Vaginas: An Abbreviated Owner’s Manual
by Sarah Gilman-Short, MD 2010 | sarah@myhousecallmd.com
Almost every woman has, at one time, experienced that “Ummm… something’s not quite right down there…” sensation. Today we’ll be discussing three cases of vaginas gone wrong – Bacterial Vaginosis, Candida Vulvovaginitis, and 
Trichomoniasis. Not the sexiest part of womanhood, but often an unavoidable aspect of it. All three have simple treatments and sound much more sinister than they actually are.
Firstly, let’s just say that, contrary to what some people (even some male doctors) believe, not all vaginal discharge is abnormal. Happy, well-adjusted vaginas can regularly release a small amount of milky, whitish, or clear fluid daily. This fluid is made up of sloughed off cells from the vaginal lining (vaginal cells slough off just like your other skin cells). The color and consistency of the fluid 
can change with your menstrual cycle. Yes, it’s true – the vagina is a self-cleaning organ. And even though it may be slightly unpleasant to think about, normal vaginas are full of bacteria (just like many other places in the body…your nose, for instance, is packed full of bacteria). Every woman’s “vaginal flora,” as we medical folk call it, is made up of a personalized balance of different species of bacteria, kind of like how every forest has a slightly different mix of foliage. Most vaginas are in a peaceful symbiosis with Lactobacillus acidophilus and Staphylococcus epidermidis.
Things go wrong when this delicate vaginal balance is disrupted. Here are some ways this could happen:
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Douching: We thought that people stopped doing this in the seventies, but it turns out that it is still popular in some social circles.
A word from the wise: Don’t do it! It’s never a good idea – you are flooding your personal space with a bunch of annoying, irritating chemicals that will make your vagina unhappy and make it easier for that delicate balance to be disrupted. Also, if you have a STI, (and you might not even know it if you do) douching can push the evil bacteria into your uterus and fallopian tubes in an ugly, infectious tidal wave, making the problem much, much worse. The best way to clean down there is with some gentle soap and water on the outside. Also falling into the “no no” category would be other irritants such as hygiene sprays, bubble baths, and perfumed detergents. Your vagina does not have to smell like flowers! -
Antibiotics: Remember the idyllic forest analogy? Taking antibiotics can kill the healthy bacteria your vagina likes and needs, making room for other bacteria or yeast that your vagina hates. But of course, this isn’t a reason for not taking antibiotics if you really need them. An imbalanced vagina is easier to treat than Scarlet Fever.
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Contraception: Oral contraceptive pills, IUD’s, condoms, and spermicide (especially nonoxynol-9) have been associated with increased yeast infections. Once again, this is not a good reason to stop using contraception – yeast infections, though annoying, are much less annoying than unwanted babies and incurable STD’s.
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Health conditions: Diabetes, pregnancy, or infections can mess with your vaginal flora.
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Sluttiness: Just kidding, we don’t judge – but having unprotected sex can put you at high risk for a lot of bad things, including Trichomoniasis.
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Who knows? Women can get BV or yeast infections out of nowhere, for no identifiable reason whatsoever. It sucks, but there’s a lot that we doctors just don’t know.
Bacterial Vaginosis (BV)
BV is a very common cause of vaginal annoyance – a third of women who visit their doctor complaining of a vaginal issue end up being diagnosed with BV. Although almost half of women with BV have no symptoms at all, most complain of a fishy-smelling discharge that can be yellow, 
creamy white, green, or gray (have we ruined your appetite yet? Our sincere apologies). They can also have some minor itching. No one knows the exact cause of BV, but we know that somehow there is an overgrowth of new, annoying bacteria in the vagina, usually Gardnerella vaginalis, Mobiluncus, or Mycoplasma hominis (the can be seen in the picture to the right…the little dark spots mixed in with the large healthy cells are the unwanted intruders). BV can be more likely to rear its ugly head when a woman has been involved with a new sexual partner, and studies have shown a concordance of BV between lesbian partners; however, there is no clear evidence that it is sexually transmitted.
Candida Vulvovaginitis (a fancy term for a yeast infection)
Candida is a yeast – yes, similar to the yeast that makes your bread and beer delicious – that is present on many people’s skin, but can make vaginas exceptionally angry. This is the type of yeast that many women self-treat with 
over-the-counter creams but it is, in fact, less common than BV, accounting for about a quarter of the women who come to the doctor with vaginal symptoms. Women with yeast infections often have a thick, curd-like white discharge that kind of smells, well, yeasty. Unlike BV, yeast infections can make your vagina and vulva notably painful, itchy, and red. As we said before, many women will try over-the-counter creams but, if for some reason the symptoms persist or come back, it is important to see a doctor and make sure there isn’t something more serious going on. Studies have shown that most women aren’t very good at diagnosing yeast infections on their own so don’t hesitate to go in for a check-up if you’re unsure.
Trichomoniasis
Trichomoniasis is caused by a little protozoan with a tail (named Trichomonas) that swims around in seminal or 
vaginal fluid, causing mischief. Trichomonas, although cute, is without a doubt an STI, and can be easily prevented by wearing condoms with every sexual encounter. Trichomonas can live on objects like sex toys and towels and can also be found in urine. Women with Trichomoniasis usually have a significant amount of thin, discolored, foamy discharge, as well as a strange odor and itching. When the infection gets really bad, it can cause fever and lower abdominal pain (but these can be symptoms of other serious infections as well). Trichomonas also likes company – a third of women who have it will have another STI at the same time.
Your Take Home Message
Vaginas can be rather finicky and complicated. Happy, healthy vaginas have their own natural balance of bacteria and anything that disrupts that delicate balance can cause itching, discharge, or odor. If you think that your vagina’s balance is off, it’s a good idea to see a doctor. With a quick swab of your vagina (you don’t usually need a speculum for this) and examination via microscope or laboratory, he or she can diagnose the problem and treat it accordingly. All three conditions can be cured quite easily so there’s no reason to try and fight it off alone. We’re here for you… might as well let us help!
Questions? E-mail Sarah: sarah@myhousecallmd.com
Did you know that there are 13 months in a year? Maybe not true for everyone, but true if you’re a woman using birth control pills. How is that possible you ask? Let’s do the math. There are 365 days a year and 28 days worth of pills in each month’s supply of birth control, while we’re all aware that most months have 30 or 31 days. So 365 divided by 28 gives us 13. That’s right. Women have to pay for an extra month’s worth of medication. This is unheard of for any other medicine. With no medical reason to only give 28 days worth of pills when 30 or 31 would work just as well, what’s a woman to do? Maybe we can embrace this special month that only we get, by naming it. I personally like the way “Notpregnantember” rolls off the tongue. Really though, short of demanding two more pills from your pharmacist every month, a request that sadly the pharmacist can’t possibly oblige, what’s a woman to do if she’s really put off by this extra co-pay and daily pills? Women can choose to be informed consumers. There are a multitude of products out there that work just as well, if not better than, the traditional birth control pill and they don’t require us to cross days 29-31 off our calendars or make up new names for imaginary months, as fun as this may be.
