Doctors' Answers to "Frequently Asked Questions" - Vaginal Infections

Related Women's Issues

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

Yeast Infections [posted 1/14/98]
Question: I had a total hysterectomy in April 1997, and I got a real bad yeast infection, all over my body, vagina, rectum, breast and even my throat and mouth. Before that, for 3 years I kept telling the doctor I felt like I had a yeast infection even though I had no discharge and it felt like it was on the outer fold of the vagina. However, they would always go too high up for the smear, so they were missing it. Then during surgery it really went wild, I finally went to a female GYN and she put me on Diflucan 100 mg one a day for three weeks. Eventually one every other day for a week then twice a week. Now I am on one once a week, but my yeast is gone and I am afraid to come off because I had such a hard time getting cleared up, but now I have a potassium reading of 5.8 and I'm wondering if the Diflucan could be causing it? So after all this, do I come off Diflucan cold turkey or taper off? Sorry such a long story, but I don't want to go to the doctor just to ask her a question and I don't make a habit of calling doctors on the phone.

Answer: I'd stop the Diflucan. If you worry about recurrent yeast infections, the Israelis treat theirs like this. Take a tablespoon of active yogurt (not pasteurized) available in health food stores or with your own yogurt maker in a pint of warm water and douche with it once or twice a week. It is effective, cheap and no systemic side effects.

Vaginal Odor [posted 1/11/98]
Question: My daughter is 13 years old and for the past few weeks she has had a terrible vaginal odor. It does not appear to be a yeast infection. It is kind of a strong urine smell. We have purchased some vaginal spray (FDS), but it hasn't seemed to help. Is there any other recommendations you might have?

Answer: Probably not yeast unless there is itching and a cheesy discharge. Most likely it is bacterial vaginosis caused by bacteria including Gardnerella and others, and is treated by antibiotics. You'll need to see an ob-gyn for diagnosis.

Vaginal Thrush [posted 11/11/98]
Question: For the last four days I have been getting syptoms which strongly suggest that I have vaginal thrush. My vagina is very itchy and has been red and sore, although this has now died down a bit. Since the syptoms first occured I have been applying a gentle antiseptic cream. However, the skin on the outside of my vagina has started to flake a little. I have also noticed what seems to be a rash (small red dots) and this is dotted around the outside of my vagina, particularly in the area between my vagina and anus. The 'rash' itself is not itchy. I have just had a very light period off and on for a few days. There has been no offensive odour and little, if any discharge. How can I treat these symptoms? I can not go to a doctor. Is there an over the counter treatment? Is this harmful? I am living in England. I would appreciate any advice.

Answer: Well, there is here in the US, any of the anti-yeast vaginal creams will work. An antiseptic cream may be making the problem worse, I would not use it if you suspect yeast infection. If you don't have access to anti-yeast creams, a douche of active(not pasturized) yogurt-one tablespoon in one pint of warm water will sometimes help.

Bleeding [posted 8/14/98]
Question: I had a complete hysterectomy on November 7, 1997. I developed a hematoma soon after surgery that is attached to the bladder. I have experienced lots of pressure and discomfort urinating during the past 8 weeks, although, these discomforts have steadily decreased. My concern is sporadic vaginal bleeding. This is not old blood. The coloring is very bright and/or sometimes a watery pink. Where is this coming from and how long should it continue? I might add, it is not perpetrated by intercourse. I have lots of lower back pain. I have spoken to my doctor about this and while I do not want to accuse him of being negligent, I do not feel he is giving this adequate attention. I have been told not to worry and to be patient. I began bleeding again a few days ago and it is not excessive, but does require me to use some protection.

Answer: You need a second opinion or a urologist to examine your bladder. It sounds like there was a surgical misadventure.

Bleeding [posted 7/23/98]
Question: I am a 23 year old female and recently started bleeding irregularly. when it began it was only during intercourse or periods of intense physical fitness. I thought it may have been due to the depo provera shot since I've been on it for nearly three years so I consulted a doctor. the doctor I saw said that it may be occurring due to remaining scar tissue from cryo-treatment that I received over 2 years. I received this treatment due to high dysplasia. Since then I've had several culposcopy exams in which a different doctor said everything was normal. Since my last visit when the doctor said I should be getting better because the scar tissue was healing, my problem has become much more serious. Now I bleed all the time. It is not heavy bleeding, but bleeding just the same. I am in the military and overseas therefore I have limited access to medical facilities. My question is if this is being caused by the birth control or should I take a trip back to the United States and get a second opinion?

