Vagina's Problems

Causes of Vaginal Dryness A woman's vagina naturally produces a clear, relatively odorless vaginal lubrication that assists in sexual penetration. How much lubricant is produced is influenced by a number of different factors and varies from woman to woman. Factors that can influence vaginal dryness are:

• Intercourse
• Diaphragms
• Antidepressants
• Antihistamines/decongestants
• Antibiotics
• Chemotherapy
• Radiation
• Allergens such as dyes and fragrances in toilet paper and laundry detergent
• Drying soaps
• Douches
• Tampons
• Condoms

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Low Estrogen and Vaginal Dryness

For most women, however, vaginal dryness is a direct result of lower estrogen levels that occur naturally during menopause, after the ovaries are removed and at other times in life. Estrogen causes the vagina to thicken. When estrogen decreases, the tissues of the vagina naturally thin, become less elastic, drier and more fragile.

Low estrogen levels may result from:

• Menopause, perimenopause, postmenopause
• Hysterectomy and related surgeries
• Menstrual cycle changes
• Pregnancy
• Childbirth
• Nursing
• Some hormonal contraceptives
• Endometriosis drugs
• Infertility drugs
• Stress, fatigue
• Rigorous exercise

Over 80% of women suffer from vaginal dryness during perimenopause and beyond. For women who stop using HRT, vaginal dryness may be especially difficult.

Treatment Options

Whatever the cause or severity, you don't need to live with symptoms such as vaginal itching, burning, irritation and pain. Whether constant or intercourse-related, these symptoms should be brought to the attention of your health care provider.

Self-care

Women have several options for improving vaginal dryness and increasing the health of vaginal tissue without a prescription and without using hormones. Self-care basics include increasing your water intake to be sure your entire body is properly hydrated and avoiding certain products that may increase dryness or irritate sensitive vaginal tissue. These include soaps, detergents, bubble bath, douches, feminine sprays and other products with allergens, dyes and fragrances. Kegel exercises may help increase circulation to the pelvic area to keep tissue healthy and strong. Regular sexual activity can also help boost your body’s ability to produce vaginal moisture even after menopause.
Water-based Lubricants. If dryness is a problem during sexual intercourse, a water-based lubricant like Astroglide can increase vaginal comfort. Always use a personal lubricant that's water-based and water-soluble, and slightly acidic (pH balanced) to match normal body fluids. This slight acidity helps inhibit the growth of harmful microorganisms, particularly yeast. Never use a petroleum-based product, petroleum jelly, mineral oil or edible oil in place of a good personal lubricant. These can adhere to vaginal walls, masking infections and providing a place for harmful organisms to multiply. They can also damage latex condoms and diaphragms, compromising their effectiveness for safe sex or birth control.
Moisturizing Creams. Although lubricants are fine for occasional dryness during intercourse, vaginal moisturizing creams are formulated to help improve the health of vaginal tissues and moisturize the vagina for a longer period of time. Some formulas include phytoestrogens that may help to naturally replenish declining estrogen levels. Generally, a small of amount of these creams is applied two or three times a week. Moisturizers may also help maintain the acidic environment in the vagina and decrease infections.
We have created a collection of products you can use to help improve your vaginal health.

Treatment Options

Whatever the cause or severity, you don't need to live with symptoms such as vaginal itching, burning, irritation and pain. Whether constant or intercourse-related, these symptoms should be brought to the attention of your health care provider.

