Let’s talk about some of the health problems that people with vaginas can encounter and what the signs are that it may be time to talk with a medical professional. In many ways vaginas are like ecosystems: if one species overgrows or goes extinct, the whole system can be thrown off. The vaginal ecosystem is not made up of animals and plants but of bacteria, your body’s own blood and tissue cells, and fungi. When this system is thrown off, infection can result. Although we’re used to thinking of bacteria as harmful, we’re learning more and more every day about the important role they play in our lives and health. We’re actually all covered in bacteria! Every part of our skin and all of our organs--teeming with bacteria. Most of this bacteria does NOT cause disease and actually helps us go about our lives. For example, your intestines have lots of bacteria that help you digest food. If you’ve ever taken a probiotic to help with digestion, you’ve essentially swallowed extra bacteria in the hopes they’ll stay and set up shop in your intestines.
Your vagina, as it turns out, is also home to a lot of bacteria. When your vagina is healthy there are many helpful bacteria (“lactobacilli,” to be specific) that produce lactic acid. This acid is thought to discourage the growth of bad bacteria. When something happens so that there are fewer of the helpful bacteria and more of the bad bacteria, an infection can result and the acidity, or pH, of the vagina can change. This can cause a change in odor, the discharge produced, and/or sensation. Two of the most common vaginal infections are candidiasis (yeast infections) and bacterial vaginosis.
Yeast: a yeast infection happens when a fungus called yeast overgrows in the vagina. Low levels of yeast may be present in a healthy vagina, but when conditions are right for the yeast to increase and overgrow, the vagina may become irritated. Yeast can feel like having a sore, raw, dry, itchy, burny/stingy, irritated vagina. You might have a clumpy discharge that looks like cottage cheese; some people get watery discharge; and it can be white, yellow, pink, brown, or even bright green! If the infection lasts a while or you scratch hard enough, you might get small cuts or sores on the vulva or vagina. Sometimes people experience swelling or redness of the vulva and groin. Going pee and having sex will likely be painful. Luckily, yeast infections are pretty easy to treat. You can buy over-the-counter medications at the pharmacy like Monistat or Azo, or you can go to a healthcare professional for a prescription pill or cream. If these don’t help or you notice you keep getting yeast infections, talk to your health professional about other options like boric acid or obtaining a yeast culture.
Yeast infections can be triggered by an increase in estrogen (due to hormone use, pregnancy, or where you are in your cycle), an increase in moisture (yeast infections increase in the summer, when everyone is hot and sweaty or going swimming more often), an increase in sugar in the urine due to uncontrolled diabetes, a problem with the immune system, the vagina coming into direct contact with sugar, saliva, or scented products, or contact with someone else’s genital bacteria. Sometimes bodies have different kinds of bacteria that aren’t compatible, which can lead to imbalances. People with penises can get yeast infections too, which we call balanitis. Yeast infections in the mouth, which are much less common, are called thrush. That being said, please know that yeast infections are not contagious or sexually-transmitted.
Some ways to avoid yeast infections include changing underwear daily and wearing cotton underwear, changing out of any wet clothing or bathing suits as soon as possible, taking good care of your immune system and making sure to treat any other medical conditions, avoiding scented products, and having everyone involved rinse their genitals off with water before and after sex.
Bacterial Vaginosis: while most people have probably heard of yeast infections, bacterial vaginosis or BV might be a new term for you. In reality, BV is the most common kind of vaginal infection. Bacterial vaginosis happens when there are more disease-causing bacteria than helpful bacteria, leading to an increase in vaginal pH (so, a less acidic vagina). People with BV often complain of a strong unpleasant, fishy odor and an unusual amount of white or gray discharge. Sometimes the discharge is creamy like lotion; sometimes it’s more runny and watery. BV can cause some irritation but often does not cause pain or itching the way another kind of infection might.
BV is easy to treat in the short-term, but long-term cures for repeat infections are still desperately needed. For BV your healthcare provider might prescribe antibiotics (either a pill you swallow or a gel that goes inside the vagina) for about a week. The most common kind of antibiotic for BV is called metronidazole (pronounced meh-tro-nai-duh-zal) or flagyl (pronounced flah-jil). The pill form can cause your stomach to be upset and some people report it tastes very bitter/metallic; this can be helped by eating before you take it and eating a bit of yogurt right after you take the pill. It is very important to not drink alcohol while taking the metronidazole pill, as that combination can make you VERY ill. The gel form can cause some odd discharge from the vagina while you’re using it; some people use pantyliners while using the gel to absorb this discharge.
Some people who get BV often prefer the pill or the gel form for different reasons. Some people may use the gel a few times a week for many months to help with BV that keeps coming back. Some other treatments available over-the-counter for BV include oral probiotics, vaginal boric acid (important: do not swallow boric acid or have someone perform oral sex on you while you’re using it, as it’s toxic when ingested), and vaginal spermicide (especially a new spermicidal gel, Phexxi, which may help lower vaginal pH). Some people use boric acid after their periods or after sex, when vaginal pH may be high. Some people use boric acid and probiotics at the same time as metronidazole, as the boric acid can help the medication penetrate the disease-causing bacteria better and the probiotics may encourage growth of the helpful bacteria. Some people have to experiment with their birth / menstrual control method or have fewer sexual partners in order to control BV.
Ways to prevent BV include not using soap in the vagina, avoiding douching or using “feminine washes,” like Summer’s Eve, using unscented period products, wearing cotton underwear that you change daily, rinsing with water after sex especially if you came into contact with any semen, and supporting your overall health with nutrition, movement, sleep, and stress reduction. BV can be a very frustrating and isolating experience, especially if it comes back after treatment. Please know that you are not alone, you are not dirty, and you did not cause this infection. Because of the patriarchy, this condition has not gotten nearly the amount of medical research it deserves and healthcare must do better to serve people with vulvas.
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