Wednesday, April 3, 2013

You have a self-cleaning oven!

One of the most frequent  reasons to see a gynecologist is vaginal irritation.  While yeast infections, bacterial, and parasitic infections are commonly found, it is also very common to find no evidence of infection at all.  In those situations the first question I ask patients is "what is you personal hygiene regimen?"  The answer to that question is almost always the wrong one.

The right answer to the question should be "a little warm water", but it is usually some sort of soap, body wash, feminine cleanser, wipe, etc.  I respond by telling patients that for the most part they have a built in "self-cleaning oven" and that introducing all these cleansing techniques often does more harm than good.  As in the gastrointestinal tract, there is a mixture of normally-occurring microorganisms in the vagina that live together in a very delicate balance.  This balance can be affected by changes in pH, exposure to antibiotics/medications, chemicals, etc.  When the balance is off, symptoms such as discharge, odor and itching can result.

Many women, particularly fair-skinned women and older patients, can also have very sensitive skin around the vagina (the perineum) which can become red, itchy and irritated like an allergic reaction when exposed to soaps, pool chlorine, pads (especially scented ones), condoms, lubricants, etc.  As in other dermatologic disorders, sometimes it takes a little careful investigation to find out exactly what the source of the discomfort is.  Stopping the chemical irritants and waiting 4--8 weeks is often all that is necessary for balance to be restored, but intense itching can be symptomatically treated in the short run with antihistamines such as diphenhydramine or topical steroid creams such as 1% hydrocortisone cream.  Postmenopausal patients sometimes need topical estrogens to restore natural protections to the vaginal mucous membranes.

With regard to discharge, a certain amount of clear or light yellow mucous is a normal finding, particularly around the time of ovulation.  Some patients certainly experience more than others, and pregnant patients find that discharge naturally increases throughout pregnancy.  When you're not sure what normal is for you, your gynecology care provider can help you figure it out.  

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