Self-care

Women have several options for improving vaginal dryness and increasing the health of vaginal tissue without a prescription and without using hormones. Self-care basics include increasing your water intake to be sure your entire body is properly hydrated and avoiding certain products that may increase dryness or irritate sensitive vaginal tissue. These include soaps, detergents, bubble bath, douches, feminine sprays and other products with allergens, dyes and fragrances. Kegel exercises may help increase circulation to the pelvic area to keep tissue healthy and strong. Regular sexual activity can also help boost your body’s ability to produce vaginal moisture even after menopause.
Water-based Lubricants. If dryness is a problem during sexual intercourse, a water-based lubricant like Astroglide can increase vaginal comfort. Always use a personal lubricant that's water-based and water-soluble, and slightly acidic (pH balanced) to match normal body fluids. This slight acidity helps inhibit the growth of harmful microorganisms, particularly yeast. Never use a petroleum-based product, petroleum jelly, mineral oil or edible oil in place of a good personal lubricant. These can adhere to vaginal walls, masking infections and providing a place for harmful organisms to multiply. They can also damage latex condoms and diaphragms, compromising their effectiveness for safe sex or birth control.
Moisturizing Creams. Although lubricants are fine for occasional dryness during intercourse, vaginal moisturizing creams are formulated to help improve the health of vaginal tissues and moisturize the vagina for a longer period of time. Some formulas include phytoestrogens that may help to naturally replenish declining estrogen levels. Generally, a small of amount of these creams is applied two or three times a week. Moisturizers may also help maintain the acidic environment in the vagina and decrease infections.
We have created a collection of products you can use to help improve your vaginal health.

Treatment Options

Whatever the cause or severity, you don't need to live with symptoms such as vaginal itching, burning, irritation and pain. Whether constant or intercourse-related, these symptoms should be brought to the attention of your health care provider.

Self-care

Women have several options for improving vaginal dryness and increasing the health of vaginal tissue without a prescription and without using hormones. Self-care basics include increasing your water intake to be sure your entire body is properly hydrated and avoiding certain products that may increase dryness or irritate sensitive vaginal tissue. These include soaps, detergents, bubble bath, douches, feminine sprays and other products with allergens, dyes and fragrances. Kegel exercises may help increase circulation to the pelvic area to keep tissue healthy and strong. Regular sexual activity can also help boost your body’s ability to produce vaginal moisture even after menopause.
Water-based Lubricants. If dryness is a problem during sexual intercourse, a water-based lubricant like Astroglide can increase vaginal comfort. Always use a personal lubricant that's water-based and water-soluble, and slightly acidic (pH balanced) to match normal body fluids. This slight acidity helps inhibit the growth of harmful microorganisms, particularly yeast. Never use a petroleum-based product, petroleum jelly, mineral oil or edible oil in place of a good personal lubricant. These can adhere to vaginal walls, masking infections and providing a place for harmful organisms to multiply. They can also damage latex condoms and diaphragms, compromising their effectiveness for safe sex or birth control.
Moisturizing Creams. Although lubricants are fine for occasional dryness during intercourse, vaginal moisturizing creams are formulated to help improve the health of vaginal tissues and moisturize the vagina for a longer period of time. Some formulas include phytoestrogens that may help to naturally replenish declining estrogen levels. Generally, a small of amount of these creams is applied two or three times a week. Moisturizers may also help maintain the acidic environment in the vagina and decrease infections.
We have created a collection of products you can use to help improve your vaginal health.

Prescription Therapy

Several prescription options are available for vaginal comfort and health. Conventional hormone replacement therapy (HRT) can be used to treat vaginal dryness and thinning associated with low estrogen as well as many other symptoms of menopause such as hot flashes and night sweats. However, your doctor may suggest localized estrogen therapy if your main concern is vaginal comfort and health. Localized therapy can:

• Help maintain muscle tone of the vagina and urethra.
• Reduce vaginal dryness, irritation, and pain.
• Reduce urinary tract irritation and tendency toward infection.

Options for localized estrogen therapy delivered directly to the vaginal area include topical estrogen creams, vaginal estradiol rings and a vaginal tablet, all available from Madison Pharmacy Associates.

Discharge

A small amount of clear or slightly milky vaginal discharge is normal. It acts as a lubricant and keeps the vagina healthy. There may be more discharge on certain days of the menstrual cycle. If there is much more discharge than normal, or it is discoloured or smelly, then it could be thrush (candida), gardnerella, or a sexually transmitted infection. Infections that cause a change in discharge:

• Gardnerella - a greyish, foamy discharge, with a strong fishy smell
• Candida (thrush) - a thick creamy whitish discharge, with a yeasty smell
• Chlamydia - increased vaginal discharge
• Gonorrhoea - yellow or greenish discharge with a strong smell
• Trichomonas (TV) - a frothy discharge, sometimes a yellowy-green colour

Gardnerella (bacterial vaginosis) is caused by an overgrowth of bacteria that naturally live in the vagina. After a swab test to confirm the infection, it can easily be treated with antibiotics.

