Girl Talk….When you just know something isn’t right “down there”

According to the America Family Physician, vulvovaginal complaints are one of the most common reasons for women to seek medical advice.  There are several reasons for a woman to experience vaginal itching, discharge, or odor.  The most common culprits are infections:  yeast, bacterial vaginosis, and trichomonas.

Yeast

  • White, thick discharge
  • Vaginal itching
  • No odor
  • Pain with sex
  • Most common risks for yeast include:  diet high in refined sugars, uncontrolled diabetes, antibiotic use (if you are one of the woman who gets yeast infections after antibiotic use, tell your doctor;  we are usually willing to provide a prescription for Diflucan with an antibiotic)
  • Treated with Diflcuan (fluconazole)

Bacterial Vaginosis

  • Normal vaginal bacteria are replaced by infectious type
  • Fishy odor – becomes more prevalent after sex or during menstrual cycle due to change pH in the vagina
  • Clear/white/grey discharge
  • Usually doesn’t cause itch  
  • Most common risks for BV include:  douching, smoking, IUD, new/multiple sex partners, unprotected sex, high dose of nonoxynol-9 spermicide
  • Treated with metronidazole or clindamycin.  Treatment of sex partners is not recommended as this is not a sexually transmitted bacteria. 
  • Can recur;  most recurrence is associated with new sex partner.  Other than refraining from douching/smoking/multiple sex partners, there is really no good way to prevent these infections.  This is a source of distress for many women who have this infection recurrently – but as of now, the only thing medical providers can do, is treat the infections as they appear.

Trichomonas 

  • Normal vaginal bacteria are replaced by infectious type
  • A sexually transmitted infection
  • Green, yellow, frothy discharge
  • Pain with intercourse
  • Painful urination
  • Most common risks for Trichomonas:  multiple sex partners, other STDs, lack of barrier contraception, drug use, smoking
  • Treatment is typically metronidazole;  sex partners should be treated;  should not have sex until both people complete treatment. 
  • Test of cure not required.

I receive a lot of phone calls from patients who have used over-the-counter yeast and bacterial infection tests.  Unfortunatley, these carry a 20% false positive rate — meaning, they show positive results, even when there is no infection.  This is why we ask to see patients in the office;  to perform an exam and culture the discharge.  Another reason –  there are causes other than yeast/bacterial vaginosis/trichomonas for vaginal irritation, itching, or discharge.  If we were to treat the results of the over the counter tests, we could be providing medications that aren’t needed.

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About cschaffer78

I'm a family practice physician in Evansville, IN. My practice is described as "full-spectrum" family practice, meaning I see patients "from cradle to grave". I care for men and women of all ages, I deliver babies, and even follow my patients when they are hospitalized. Medical Disclaimer The content of this website is provided for general informational purposes only and is not intended as, nor should it be considered a substitute for, professional medical advice. Do not use the information on this website for diagnosing or treating any medical or health condition. If you have or suspect you have a medical problem, promptly contact your professional healthcare provider
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