Answer: I don't understand the advice you are getting. First, culposcopy does not involve the lining of the uterus and rarely produces long term bleeding since the cervix is relatively avascular. Scarring of the cervix is minimal long term since the culposcopy only involves freezing/sloughing the inner core of the cervix. Usually bleeding indicates a build up of endometrial tissue of the uterus. This usually indicates a lack of progesterone (necessary to produce a complete slough of the lining with each period). A burst of progesterone during the last two weeks of your birth control pills is the usual treatment (usually 10 mg a day for the first try, maybe 20 if this doesn't work). Stopping the pills probably won't help unless you had large periods before the pill. However, it might if you can't convince anyone to cycle your uterus with progesterone. Lastly, it can happen that a young women can get cervical dysplasia. But, I would have my endometrial smears sent to the Armed Forces Pathology Institute (world class by the way) for a second reading. There are many over reads of cervical cytology resulting in unnecessary procedures.

Vaginal Discharge [posted 7/21/98]
Question: My friend and I have both been having strange vaginal discharge. We both noticed it within hours of each other, after spending the day together. Could it possibly be related to something we ate? We've both never experienced spotting between periods until this. The discharge is brownish and has a strange smell, but not a strong or offensive one. This has been going on for three days now. I had a baby 4 months ago and have had two normal periods since (the last one ending 2 weeks ago). My friend is taking birth control pills, but I'm not. We've also both been experiencing mild cramps, but much different from a period. She had a very bad headache yesterday (she rarely gets headaches). I would greatly appreciate any answers as to what may have caused this or advice.

Answer: Should be no relationship unless there was sexual contact.

Enterococcal Infection
Question: I have a vaginal enterococcal infection that includes swollen abdominal lymph nodes. I acquired the infection during one of my previous hospital stays. My OBGYN treated me with ampicillin suppositories which had no effect. Then she tried augmentin and it produced no effect. Now she wants to try steroids because she thinks that I have a weakened immune system. I think it is a resistant form of enterococcus. However, I don't want to continue trying different drugs until I find the right one. What would be the best course of action/treatment? Also, the possible hearing loss associated with taking aminoglycosides scares me. How likely is it I could lose any of my hearing?

Answer: This is a probably reason to see an Infectious Disease specialist. Culture of the bacteria should yield the sensitivities that would best treat this particular infection. Has this been done? Also, do not use steroids until the problem which caused this uncommon infection is defined. It sounds like your doctor is getting out of their depth.

Vaginal Inflammation
Question: My wife recently had a Pap smear and was told that the results were within normal limits, but that she had a slight inflammation. The doctor wants her to take Flagyl for a week and come back for another Pap in a month. It has been a week since the original test and she has no symptoms. She was also told not to drink any alcohol while on the medication. Is the medication really necessary? Why wait a month for a re-test? Why does she need such a strong medication? She gets upset stomachs from mycins. Is this drug likely to upset her stomach too? If so are there good alternatives?

Answer: This is a fairly common problem. There are several types of bacteria which produce vaginal inflammation(not sexually transmitted). Treatments focus on Flagyl which is effective against those bacteria which do not need oxygen. The admonition against alcohol has to do with the flagyl since occasional people will become markedly nauseated on flagyl with alcohol. Most women with these infections have minimal symptoms. If there are any symptoms, it is usually a minimal vaginal discharge which smells slightly fishy. The wait is to see if the bacteria returns and that she will need re-treatment. If the repeat pap is abnormal, have the slides seen by pathologist(cytologist specialist) who specializes in pap smears. The tests are generally read by cytology techs and are notorious for being overread(for liability protection). There is no sense being treated for an overread test.

