Womenâ€™s intimate health
Vaginal symptoms tend to be taboo topics but they are surprisingly common, affecting most women at some point in their lives, writes Victoria Goldman...
Three in four women will experience thrush at least once in their lifetime, one in three women will suffer with bacterial vaginosis and one in two women will get symptoms of vaginal dryness after the menopause, according to Bayer, makers of Canesten.
Surveys show that women with these symptoms are often reluctant to seek help from their GP, preferring instead to try to self-diagnose and manage the problem themselves. This may well bring them into their local pharmacy for suitable products, as well as advice.
Vaginitis, also called vulvitis or vulvovaginitis, refers to itchiness, soreness or burning in the vulval area. This may be triggered by an infection, irritation from tampons, allergic dermatitis, the menopause or poor hygiene, and the symptoms may flare up and down depending on the cause. If vaginitis is due to an infection, women may notice some vaginal discharge as well.
“The first step towards managing the symptoms is to see if there are any irritating factors that can be changed or removed,” says Dr Larisa Corda, obstetrician and gynaecologist. “Advise women to use only water to wash their vagina (avoiding soaps and deodorants) and avoid very hot baths with potentially irritating products such as bubble baths.
“Women should also wear natural-fibre underwear, such as cotton, and use a range of alternative sanitary products to tampons if these cause irritation.”
If women have vaginitis for the first time, other symptoms such as abnormal discharge, or simple lifestyle changes aren’t helping, they should be referred to their GP or a sexual health clinic for an assessment.
Treatment will depend on the cause. Women may require emollients and a low-dose topical corticosteroid to treat any inflammation, for example, antibiotics for a sexually transmitted infection or anti-fungals for thrush. Occasionally vaginitis may be associated with diabetes, urinary incontinence or another condition that requires further investigation.
“Thrush can present with vaginitis, as can STDs,” says Dr Corda. “There are also a number of skin conditions that may be responsible, such as eczema and lichen planus. If women have had vaginitis before but this feels different in any way - including vaginal discharge that isn’t normal for them - or they develop any other symptoms such as feeling hot and shivery or pain in their lower tummy, they must see their GP for an examination. Depending on the cause, a GP may consider changing their contraceptive to see if it helps or starting HRT if they are in the menopause.”
Around one in two women aged 45 to 65 have experienced vaginal dryness, according to a new survey from Vagisan. Many women going through the menopause confuse discomfort during sex - the most common sign of vaginal dryness - with vaginal infections such as thrush or cystitis, or simply assume they are no longer attracted to their partner.
Vaginal dryness can also cause burning, pain and itching and an urge to urinary more frequently (which increases the risk of urinary tract infections). Vaginal dryness can have a huge impact on women’s quality of life, with almost three-quarters of women saying it affects their sex life more than it affects their day-to-day activities, according to Vagisan.
The survey revealed that 80 per cent of women are embarrassed to talk about the condition and 50 per cent don’t talk about it at all, with 68 per cent of them not discussing it with their GP. Nearly half of women suffering from vaginal dryness don’t treat it, even though effective treatments are available.
According to Dr Dawn Harper, a GP specialising in women’s health, the symptoms can easily be confused for thrush. “I think vaginal dryness is one of the last taboos,” she says. “It is often the symptom mentioned at the end of a consultation with the hand on the door handle, or even more commonly not mentioned at all until I specifically ask.
“It’s a shame because it is an easy symptom to treat and left untreated can literally wreck relationships, as women recoil from any kind of sexual contact and ultimately any intimacy for fear of painful sex.”
Women are most prone to vaginal dryness during the menopause, but the symptoms can also be triggered by other hormonal changes or chronic conditions such as diabetes or Sjogren’s syndrome.
“Vaginal dryness is usually caused by a relative lack of oestrogen, which is why it is so common around and after the menopause,” says Dr Harper. “It can also be related to a progestogen-dominant contraception or sometimes as a result of treatments like radiotherapy to the pelvis. In most instances it can be very easily treated with OTC non-hormonal preparations or topical oestrogen cream or pessaries.”
If women have mild to moderate symptoms, they may find that using OTC products can help. Pharmacists can advise on the difference between:
· water-based lubricants, which are used during sex to prevent pain and heighten pleasure.
· vaginal moisturisers, which are used on a regular basis (every day or once every two to three days) to ease the dryness.
Vaginal moisturisers rehydrate the dry tissues and lower vaginal pH and can be used by women who aren’t necessarily sexually active. Dr Harper recommends that women try a vaginal cream rather than a gel, as these tend to be more soothing.
If these don’t work, or women have severe symptoms, the pharmacist should refer the customer back to their GP to consider hormonal treatments. Any unusual discharge or bleeding after sex, or between periods, should also be assessed.
“It is not uncommon to find that women on systemic HRT - tablets or patches - still have some vaginal dryness,” says Dr Harper. “In this instance, depending on the severity of the symptoms, I would advise adding in a non-hormonal cream or oestrogen cream or pessary.”
Vaginal discharge changes
Vaginal discharge varies from woman to woman and changes naturally throughout the menstrual cycle and during a woman’s life. According to the NHS website, most women don’t need to worry if their vaginal discharge is clear or white, thick and sticky, slippery and wet and doesn’t have a strong or unpleasant smell. If vaginal discharge is particularly heavy, or women are concerned about any odour, they can use panty liners on a daily basis.
However, any abnormal changes in smell, colour or texture should be discussed with a pharmacist or assessed by a GP, especially if these are associated with pelvic pain or bleeding.
Bacterial vaginosis (BV) and thrush are two common vaginal infections and are easily confused. Both can be caused by changes in the natural balance of the bacteria in the vaginal flora. “It always surprises people to hear that bacterial vaginosis (BV) is actually twice as common as thrush and yet, as a condition, it is much less well known,” says Dr Harper.
“Thrush is caused by a fungal infection, while BV is caused by an imbalance of the normal bacteria living in the vagina. Neither is a sexually transmitted disease but both can be transmitted through sex.”
Thrush causes creamy white, often odourless discharge, soreness during sex or urination, and vaginal itching and irritation. It is more common in women taking antibiotics or those with a weak immune system or undiagnosed or poorly controlled diabetes.
BV doesn’t cause itching or soreness but is characterised by a greyish-white, thin and watery vaginal discharge with a strong fishy odour, particularly after sex. However, around 50 per cent of women with BV don’t have any symptoms.
Women are more likely to develop BV if they are sexually active, have had a change of partner, have an IUD (intrauterine contraception device) and/or use perfumed or medicated products in or around their vagina on a regular basis.
Because BV and thrush have different causes, these infections need to be diagnosed before they can be treated, unless the cause is clear from the symptoms.
“Both conditions make women feel miserable, and the sooner they are diagnosed the quicker they can get back to normal,” says Dr Harper.
“Unfortunately they often recur, so although women may need a swab to confirm a first diagnosis, recurrent infections can often be managed by a trip to a pharmacy rather than waiting for a GP appointment.”
If women have thrush they will need an antifungal medicine – either a cream, pessary or oral tablet – and the infection should clear up within a week. BV is usually treated with antibiotic tablets or lactic acid gels or creams that regulate the pH balance of the vagina.
Customers should be warned that some creams can damage latex condoms and diaphragms, which mean these contraceptive methods won’t work.
If women are under 16 or over 60, have symptoms of thrush or BV for the first time, their symptoms keep coming back or they are pregnant or breastfeeding, they must consult their doctor. There is a small chance that BV can cause pregnancy complications.
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