both at the same time), but there are a few ways we can usually tell them apart:

• While both can cause itching, itching with yeast infections is usually waaaay worse, and often accompanied by a burning feeling; with BV, women will complain that something “just doesn’t feel right down there” or intercourse becomes generally uncomfortable.
• The discharge from BV is associated with a strong fishy smell (particularly after a woman has been with her husband – there’s a chemical reaction with semen); yeast infections often come with a chunky white “cottage cheese” discharge.
• BV is sometimes caused by douching (cleaning inside the vagina) or very frequent bedikah checks; yeast infections are often seen after a woman has been on oral antibiotics for a different infection.

Reactions or Allergies

Women may also experience vaginal reactions or allergies to products such as a new detergent or spermicide. Douching is not recommended in general (because it messes with the balance of those protective bacteria and yeast), and douches can also cause reactions.

Other Causes of Vaginitis

When a woman goes through menopause or has been breastfeeding for a long time, particularly before her period returns, low levels of estrogen can cause “atrophic vaginitis,” where the vagina becomes dry and less elastic. Talk to your physician about local (in the vagina) replacement of estrogen if you’re experiencing painful intercourse, itching or burning.

Lastly, very occasionally a systemic (whole body) virus can actually cause a woman to have a change in discharge, particularly large quantities of odorless clear discharge. (This is more often seen with a virus that’s transmitted by a sexual partner, aka an STD or STI, but it’s possible with other viruses as well.)

Remember!

Call your doctor or midwife if: your vaginal discharge changes colors, becomes much heavier, or develops an odor; it burns when you pee; intercourse becomes uncomfortable; you notice itching, burning, swelling or soreness around your vagina. For a new diagnosis, your provider will probably want to do a vaginal swab, though they may treat just based on symptoms and history. Some women get yeast infections or BV often, and if they don’t usually have both, the provider might be comfortable calling in a prescription without even seeing them each time the symptoms reappear.