- Vaginal Health Fact Sheet - WHA 2010
- Dangers of douching - WHW July 1997
- Overcoming Vaginal Thrush- J.Dunn
Maintaining good vaginal health is generally not too difficult as to a large extent, nature has designed our vaginas to be self-cleansing. There are a few simple things women can do to keep their vaginas healthy.
- washing the genital area daily;
- avoiding the use of perfumed soaps, deodorant sprays, wipes and talcum powder on the vaginal area;
- wearing cotton underwear and avoiding tight jeans and other tight clothing;
- wiping from front to back after urinating and after a bowel motion;
- avoiding the use of deodorised panty shields, bath products, and bubble bath solutions.
It is also very important to avoid douching because the vagina cleans itself with its own natural secretions. Douching interferes with the useful bacteria that live in the vagina and keep harmful bacteria under control.
This fact sheet looks at some of the common problems that occur.
Vaginal thrush is a very common yeast infection that will affect most women at some point in their lives. For some women it is a recurring and distressing problem that can affect and disrupt their sex lives.
Thrush is caused by an overgrowth of yeast known as Candida albicans that is present in the intestines, vagina, mouth and skin where it is normally kept under control by naturally occurring harmless bacteria. If conditions change and the pH (acid-alkaline) balance is disrupted, the yeast can increase rapidly and cause extremely unpleasant symptoms such as itching and soreness around the vagina.
The most common signs of thrush are painful itching, soreness and swelling of the vaginal area, a chalky white yeasty-smelling discharge, pain during sexual intercourse, and pain when urinating due to the urine stinging the inflamed tissues. Although it is difficult to avoid scratching, scratching only makes the problem worse.
Causes of vaginal thrush
As noted above, thrush is caused by a change in the natural balance in the body's bacteria. This can occur as a result of:
- the use of antibiotics as antibiotics kill friendly bacteria
- a weakened immune system as yeast will often multiply when the body is fighting another infection
- an increase in sugar levels which encourage the growth of bacteria. This can be a result of
- diabetes or raised glucose levels as diabetes increases blood sugar levels in urine and in vaginal secretions
- the contraceptive pill as the pill affects the hormones which can affect a woman's ability to process sugar
- pregnancy as hormone levels change during pregnancy creating high levels of sugar in vaginal secretions
- periods - as vaginal secretions change throughout the menstrual cycle and menstrual blood can change the acidity of the vagina
- sex - thrush is not a sexually transmitted infection but symptoms may be worse after sex if the genital or vaginal area becomes irritated during sex
- products that change the natural acidity of the vagina such as vaginal deodorants, sprays, gels and wipes, perfumed bubble baths, and douching.
- clothing that is too tight and prevents air from circulating which creates a warm, moist place for thrush to develop
- emotional or physical stress such as a poor diet, lack of sleep, smoking.
Some of the symptoms of thrush are the same as those of other vaginal infections so the only way to be certain that you have thrush is for a doctor or nurse to take a swab from the inside of the vagina and look at the vaginal area. The test for thrush is usually very accurate in women.
Sometimes the signs of thrush will be noticed when you have a cervical smear. Treatment is not necessary unless you have symptoms such itching or a discharge.
Thrush is caused by a fungus, so antifungal drugs will be used to treat the infection. These medications stop the growth of yeast infection without affecting the friendly bacteria in the vagina. The treatment is simple and can be offered in several ways.
You may be prescribed an antifungal cream which is inserted into the vagina using an applicator. Alternatively, pessaries may be used. A pessary is a pill that is inserted high into the vagina with the aid of an applicator. The third method is by swallowing a tablet. If tablets are prescribed you will also be given a cream to help soothe the itching in the vaginal area. However, pregnant women should not take oral antifungal pills for thrush.
Whatever method is used it is important to complete the full course of treatment.
The side effects of the antifungal drugs - irritation of the skin and burning - are the same regardless of the method used. As these side effects are similar to the symptoms of thrush it can be difficult to tell if the effects are those caused by the yeast infection or the treatment.
There are a variety of complementary treatments that work for some women. Not all of them are supported by research but many women find they help.
- Calendula (from marigold flowers) is an antifungal agent and is very soothing.
- Garlic also has strong antibacterial and antifungal properties.
- Tea tree oil is also known to be helpful in treating thrush and its effectiveness against Candida albicans has been confirmed in some scientific studies.
- Yoghurt is also used by many women and can be used either by eating it or inserting it into the vagina. However, it must be an unsweetened live natural yoghurt. Yoghurt is known to help the body maintain the balance in acidity levels by keeping the yeast in the gut under control.
