I spend a good part of my office day, literally EVERYDAY, talking to women about their vaginas. I get so many women that come in for an itch, an irritation, a new lump or bump, discharge, and a variety of other alarming complaints along with the fear that there is something horribly wrong with them. Jen Gunter, an obstetrician gynecologist in California puts it well, “it’s as if the vagina, an internal structure that is capable of handling menstrual blood and stretching and even tearing to deliver a baby, is constantly one drop of water or wrong pair of underwear away from total meltdown.”

And then to add to the confusion, there are a plethora of “feminine products” on the internet or the shelves of CVS that women think they need.

So let’s talk about what’s normal and not normal.

Normal vaginal discharge

All women, from puberty to menopause, have varying amounts of discharge depending upon where they are at in their cycle. It can range from white discharge to more clear, mucusy discharge around ovulation. Your discharge may change if you are on hormonal birth control. The white discharge is just shedding of the superficial cells of the vagina (remember, self-cleaning) and the mucus discharge is from the cervix. Some women have more discharge than others and sometimes you will see discharge on your underwear.

The vagina is self cleaning!

All those products sold over the counter that promise a “fresher” or “cleaner” or “better smelling” vagina are worthless and can actually cause more harm in the long run. The vagina is meant to be at an acidic pH (3.5-4). Many of these products alter the pH of the vagina to an abnormally high pH and increase your risk of infection. They also remove the “good” bacteria that are there to keep the vagina healthy and free from infection. If you wash those good bacteria out, you are again setting yourself up for an infection.

When should you see your doctor?

  • Itching – if you are experiencing heavier discharge, many describe as “cottage cheese” discharge, with itching, you may have a yeast infection. In studies, it has been shown that 50% of women who think they have a yeast infection don’t. So even though there are over the counter treatments for yeast infections, it is always best to be seen by your doctor first to make sure you are treating the right thing. Itching can also be caused by many skin disorders, like lichen sclerosus, that are not infections and are treated completely differently.
  • Odor – if you are experiencing a thinner discharge with a fishy odor to it, especially after sex or your period, you may have a bacterial infection. Bacterial vaginosis is as common as yeast infections and is when there is an overgrowth of bacteria that is normally held in check by those good bacteria. It is commonly seen with a high vaginal pH. Again seeing your doctor to make the right diagnosis is important.
  • Redness and/or swelling – there can be many reasons you are experiencing these particular symptoms including yeast infections, a contact dermatitis (basically, an allergic reaction), or a variety of vaginal or vulvar conditions. If it doesn’t go away in a day or 2, see your doctor.
  • A new lump or bleeding – there are many glands that assist in lubrication in the genital area and sometimes they become blocked, the most common one being a Bartholyn cyst. Sometimes these need to be drained, sometimes they can resolve just with warm compresses. Any time there is bleeding from the vulva or vagina, that should be seen.
  • A new growth – a new growth can many times just be a skin tag, but it may be a genital wart. Women can also have cancer, although rare, of the vagina or vulva.
  • STIs – STIs, like gonorrhea or chlamydia, may not cause abnormal discharge, but if you are concerned you may have been exposed, see your doctor. Other STI’s like herpes will cause a painful ulcer or HPV (human papillomavirus), a warty growth.

Let’s get back to yeast and bacterial infections since they are the most common reasons women come to the gynecologist.

Yeast Infections

Pretty much every woman at some point in their life will get a yeast infection. Some women, like those with diabetes or compromised immune systems, will get them more frequently. Pregnancy can also be a time we see yeast infections more often. They are usually easily treated with either a cream or suppository or an oral pill. However, if you are dealing with frequent yeast infections, then you need to work with your doctor to find a treatment that will break this cycle. Some options include the use of boric acid or a pill that you take weekly.

Bacterial Vaginosis (BV)

As I said before, this is actually an error in the ratio of the bacteria normally seen in the vagina. It is seen when the pH of the vagina rises to abnormal alkaline level. So the treatment, with either a vaginal gel, oral pill or powder, aims to reestablish the normal pH. This is also seen more commonly after a women’s period or after sex becasue in both instances, the pH of the vagina is elevated due to either blood or semen. BV can become recurrent also and again, it is important to work with your doctor to see if there is a trigger you can avoid or use a regimen that will break the cycle of recurrence.

Bottom line, any time you have concerns about your vagina, go see your doctor first instead of trying various products over the counter – these products not only may harm you more than help, but it may make it more difficult for your doctor to know what the problem is if is is masked by some over the counter product. Find out if it is normal or if there is an issue that needs addressing.

Most importantly, your vagina is amazing at taking care of herself, so don’t mess with her!!

Andrea Eisenberg

Andrea Eisenberg

Andrea Eisenberg, M.D. has been in practice for over 26 years and is certified by the American Board of Obstetrics and Gynecology. She graduated from Wayne State School of Medicine in 1989 and completed her residency at Sinai Hospital in Obstetrics and Gynecology in 1993. She is affiliated with William Beaumont Hospital which now includes the ability to deliver at the Karmanos Natural Birth Center. She has delivered countless babies and enjoys being a part of such a special time for families. Her special interests include family planning, infertility, adolescence, menopause and helping women transition through different phases of their lives. Dr. Eisenberg also has an interest in narrative medicine and originated a program with the residents of Beaumont hospital. In 2020, she was awarded CREOG’s National Faculty Award for excellence in teaching. She also has been published in Intima, Journal of Narrative Medicine; Pulse, Voices From the Heart of Medicine; The Examined Life Journal; ACOG District V Special Delivery, and After Rounds as well as having her own blog, www.secretlifeofobgyn.com.

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