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Vaginal Health

The vagina is often referred to as a "self-cleaning oven," and rightly so. Less is more when it comes to keeping your vagina helpful. What's important is to know what's normal and when things may be off—and when to seek care.

What keeps a vagina healthy? Like many things in life, it’s all about balance. In a healthy vagina, there is a balance among many kinds of bacteria. That’s right—a healthy vagina is full of bacteria. Some kinds of bacteria are considered “good” while others are “bad.” Good bacteria help keep the vagina a little bit acidic. This keeps bad bacteria from growing too fast. Sometimes, though, the bad bacteria can take over and cause problems.

What can cause bacteria to get out of balance? Lots of things. Among them are antibiotics, douching, tight pants, vaginal products (sprays, lubricants, birth control devices), and pregnancy.

One sign that things are out of balance is discharge. Vaginal discharge isn’t always a problem—a healthy vagina does makes a discharge—slippery and clear or whitish when moist, may turn yellowish when dried, and has little odor. This healthy discharge may also be thicker during some parts of the month. Unhealthy discharge is different. It often has an odd color (yellow, greenish, gray or thick white) and may also have strong, unpleasant odor.

Discharge isn’t the only sign to watch out for, though. Swelling, itching or burning in and around the vagina can also signal a problem. These symptoms are referred to as vaginitis, a broad term to describe different types of vaginal infections. Vaginitis is very common, and most women will have vaginitis at some point in their lives—possibly several times.

While vaginitis can be caused by a sexually transmitted infection, like trichomoniasis, it is more often the result of an imbalance of bacteria. Two of the more common types of vaginitis are yeast infections and bacterial vaginosis (BV).

While yeast infections and BV have some similar symptoms—discharge, redness and irritation, odor—they are different infections, and need to be treated differently. A yeast infection is caused by a fungus called candida, which (like bacteria) is normally found in the vagina. Specific bacteria in the vagina (lactobacillus) help prevent an overgrowth of yeast. But when that bacterial balance is upset, the result can be an overgrowth of yeast. BV is also caused by an imbalance—again, when the “bad” bacteria greatly outnumber the “good.”

Treating Problems

Before you consider treatment for any vaginal problems, it’s important to know exactly what you’re dealing with. A healthcare provider can properly diagnose the cause of vaginitis and ensure you get the right treatment. While it can be tempting to self-diagnose and self-treat with over-the-counter products or natural remedies, many women misdiagnose the problem. In a recent survey conducted by ASHA, about 62% of women mistook BV for a yeast infection prior to diagnosis.

Correct diagnosis is important. Left undiagnosed and untreated, BV can increase a woman’s risk of sexually transmitted infections (STIs), including HIV. Pregnant women can face additional problems, as BV may cause babies to be born early or with low birth weight.

To help diagnose what’s causing vaginitis, a healthcare provider will likely perform an exam and take a sample of vaginal discharge. They may examine the sample under a microscope in the office or send it to a lab to be tested.

Yeast infections can be treated with over-the-counter medications or prescription antifungals. Treatment for BV requires a prescription antibiotic by a healthcare provider. There are different options—including a gel or cream that can be inserted into the vagina, or medications that are taken orally. Some medications need to be taken over several days, while one newer treatment requires only a single dose.

Even when treatment works, BV can come back. It’s common for women to get BV again within a year of being treated. If BV does recur, a healthcare provider may suggest a long-term treatment strategy.

If you have symptoms of vaginitis, see your healthcare provider for a correct diagnosis. To help your provider find out what you have, prepare for the exam by following these tips:

  • Schedule the exam when you’re not having your monthly period.
  • Don’t douche 24 hours before your exam.
  • Don’t use vaginal sprays 24 hours before your exam.
  • If you have sex less than 24 hours before the exam, use condoms.

Keeping Your Vagina Healthy

The vagina is designed to keep itself clean with natural, healthy vaginal secretions. You can keep your vagina healthy with the same things that keep your whole body healthy—regular hygiene and a good diet. There are some basic dos and don’ts you can follow:
  • DON’T douche—it upsets the natural balance of the vagina. Most doctors and the American College of Obstetricians and Gynecologists (ACOG) suggest that women steer clear of douching. Douching may make a woman more prone to vaginal infections.
  • DO wash your vaginal area with mild, unscented soap. There is no need to use anything special to clean the vulva and vagina. Rinse well and pat dry.
  • DO wipe your vagina and anus from front to back to avoid spreading germs.
  • DO take antibiotic medicine only when needed. Antibiotics can kill “good” bacteria in the vagina.
  • DO try to stay as dry as possible. To reduce sweating and moisture, wear cotton or cotton-lined underpants and avoid tight pants.

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