For women who are susceptible to recurrent episodes of vaginal thrush the best way to avoid a recurrence is to try and work out what the factors are that trigger a yeast infection for you. A diary and/or your doctor can help with investigating and diagnosing any underlying condition that may be causing recurrent episodes of thrush.
Recommended tips for preventing vaginal thrush:
- Ask your doctor for an antifungal treatment when being prescribed an antibiotic
- Do not use vaginal douches as the vagina cleans itself
- Avoid deodorised panty shields, bath products, and bubble bath solutions
- Wear loose cotton underwear and avoid tight clothing
- After urinating, always wipe from the front (vagina) to the back (anus)
- Avoid the use of perfumed soap, deodorants, sprays, wipes, gels or talcum powder on the genital area
- Avoid spermicidal condoms and use only water-based lubricants
- Make sure the vagina is well lubricated before intercourse.
Cystitis is an infection in the bladder caused by bacteria that usually live harmlessly in the bowel. While children and men can also get cystitis, it is most common in women. Because the infection usually only affects the bladder it is called a lower urinary tract infection (UTI). Some women are more prone to getting UTIs than others.
Cystitis is most often caused by the bacteria known as E coli (Escherichia coli) that gets into the urethra from the surrounding skin (the urethra is the tube from the bladder used when passing urine). As the urethra is nearer to the anus in women than it is in men, it is easier for the bacteria to get transferred into the urethra. While cystitis is often very painful, it usually clears up within a few days.
The symptoms of cystitis include:
- a stinging or burning sensation when urinating
- the need to urinate frequently
- feeling the need to urinate urgently, even if you pass very little or no urine
- urine that is cloudy or dark coloured, and may have a strong smell
- blood in the urine
- pain or tenderness in the lower back or lower abdomen
- a general feeling of being unwell
Cystitis does not necessarily cause a fever when the infection is in the urethra or bladder. If you have a fever it can mean that the infection has reached the kidneys and you should go to your doctor.
Causes of cystitis
There are a number of ways that bacteria can get into the urethra and travel up to the bladder. There are also a number of other factors that can result in an episode of cystitis. They are:
- contraception using spermicide-coated condoms or a diaphragm with spermicide
- being sexually active - the risk seems to go up with the frequency with which you have intercourse
- diabetes or raised glucose levels as an increase in the sugar in the urine encourages bacteria to grow
- having been through the menopause as this causes changes to the lining of the vagina and urethra which make bacteria in the urine more likely
- a urinary catheter can introduce bacteria directly into the bladder
- having a condition that prevents you from emptying your bladder - for example if you have bladder or kidney stones or are pregnant
- using bathing and hygiene products such as talcum powder or perfumed soaps, deodorant sprays, wipes and gels as these products may also irritate your urethra or bladder.
As the symptoms of cystitis are very similar to those of other infections such as sexually transmitted infections (STIs) like chlamydia, it is important that you go to your doctor or visit a Family Planning clinic or a sexual health clinic if the symptoms persist. The doctor will ask you to provide a sample of urine that will be sent to a laboratory to be tested.
Antibacterial drugs - antibiotics - are used to treat cystitis and you will usually be asked to take them for three to six days. It is important to take the full course of treatment because symptoms may disappear before the infection is fully cleared. Which antibiotic is prescribed will depend on which bacteria has caused the infection.
There are some things you can do to treat the cystitis yourself. They include drinking lots of water to flush out the infection, taking painkillers to ease the pain, and making your urine less acidic by drinking a glass of water with half a teaspoon of bicarbonate of soda dissolved in it.
Some women get cystitis repeatedly. In order to reduce the risk of repeat infections you can try the following recommended tips:
- Urinate when you feel you need to - don't resist the urge to urinate
- After urinating, always wipe from front (vagina) to back (anus) to prevent bacteria from around the anus entering the urethra
- Urinate immediately after sexual intercourse
- Take showers instead of baths
- Drink plenty of water every day
- Avoid the use of vaginal douches and do not use perfumed soaps, deodorant sprays, wipes, gels and talcum powder on the vaginal area
- Wear cotton undergarments, which allow air circulation and discourage the warm, moist environment needed for bacteria growth.
- Some doctors recommend drinking cranberry juice as there is good evidence that cranberry juice and cranberry extract capsules can help prevent cystitis. There is, however, no evidence that cranberry juice is effective as a treatment for cystitis.
