Emmanuel K. Essel, M.D.

Obstetrician Gynecologist

5040 Oberlin Avenue

Lorain, Ohio

Vaginal Infections - Know How to Identify them and Seek Treatment

I often overheard my sister Mary and her friends talk among themselves in hush tones about "discharge" many times. These were college students in their twenties. They were ashamed to talk about what ailed them. My sister's friend went to see her doctor and told him she had discharge. The doctor prescribed some medication for yeast infection. Of course she did not improve.

Vaginal infections are some of the commonest reasons for a woman to visit her gynecologist and yet only a few women know about it. A recent Gallup survey showed only a few women had any understanding of vaginal infections. While 95% of surveyed women knew about yeast infection, only 34% knew about bacterial vaginosis. Thirty seven percent had heard of Trichomonas vaginalis infection.

The normal vagina may be considered as a well kept lake with a clean pool of water. You can see the bottom of the lake through the crystal clean water. The water has no odor and its banks may be adorned with shrubs, plants and flowers that may be salubrious to the eye. In a neglected lake, the water turns dirty and begins to smell, the fishes begin to die, and the plants on its banks become stunted and wither.

The normal vagina has protective germs called Lactobacilli. These germs maintain the vaginal environment acidic. Acidity prevents overgrowth of harmful germs in the vagina. Anything that interferes with the Lactobacilli in the vagina may change the acidic environment to more alkaline. This may promote the growth of harmful germs in the vagina.

Antibiotics may kill some of the Lactobacilli and encourage the growth of yeast cells. Pregnancy, Diabetes Mellitus and Human Immunodeficiency virus (HIV) can also encourage the growth of yeast infection. The worst type of vaginal abuse is for a woman to have sex with an infected male partner. This will inoculate the vagina directly with the harmful germs which may cause disease.

Types of vaginal infections:

The three most common types of vaginal infections are Bacterial vaginosis, (BV), yeast infection and Trichomonas vaginalis infection. Bacterial vaginosis: This is the most common vaginal infection. It occurs mainly in sexually active women but may also affect virgins too. It is debatable whether it is transmitted sexually or not. BV has been associated with Pelvic inflammatory disease (PID), inflammation of the cervix, the uterine cavity, mildly abnormal Pap smear and premature labor.

Patients usually complain of increased creamish, whitish thin vaginal discharge which "smells like fish" especially after sexual intercourse. They may also itch and have irritation at the vulva, the entrance of the vagina. I make the diagnosis from the history, examination and microscopy. To examine the vagina, I insert an instrument called a speculum into the vagina to observe the walls for any signs of inflammation, the color of the discharge and its associated odor. The cervix is examined for infection. If I suspect infection, I do cervical cultures to rule out gonorrhea and Chlamydia infections. The mainstay of diagnosis is looking at the discharge under the microscope to discover the tell tale "clue cells." The fishy odor may also be reproduced by adding a non acidic solution, ten percent hydrogen peroxide to a drop of the discharge on a glass slide.

Yeast Infection:

It is the second most common vaginal infection and accounts for many telephone calls to our office. The vagina, the mouth and the intestinal tract contain small amounts of yeast cells. Pregnancy, antibiotics, diabetes mellitus and the human Immunodeficiency virus can cause overgrowth of the yeast cells.

The patient typically complains of "cottage cheese-like" discharge with no odor. They have intense itch at the vaginal entrance. Examination of these patients may show redness and scratch marks at the vulva. The vagina also displays the thick white curdy "cottage cheese- like" discharge which stick to the walls like yeast infection in the mouths of babies. Microscopy confirms the diagnosis by disclosing the yeast cells.

Trichomonas vaginalis vaginal infection:

This infection is also common. It is sexually transmitted and may coexist with other sexually transmitted diseases (STDs) like Chlamydia and Gonorrhea. Studies show it is diagnosed in 50-75% of prostitutes, 5-15% of women visiting gynecology clinics, 7-32% of women in STD clinics and 5% of women in family planning clinics.

The patient may complain of yellowish, green frothy discharge which may also smell like fish. The discharge itches intensely and may cause painful urination and painful intercourse. Examination shows the foamy yellowish greenish discharge in the vagina. The walls of the vagina are usually intensely inflamed. Microscopy shows the offending agent, Trichomonas vaginalis.


The good news is that treatment is available for these infections. Yeast infection can be treated with creams or tablets. The treatment of Trichomonas vaginalis and BV are similar. The patient's sexual partner has to be treated if she has the former disease. The partners of patients with BV need not be treated unless they have recurrent infections.

Some women may not inform their gynecologists or clinicians about vaginal discharge. They may be embarrassed about the fishy odor and assume that screening for vaginal infection would automatically be part of the examination. Other women believe that the Pap smear screens for vaginal infections and hence their physicians need not be informed of the discharge.

Douching is not an acceptable treatment for an unpleasant vaginal discharge. It may clean the vagina temporarily, but will not cure the disease. It may also spread the disease into the uterus and into the pelvic cavity and set up generalized inflammation of the pelvis (Pelvis Inflammatory Disease).

If the discharge is white, cheesy thick and has no odor, you most probably have yeast infection. Over the counter monistat may help. When the infection recurs frequently, you must seek medical assistance to exclude other vaginal infections or such diseases as diabetes mellitus and HIV. If it is yellowish, creamish or greenish with an odor and an itch, it is imperative you see your gynecologist or clinician to make the diagnosis and give you the appropriate treatment. This is important since there may be other infections like Chlamydia and Gonorrhea.

Above all, take good care of your vagina. It is one of the most precious organs you possess. If you get yeast infection whenever you take antibiotics, inform your doctor so he gives you medication for yeast infection at the same time. If you are sexually active and not involved in stable relationship, encourage your partner to use condoms or you should invest in the female condom. Your clinicians are there to help you. If you don't tell them what ails you they may not be able to help you.

Manny Essel

Copyright (c) 1996 Alexander H. Boye-Doe, M.D. Inc.

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