Top vagi­nal is­sues you are afraid to ask your doc­tor about.

Shape (Singapore) - - November 2018 -

MMany women ex­pe­ri­ence vagi­nal prob­lems at some point in their lives. Dr Regina Zuzarte-Ng, ob­ste­tri­cian and gy­nae­col­o­gist at Gy­naeMD Women’s Clinic, breaks down com­mon com­plaints and shares tips on how to tackle them.

Itch­i­ness and cot­tage cheeselook­ing dis­charge

This is most likely caused by a yeast or fun­gal in­fec­tion, com­monly known as thrush. DEAL WITH IT… Head to a phar­macy and grab some over-the-counter or phar­ma­cist­dis­pensed an­ti­fun­gal creams and vagi­nal pes­saries. Tak­ing pro­bi­otics can also help. If the in­fec­tion does not go away even af­ter you’ve taken the above mea­sures, or if you keep get­ting the in­fec­tion, pay the doc­tor a visit.

Wa­tery white, grey or yel­low dis­charge with a fishy smell

This is most likely a symp­tom of bac­te­rial vagi­nosis (BV), an in­fec­tion caused by an over­growth of ab­nor­mal bac­te­ria, which can be in­duced by any­thing that changes your nat­u­ral vagi­nal pH bal­ance, such as douch­ing, sex or an­tibi­otics. DEAL WITH IT… Avoid scented soaps and bub­ble baths, and make time for a med­i­cal con­sult. While BV can some­times clear up on its own, it’s best to al­ways see a doc­tor and get treated with med­i­ca­tion (oral or vagi­nal). This is es­pe­cially im­por­tant if you’re preg­nant as it can trig­ger preterm labour, or if you’ve re­cently un­der­gone gy­nae­co­log­i­cal surgery.

Frothy yel­low or green­ish dis­charge with a foul smell

This could be in­dica­tive of tri­chomo­ni­a­sis, a sex­u­ally trans­mit­ted in­fec­tion (STI) caused by a par­a­site known as tri­chomonas vagi­nalis. DEAL WITH IT… Talk to your doc­tor, who will ex­am­ine your vagi­nal dis­charge for ev­i­dence of the par­a­site and also screen for other STIs. Tri­chomo­ni­a­sis is eas­ily cured with an­tibi­otics, which you and your sex­ual part­ner will need to take. You will also need to re­frain from sex dur­ing treat­ment.

Bleed­ing or spot­ting out­side of your pe­riod

There are many rea­sons for this, in­clud­ing rough sex; hor­monal im­bal­ance; ab­nor­mal growths such as fi­broids, en­dome­trial polyps and ovar­ian cysts; ec­topic preg­nancy or mis­car­riage; in­fec­tions of the vagina or cervix; and can­cer. DEAL WITH IT… Make a note of when it oc­curs. Spot­ting is to­tally nor­mal if you’re on a low-dose birth con­trol pill, but bleed­ing af­ter sex could be a symp­tom of cer­vi­cal can­cer. See a doc­tor if you no­tice per­sis­tent spot­ting.

Cloudy or yel­low dis­charge

This could point to an in­fec­tion, but it could also be part of the nor­mal phys­i­o­log­i­cal changes (in colour, tex­ture and/or amount of the vagi­nal/cer­vi­cal mu­cus) that oc­cur dur­ing the men­strual cy­cle. DEAL WITH IT… Mon­i­tor the dis­charge through­out an en­tire men­strual cy­cle. If the dis­charge is foul-smelling and ac­com­pa­nied by pelvic or ab­dom­i­nal pain or itch­i­ness, see a doc­tor im­me­di­ately.

Bumps, lumps or blis­ters in the gen­i­tal area

These are com­monly caused by STIs, al­though they could also be the re­sult of skin dis­or­ders and other in­fec­tions. The bumps or lumps could be gen­i­tal warts, an STI caused by cer­tain strains of the hu­man pa­pil­lo­mavirus (HPV). Of course, they could be com­pletely be­nign: a sign of skin ir­ri­ta­tion; in­grown hairs caused by shav­ing or wax­ing; or se­ba­ceous cysts, which de­velop when the se­ba­ceous gland – which

pro­duces the oil that lu­bri­cates the hair and skin – or duct is blocked or dam­aged. Blis­ters are usu­ally symp­to­matic of STIs such as gen­i­tal her­pes and syphilis, caused by the her­pes sim­plex virus and the bac­terium Tre­ponema pal­lidum re­spec­tively. DEAL WITH IT… See a doc­tor as soon as pos­si­ble; it is vi­tal that you get tested and treated. Mean­while, keep the gen­i­tal area clean and dry. If an in­grown hair is the cul­prit, ap­ply­ing a warm com­press should do the trick. If you are sex­u­ally ac­tive, take pre­cau­tions so that you don’t pass any­thing to your part­ner.


Hor­monal changes that oc­cur dur­ing child­birth, breast­feed­ing or menopause can cause this, as can overzeal­ous douch­ing. If you ex­pe­ri­ence vagi­nal dry­ness dur­ing sex, it’s usu­ally due to in­ad­e­quate fore­play and/ or nat­u­ral lu­bri­ca­tion. DEAL WITH IT… Avoid douch­ing, and use a good lu­bri­cant for sex. Con­sult a physi­cian if you sus­pect the dry­ness may be caused by hor­monal changes.