Soreness and itching

This can be sometimes caused by perfumes, strong soaps, nylon underwear, and tight fitting trousers. Use a mild, unperfumed soap when you wash, and steer clear of vaginal deodorants and talcs - they can irritate the area and make things worse. Women and girls who use tampons during periods have to remember to change them frequently and shouldn't forget to remove the last one when the period is over. Anyone who suffers from skin conditions like psoriasis may find that they can affect the groin area too. It could also be caused by thrush or sexually transmitted diseases such as chlamydia, genital herpes, warts, pubic lice, gonorrhoea, or trichomonas.

Lumps and bumps

Common causes of lumps and bumps are ingrowing hairs, acne spots, and blocked glands. Sexually transmitted diseases such as warts, scabies, syphilis, and herpes blisters may be the reason too. If you think you might have a sexually transmitted infection, sort it out straight away. Go to a genitourinary medicine (GUM) clinic, available at most large hospitals. GUM clinics give free and confidential advice and treatment. Or you can make an appointment to see your GP. You reduce your risk of infection by avoiding unsafe sex and using condoms.

Vaginal Infections Overview

Vaginal infections, or vaginitis is an inflammation of the vagina that creates discharge, odor, irritation, or itching. It is difficult to diagnose because vaginitis has many causes. Women use a variety of over-the-counter medications to treat the itching, discharge, and discomfort of these conditions.

• The vagina creates its own environment and maintains a balance among the normal bacteria found there and the hormonal changes in a woman's body. Vaginitis occurs when the vaginal ecosystem has been changed by certain medications such as antibiotics, hormones, contraceptive preparations (oral and topical), douches, vaginal medication, sexual intercourse, sexually transmitted diseases, stress, and change in sexual partners.

• Some vaginal infections are transmitted through sexual contact, but others such as yeast infections probably are not. Vaginitis means inflammation and is often caused by infections, but may be due to hormonal changes (especially when a woman is going through menopause) or due to trauma in young girls. Some infections are associated with more serious diseases.

• Three vaginal infections are the most common. Their causes are quite different, their symptoms similar, and treatment varies.
• Bacterial vaginosis
• Vaginal yeast infection
• Trichomoniasis

• Many women often mistakenly think they have a "yeast infection" and treat themselves when, in fact, they have a similar vaginal infection that will not respond to self-treatment with over-the-counter yeast medications. A recent study by the American Social Health Association found that 70% of women self-treated vaginal infections before calling a health care provider. Most often, they incorrectly thought they had a yeast infection when, in fact, it was bacterial vaginosis.

• The important thing is not to guess, but to recognize the symptoms if you develop a vaginal infection. See your health care provider for precise testing and to get the most appropriate and effective treatment right away.

Yeast infections

Yeast infections are a type of vaginitis. The hallmark symptom of a yeast infection is itching of the external and internal genitalia, which is often associated with a white discharge that can be thick and/or curdy (like cottage cheese). Severe infections lead to inflammation of the tissue and subsequent redness, swelling, and even pinpoint bleeding.

Yeast infections (vaginal candidiasis) can be treated either with oral antifungal medications (e.g. fluconazole [Diflucan®]) or topical antifungal medications (e.g., miconazole [Monistat®], clotrimazole [Gyne-Lotrimin®]). Doctors often prescribe antifungal medications for insertion into the vagina, either as a cream using a special applicator or as a suppository, for three to seven nights. Antifungal cream may be applied topically to the vulva (external genitalia) to help relieve itching.