Yeast Infection
Question: I have re-occurring yeast infections on a monthly basis. I would like to know if there is any over the counter drug that I could take or some form of a natural vitamin that would help. In the past I have always had to use some sort of a cream, but I would like to prevent it before this becomes necessary.

Answer: Yeast infections are bothersome and can be costly. Recurrent infections can be due to antibiotic usage, birth control pills, diabetes mellitus or other metabolic medical conditions. There are currently over the counter anti-yeast medications which can be used intravaginally. Sometimes it is necessary to stop birth control pills to correct the problem. Vaginal yeast infections in the third world are treated with natural yogurt. This is accomplished by douching with a tablespoon of active or fermenting yogurt in 8 oz of warm tap water. This replaces the lactobacillus (necessary for normal vaginal colonization) and also washes out quantities of yeast. This is not used much in the United States, but is effective. It is important to use active yogurt and not pasteurized for this effect.

Vaginitis
Question: I have been having a watery discharge along with redness of my vulva and there is no odor. This has been going on for 4 months now. I have seen a few doctors who have all done in house tests for bacterial vaginitis and yeast yet they have come up with nothing. I have had a vaginal culture to test for chlamydia, gonorrhea, and herpes, but the tests have all come back negative. It is not an allergic reaction, I don't douche, I use a hypoallergenic soap, and I wear cotton underwear. My pap shows that I have inflammation. I am very frustrated. My clitoris is inflamed, so I am pretty uncomfortable. I tried having sex once and it was painful. Do you have any clues? Could this be an infection other than the normal ones? I tried metrogel and it improved somewhat.

Answer: Non-specific vaginitis is a truly frustrating problem. After the initial studies are done and turn out negative a physician will usually focus on treatment, even without a specific cause. Topical antibiotics such as metrogel are commonly used. There is an old adage in medicine - if it works keep doing it. I'd stay with the metrogel for an extended period. Has your sexual partner been tested to ensure that you are not becoming reinfected?

Vaginal Infection
Question: I am a 38 female and for the past two years I have battled "fishy" smell from my vaginal area. I have had anti-fungus medication orally and cream, but it continues to come back. My boyfriend and I used a condom for several months before going naked. I was fine until we tried this. My doctor said it was due to the suddenly change in my pH that cause a bacterial growth and if my friend was not having any problems then he did not have to be treated. This heals for awhile and it returns. I do not know what to tell my boyfriend.

Answer: If treating you has not worked I'd certainly try treating your boyfriend. It has nothing to do with sexual transmission but, with pragmatism.

Persistant Odor
Question:I am a 23 year old female. Approximately 1 year ago my boy-friend and I noticed a change in my female "odor". We have what I believe to be a mongamous relationsihp but I had STD tests just to make sure and everything was negative. There has not been an increase or change in vaginal discharge but I did notice that "air bubbles" were coming from my vagina. I went to my gynacologist 5 months ago for my yearly checkup and he said he was concerned because he noticed air bubbles in my vaginal mucous, but when he look at it under the microscope, he says he didn't see any bacteria. I have become so exasperated with this, it really bothers me and my boyfriend notices it to. He said "You always used to smell so clean." This upset me because I am not doing anything differently than I used to, but I still have this strong odor. (There is no itching or redness either). I finally decided to try a yeast infection product (over-the-counter) and the odor was gone for about 1 week, then the airbubbles returned along with the odor. I really hope that someone knows what this is because my doctor doesn't I'm worried that there may be something wrong with me that could affect my reproductive ability. Please let me know if you have any suggestions.

Answer:There are several non-specific infections of the vagina that could cause these symptoms. These are either fungal, trichomonal infections, or non-specific bacterial infections. Of these, the one that produces an odor is usually bacterial infections. The usual organism is G. Vaginalis and is treated with clindamycin vaginal cream or metronidazole gel or orally. It is not clear whether this is sexually transmitted or not and antibiotic treatment of men does not seem of affect reoccurance. There are some who consider it a risk factor for infections of the fallopian tubes and subsequent difficulty becoming pregnant. However, if this is the case, it has been somewhat difficult to prove. This is a fairly common problem-if your doctor doesn't know how to treat this simple a problem you might consider finding one who will.



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