Vaginal douching is the practice of forcing water or a mixture of fluids into the vagina in order to clean it. Douches are usually pre-packaged mixtures of water and vinegar, baking soda, or iodine. Because the vagina cleans itself with its own natural secretions douching is not necessary and may be very unhelpful. There is now good evidence that regular douching changes the natural balance in the healthy bacteria in the vagina, and makes a woman more susceptible to infections and sexually transmitted diseases.
As well as interfering with the vagina's own self cleaning processes douching can introduce new bacteria into the vagina that may spread up through the cervix and into the uterus and the fallopian tubes. Women who douche regularly also have a much higher risk of developing pelvic inflammatory disease (PID), a chronic condition that can lead to infertility or even death.
While women say they douche to get rid of unpleasant odors, to wash away menstrual blood after their period, to avoid getting sexually transmitted diseases, and to prevent a pregnancy after intercourse, researchers and health professionals say douching isn't effective for any of these purposes. They also warn that the practice of douching can actually increase the risk of infections, pregnancy complications, and other health problems.
Overall the risks of douching far outweigh the supposed benefits.
Vaginal dryness is one of the most commonly reported symptoms of menopause. It is caused by a reduction in oestrogen levels. Oestrogen is the hormone that, among other things, helps to keep vaginal tissue healthy by maintaining normal vaginal lubrication, tissue elasticity and acidity. However vaginal dryness can also occur as a result of childbirth, during periods of stress, and as a result of taking birth control pills.
Vaginal dryness occurs most often in perimenopausal, menopausal and postmenopausal women. It is estimated to affect the vast majority of women who approach menopause and it continues to affect many of those who have completed the process.
There are various ways of overcoming the discomfort caused by vaginal dryness that do not involve the use of hormone therapy. They include increasing your fluid intake by drinking lots of water, avoiding products that change the natural acidity of the vagina such as vaginal deodorants, douches, perfumed bubble baths, etc, that may irritate sensitive vaginal tissue, and using water-based lubricants, and/or moisturising creams.
Vulval Pain (Vulvodynia)
Vulvodynia is the term used to refer to chronic pain in the vulva, the exterior tissue of the vagina and urethra. It is a condition that is very difficult to diagnose and is usually made after other conditions have been investigated and ruled out.
Symptoms of vulvodynia include chronic pain, burning, stinging, itching or irritation of the female genitalia. The cause is currently unknown and it is thought that multiple factors may be involved. For example, some of the theories about causes of vulvodynia include it being the result of
- an injury to, or irritation of, the nerves that supply and receive input from the vulva
- an abnormality in the muscles of the pelvic floor
- a localised hypersensitivity to yeast
- an allergic response to environmental irritants
- high levels of oxalate crystals in the urine
- spasm and/or irritation of the pelvic floor muscles.
There is so far no evidence that vulvodynia is caused by an infection.
Although there are a wide variety of treatments available, there have been few controlled trials testing the efficacy of them. As each woman's experience is different, what works for one woman may not work for another.
Currently available treatments include topical medications such as oestrogen cream; avoiding or discontinuing all soaps, douches, and perfumed deodorants, bubble baths; oral medications such as antidepressants; interferon injections; local anaesthetics such as lidocaine; nerve blockades; physical therapies; dietary changes; acupuncture; pelvic floor therapy; and for those with vulvar vestibulitis syndrome, surgery.
July 1997 Women's Health watch
Women who douche may risk pelvic inflammatory disease and ectopic pregnancies says a US Food and Drug Administration panel. A study found that women who used vaginal douches frequently had four times the risk of ectopic, where the fertilised egg implants itself in a place other than the uterus. Douching could increase the risk of disease by propelling bacteria into the cervix, uterus and fallopian tubes causing scarring. It could also disturb the normal organisms in the vagina reducing lactobacilli which protect against genital pathogens.
The evidence is only suggestive, said some experts called by the panel, and a causal link would be hard to prove. Douche manufacturers said it was impossible to pinpoint douching as a risk because women who douched tended to have multiple sexual partners, have had sex at an early age and be on low incomes.
Jill Dunn NZRN, Naturopath, Medical Herbalist
Some women are plagued by reoccurring vaginal thrush, (a frequent cause of vaginitis), month after month. Vaginitis is one of the most common reasons for women to seek health care. Because vaginitis may be a symptom of a more serious underlying condition, including diabetes mellitus, sexually transmitted diseases or chronic inflammation of the cervix, correct diagnosis is essential. Undiagnosed sexually transmitted diseases can cause inflammation of the uterus lining and fallopian tubes, and pelvic inflammatory disease, leading to tubal scarring, infertility and ectopic pregnancies. Therefore it is essential to have confirmed medically that the problem is in fact, vaginal thrush and not another more serious condition that requires medical treatment.... Read More