Some doctors believe that a well-balanced diet low in fats, sugars, and refined foods is important for preventing vaginal infections caused by Candida. In one preliminary trial, avoidance of sugar, dairy products, and artificial sweeteners resulted in a sharp reduction in the incidence and severity of Candida vaginitis.¹ Many doctors advise women who have a yeast infection (or are predisposed to such infections), to limit their intake of sugar, fruit juices, and refined carbohydrates. For persistent or recurrent infections, some doctors recommend that fruit also be avoided.
Another trial found that dramatic increases in intake of several sugars in healthy people partially increased stool sample levels of Candida, but only in 12 out of 28 people.²
According to one study, yeast infections are three times more common in women who wear nylon underwear or tights, than in those who wear cotton underwear.³ Additional predisposing factors for Candida infection include the use of antibiotics, oral contraceptives, or adrenal corticosteroids (such as prednisone).
Underlying health conditions that may predispose someone to Candida overgrowth include pregnancy, diabetes, and HIV infection. Allergies have also been reported to promote the development of recurrent yeast vaginitis. In a preliminary trial, when the allergens were avoided and the allergies treated, the chronic recurrent yeast infections frequently resolved.⁴ In most cases, sexual transmission does not play a role in yeast infection. However, in persistent cases, sexual transmission should be considered, and the sexual partner should be examined and treated.
Lactobacillus acidophilus is a species of friendly bacteria that is an integral part of normal vaginal flora. Lactobacilli help to maintain the vaginal ecosystem by preventing the overgrowth of unfriendly bacteria and Candida. Lactobacilli produce lactic acid, which acts like a natural antibiotic.
Lactobacillus acidophilus can be taken orally in the form of acidophilus yogurt, or in capsules or powder. It can also be administered vaginally. In a controlled trial, women who consumed 8 ounces of Lactobacillus acidophilus-containing yogurt per day had a threefold decrease in the incidence of vaginal yeast infections and a reduction in the frequency of Candida colonization in the vagina.⁵ In another trial, women who were predisposed to vaginal Candida infection because they were HIV-positive received either Lactobacillus acidophilus vaginal suppositories, the antifungal drug, clotrimazole (e.g., Gyne-Lotrimin®), or placebo weekly for 21 months.⁶ Compared to those receiving placebo, women receiving Lactobacillus acidophilus suppositories had only half the risk of experiencing an episode of Candida vaginitis—a result almost as good as that achieved with clotrimazole.
Many women find relief using an acidophilus-containing yogurt douche daily for a few days or weeks, depending on the severity of the infection.⁷ Three capsules of acidophilus or one-quarter teaspoon of powder can be taken orally one to three times daily. Acidophilus can also be taken preventively during antibiotic use to reduce the risk of Candida vaginitis.^{8 9}
Boric acid capsules inserted in the vagina have been used successfully as a treatment for vaginal yeast infections. One study demonstrated that 85% of women who used boric acid vaginal suppositories were cured of chronic recurring yeast vaginitis.¹⁰ These women had all previously failed to respond to treatment with conventional antifungal medicines. The suppositories, which contained 600 mg of boric acid, were inserted vaginally twice a day for two weeks, then continued for an additional two weeks if necessary. Boric acid should never be swallowed.
A small, preliminary trial found that a mouthwash with diluted tea tree oil was effective in decreasing the growth of Candida albicans and in improving symptoms in AIDS patients with oral Candida infections (thrush) that had not responded to drug therapy.¹¹ People in the study took 15 ml of the oral solution (dilution of tea tree oil was not given) four times per day and were instructed to swish it in their mouth for 30 to 60 seconds and then spit it out. For use of tea tree oil as a mouthwash, one should not exceed a 5% dilution and should be extremely careful not to swallow the solution.
Many doctors recommend that people with recurrent yeast infections take measures to support their immune system. Echinacea, which has the capacity to enhance immune function, is often used by people who suffer from recurrent infections. In one study, women who took echinacea experienced a 43% decline in the recurrence rate of yeast infections.¹²
The essential oil of cinnamon contains various chemicals that are believed to be responsible for cinnamon’s medicinal effects. Important among these compounds are eugenol and cinnamaldehyde. Cinnamaldehyde and cinnamon oil vapors exhibit extremely potent antifungal properties in test tubes.¹³ In a preliminary study in people with AIDS, topical application of cinnamon oil was effective against oral thrush.¹⁴
A test tube study demonstrated that oil of oregano, and an extract in the oil called carvacrol in particular, inhibited the growth of Candida albicans far more effectively than a commonly employed antifungal agent called calcium magnesium caprylate.¹⁵ However, clinical studies are needed to confirm these actions in humans.