In June we have been focusing on Women’s Health, and today’s topic is vaginal health. It is a topic not commonly discussed due to the sensitivity of the subject, but it is very important to know and to openly discuss in a professional manner.
The five major areas of possible concern are yeast infections (medically termed vaginal candidiasis from the name of the yeast that causes it), cervical pre-cancerous and cancerous changes, urinary tract infections, dryness of the vagina during and post menopause, and (usually later in life) possible cancerous changes of the outer vagina.
Let’s start with the yeast infection. It is caused by yeast called Candida albicans. It’s a normal inhabitant of the vagina in most women but normally it is kept in check by the invisible good bacterial flora such as the lactobacilli. When this healthy flora is hindered, the Candida has “room” to multiply and flourish. Such disturbances to the normal bacterial flora can be caused by frequent lavages with a detergent, the use of antibiotics, or a weakened immune system. A weakened immune system can be the consequence of improper diet and/or supplementation, exposure to toxins, and in more severe cases due to medical conditions such as diabetes or HIV.
A candida infection cases a white gelatinous discharge as well as irritation to the vaginal walls and the cervix, making both more susceptible to infections. Such infections may even be in the form of human papilloma virus, which is the cause of most cervical cancers. Finally, Candida also makes an unfriendly environment for sperm, making this infection a significant hindrance to insemination and the initiation of pregnancy.
There are many effective anti-fungal medications for Candidiasis. Unfortunately, the oral ones have a negative impact on the liver. The local suppository ones are very effective and are minimally absorbed into the blood, thus being much less toxic to internal organs. However, these pills and suppositories also kill the good bacteria such as lactobacilli. This may be problematic as the lactobacilli keep the pH of the vagina at a proper level. Killing off the lactobacilli also leaves room for Candida to return once the treatment is completed.
There is a very simple remedy that solves this dilemma. Simply soaking a tampon in kefir or sour milk will provide a healthy dose of good bacteria, making less room for Candida to thrive. Dip the tampon to make sure that it is covered with the kefir or sour milk. The tampon should not be left in place for more than 8 hours, but the procedure may be repeated to increase the effectiveness of this method. It may not be as effective as anti-fungals for a full blown infection, but applying this therapy prophylactically will substantially decrease the chances of getting the infection in the first place. It is also great right after anti-fungal treatment for the replenishment of the healthy vaginal flora.
With regards to the cervix, the major concern is cervical cancer. This happens due to an infection with human papilloma virus (HPV). This virus is sexually transmitted. The risk of such an infection increases when one has intimate contact with multiple sexual partners, when practicing unprotected sex with a partner of unknown sexual history, and when cigarette smoking. Smoking has a direct effect on cervical cancer through its carcinogens, but it also makes the cervix more favorable for the papilloma virus to infect as well as for the virus to cause cancerous changes.
With the advent of the Papanicolaou test (Pap smear), the rate of cervical cancer has dropped dramatically in developed countries. What is a little bit perplexing is the recommendation as to the age when the test should be first done and the frequency of retesting. The most logical approach is to begin the test at the age of 21 or 1 to 2 years after first intercourse. The test should be performed every three years if there were no negative changes during the previous tests. This can be increased to every five years if three tests in sequence come back negative. If the test comes back positive, medical measures should be undertaken (the nature of which depend on the severity of the changes) and the Pap smear should be done every year thereafter for at least five years.
Although the test is not recommended for someone that has never been sexually active, there is a slight chance that the person may acquire cancerous changes due to cigarette smoke or just spontaneously. In this case, I recommend doing the first test at the age of 25 and then every five years thereafter. The test is also not recommended for individuals past the age of 65. But again if someone is sexually active at that age (especially when there are multiple sexual partners and/or the person is a smoker) the tests should continue.
Urinary Tract Infections
With regards to urinary tract infections (UTIs), vaginal hygiene is very important. The reason for this is simply that the urethra empties on the upper portion of the outer vagina. Frequent washing with soap is important. Make sure that the soap is made from natural sources and does not contain paraben (check out my blog article on paraben). I do not recommend lavages or douches since they wash out the good probiotic flora, making it more favorable for a yeast infection to occur. It is also important that the sexual partner keeps good genital hygiene, as it is very common for the partner to introduce the bad bacteria that cause UTIs. Drinking cranberry juice (unsweetened) or taking cranberry extract is also excellent for prevention of UTIs and for shortening their duration once they occur. Cranberries contain compounds that hinder the attachment of bacteria to the inner lining of the genito-urinary tract. Finally with regards to wiping, it is important to wipe away from the vagina and not towards it. For obvious reasons wiping towards the vagina may introduce bacteria normally present in the colon, which can cause UTIs.
Dryness of the vagina during menopause or post menopause can be problematic for women with regards to general comfort as well as during sexual intercourse. This can be resolved by using natural lubricants and estrogen creams (again pay attention that they do not contain a long list of chemical names that are difficult to pronounce). Estrogen creams get absorbed through the skin and though the mucosal surfaces of the vagina, but this absorption happens to such a small extent that it practically poses no risk with regards to estrogen exposure (i.e. breast cancer, endometrial cancer or increased coagulability of blood). Simply put, estrogen creams cannot be compared to hormonal replacement therapy. Furthermore such creams can be very effective as it is the drop in the natural estrogen, during and post-menopause, that causes vaginal dryness in the first place.
With regards to cancers of the outer vagina (the part of the vagina visible on the outside, in contrast to the inner vagina leading towards the uterus), these cancers usually occur later in life. Therefore, it is important to examine the vagina on a regular basis. Any suspicious growth or hardened areas on the surface or under the skin should be quickly examined by a gynecologist. Also any change in pigmentation of the vagina or the surrounding skin should also be quickly examined as this may be the first sign of melanoma (an aggressive cancer of the pigment cells).
As a final note, although not directly related to vaginal health, any vaginal bleeding past menopause should be quickly examined by a gynecologist. In some cases this can be caused by uterine tumors. Some of them are not dangerous (such as uterine fibroids) but some may be cancers. Vaginal bleeding past menopause may also signify inner vaginal cancers, although this is very rare. In either case such bleeding should be expeditiously examined by a professional.
That about covers vaginal health. Thank you and see you next time.
Dr. Karol, MD