We have all been there…random itching, random discharge, or random odor. It’s frustrating, uncomfortable, and embarrassing. But what are the reasons we have a change in smell and everything else going on down there? There are many different reasons, and they are not all treated in the same way. Of course, I will say go to your provider to find out which one and don’t just guess, but this is a short guide to help steer you in the right direction.
Vaginitis
Who is baking biscuits??
Candida is the medical term, but the layman’s term is a yeast infection. You can have vaginal odor that literally smells “bready”, cottage cheese like discharge, and vaginal itching. Do you have to have all three symptoms? No. Sometimes you just have vaginal itching (it can be internal or external), or you just have the discharge. Although we usually associate yeast infections with white thick discharge it can also be green or light yellow. And sometimes we don’t have any symptoms at all, or we just have changes to our periods (heavier, spotting, etc.).
Pregnancy causes us to have a weaker immune system which can lead to an increased chance of vaginal infections. Additionally, women with diabetes, especially uncontrolled diabetes have a higher chance of a yeast infection and often have recurring yeast infections. Think of how yeast likes to activate in warmth and sugar.
Antibiotics are another cause of yeast infections. Why? Because antibiotics are made to strip us of the bacteria causing the infection. The problem is antibiotics remove all bacteria, both good and bad. We need the good bacteria to help us balance our vaginal flora (healthy bacteria) and reduce our chances of infection.
So, what can we do for prevention? If someone has recurring yeast infections and it is due to uncontrolled diabetes, the number one goal is to get your blood sugars under control.
Either way with pregnancy, diabetes, or antibiotics, taking a probiotic is super helpful to not only our gut health, but also our vaginal health. Probiotics help us with our vaginal balance or pH and helps with vaginal odor. I understand that not everyone is comfortable with taking a pill every day. If that is the case, kombucha and yogurt have probiotics and work just as well. Use cotton underwear or sleep without underwear to allow for a breathable space.
**If you take a daily probiotic or yogurt do not take a probiotic and an antibiotic at the same time. Antibiotics want to get rid of all bacteria, meanwhile a probiotic is trying to keep the good bacteria. Taking them together cancels them out because they are working against one another. Whenever you have to take an antibiotic, continue your probiotic or yogurt BUT separate them by at least two hours.
Treatment: yeast infections are treated with an antifungal. This can come in the form of over the counter (OTC) cream or a prescription pill. For the OTC cream, get the 7-day treatment, the 1- and 3-day forms just do not work as well (trust me, quick does not always mean better). For the pill version, you will get one pill that works over the course of 3 days. So, you take the one pill and that is it. Sometimes people need a second treatment which should not be taken until the 3 days after the original dose has passed.
Why am I at the marina all of a sudden?
Oh, lovely BV or bacterial vaginitis and the lovely (not really) smell of fish. Like yeast, you can have vaginal itching externally or internally and this time grayish discharge. This used to be considered a sexually “associated” vaginitis meaning that it would occur after sex but was not considered a sexually transmitted infection (STI). In the last year, BV is now considered an STI. This occurs when the pH balance of both partners is just…off and is an overgrowth of our normal bacteria. That’s the best way to describe it.
In the past, women would just get treated and treated and treated and just keep getting BV. FINALLY last year, it was recommended that your partner should also get treated if you have a positive result. Yay, thank goodness! Finally, there will be some relief for those that suffer from recurrent BV.
Treatment: antibiotics. Remember what I said above, you want to take daily probiotics when on an antibiotic. It happens too often that we get treated for BV just to end up with yeast right after from the antibiotics.
**Boric acid is another great tool to help with vaginal odor and improve your vaginal flora especially if you cannot get to your clinic quickly. pH-D makes a great one.
Sexually Transmitted Infections (STIs)
Trichomonas
Trichomonas is making a comeback, and this usually causes a frothy green discharge and sometimes a foul vaginal odor.
Gonorrhea and Chlamydia
Although most of the time there are no symptoms (especially for women), you can sometimes have yellowish, green, mucousy discharge with these.
The biggest thing for prevention is condom use and getting yourself (and any new partner) tested.
Nothing?
Perimenopause and Menopause
As we enter the perimenopausal age range (also ask your mom what age she went into menopause to give yourself a better picture) we can start to have vaginal dryness from the estrogen decrease. This can cause atrophy which means thinning and dryness of the vaginal skin. This leads to itching (imagine dry, cracked hands). In this age group, you may feel like you constantly have some kind of infection going on, but every time you get tested the yeast and BV test are negative. That is super frustrating. Additionally, when we exercise and get sweaty, this can also lead to vaginal itching and fishy odor.
So, what can we do?
Keep the area as clean and dry as you can. That does not mean multiple showers a day or putting soap directly on the vaginal skin. Too many times, do I hear patients say they take multiple showers and can’t shake the itching and odor. This is drying out your skin further.
Make vaginal moisturizers your friend. This can be OTC (Replens makes a great one), or you could even use coconut oil. I would honestly start this in your 30s before you actually really need it.
Once you are in menopause, you should continue with a vaginal moisturizer and consider estrogen cream.
Regardless if you are pregnant or not, get treated for these conditions. Someone who is not pregnant and does not seek treatment can have irregular bleeding/periods and severe pelvic pain (especially if it is an STI). If you are pregnant with these conditions, PLEASE GET TREATED. Again, too many times people don’t want to get treated because they are pregnant. The antibiotics used to treat these conditions are safe. Going untreated can lead to bleeding, preterm contractions with labor and delivery; preterm rupture (water breaks too early), and more.
Biggest takeaways:
- Probiotics, probiotics, probiotics.
- Vaginal moisturizers! Start in your 30s.
- Control chronic conditions.
- Wear a condom.
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