Ex­treme vagi­nal itch­i­ness, burn­ing or ir­ri­ta­tion (with no dis­charge)

This could be caused by a num­ber of things, such as an in­fec­tion and eczema. It could also be due to the hor­monal changes dur­ing menopause, or sim­ply a re­ac­tion to an ir­ri­tant such as strong, scented soap. DEAL WITH IT… Avoid us­ing per­fumed toi­let pa­per, and bath and fe­male hy­giene prod­ucts. To pre­vent fur­ther ir­ri­ta­tion, do not douche for the time be­ing. If the itch­ing, burn­ing, red­ness or ir­ri­ta­tion per­sists, or if you sus­pect it’s due to menopause, see a doc­tor.

A spot that’s al­ways itchy and ir­ri­tated

An in­fec­tion or eczema could be the cause. In rare cases, this could be a symp­tom of vulva can­cer. DEAL WITH IT… Stay away from all things that would make the itch and ir­ri­ta­tion worse, such as bath salts, bub­ble baths, and scented oils, bath and fe­male hy­giene prod­ucts. Avoid scratch­ing or rub­bing the spot, as this would make the itch worse. Con­sult a doc­tor if the itch per­sists de­spite the above ac­tions, or if the spot on your vulva looks dif­fer­ent than usual.

Deep, in­ter­nal vagi­nal pain

This type of pain can stem from a va­ri­ety of con­di­tions. These in­clude en­dometrio­sis, a painful dis­or­der in which tis­sue that nor­mally lines the in­side of the womb grows out­side it and can cause ovar­ian cysts or pelvic ad­he­sions (in­ter­nal scars); pelvic in­flam­ma­tory dis­ease, which is an in­fec­tion of the fe­male re­pro­duc­tive or­gans; uter­ine fi­broids, non-can­cer­ous growths of the uterus; ir­ri­ta­ble bowel syn­drome, a chronic con­di­tion of the large in­tes­tine that causes cramp­ing, ab­dom­i­nal pain, bloat­ing, gas, di­ar­rhoea and con­sti­pa­tion; scars from pre­vi­ous ab­dom­i­nal or pelvic surgery, chemo­ther­apy or ra­di­a­tion; and emo­tional stress. DEAL WITH IT… See a doc­tor if the pain per­sists for more than a day or two, es­pe­cially if it is ac­com­pa­nied by dis­charge or fever. Your physi­cian will likely con­duct a pelvic exam or an ul­tra­sound to find out what ex­actly is caus­ing the pain.

Painful and fre­quent uri­na­tion

Com­mon causes in­clude a uri­nary tract in­fec­tion (UTI), kid­ney stones, menopausal changes and in­ter­sti­tial cys­ti­tis (a chronic con­di­tion in which the blad­der be­comes in­flamed). DEAL WITH IT… Wipe from front to back af­ter uri­nat­ing or bowel move­ments, so fae­cal bac­te­ria isn’t in­tro­duced into the uri­nary tract, wors­en­ing ex­ist­ing symp­toms. Also, up your fluid in­take, es­pe­cially plain wa­ter. In the case of a UTI, drink­ing more wa­ter in­creases uri­na­tion, which flushes out the in­fec­tion-caus­ing bac­te­ria from the uri­nary tract, help­ing to elim­i­nate the in­fec­tion faster. In the case of rel­a­tively small kid­ney stones, the in­creased uri­na­tion will help speed up the process of pass­ing a stone nat­u­rally.

A med­i­cal con­sult may be best if you sus­pect it’s a UTI (which can be eas­ily treated with an­tibi­otics), if the prob­lem per­sists or if it oc­curs re­peat­edly. If it’s a UTI, re­frain from hav­ing sex un­til the in­fec­tion has com­pletely cleared up (a week or so), as the act may fur­ther ir­ri­tate the af­fected tis­sues. See a doc­tor im­me­di­ately if blood is present, or if the painful uri­na­tion is ac­com­pa­nied by fever or a back­ache, which may sig­nal a kid­ney in­fec­tion rather than just a blad­der in­fec­tion.

Pelvic pain, ac­com­pa­nied by dis­charge or fever or both

This could in­di­cate pelvic in­flam­ma­tory dis­ease. DEAL WITH IT… It’s best to see a doc­tor im­me­di­ately, es­pe­cially if the pain is per­sis­tent and ac­com­pa­nied by fever. You will most likely need a course of an­tibi­otics. Se­vere cases may even re­quire surgery to drain the pus in­side the pelvis.

Hav­ing sex is al­ways very painful, as is us­ing tam­pons

If you find sex painful and it isn’t be­cause of in­ex­pe­ri­ence, anx­i­ety or a lu­bri­ca­tion is­sue, it could be due to en­dometrio­sis, an in­fec­tion, pelvic in­flam­ma­tory dis­ease or vagin­is­mus, a rare but painful con­di­tion where the vagi­nal mus­cles get so tight, they ba­si­cally close off the open­ing of the vagina. DEAL WITH IT… Try ex­tended fore­play or dif­fer­ent po­si­tions to see if that al­le­vi­ates the pain. If the pain per­sists, or if there is ab­nor­mal bleed­ing, con­sult a physi­cian for a di­ag­no­sis.

Hav­ing sex is sud­denly painful – and you used to en­joy it!

Pain dur­ing what’s usu­ally a plea­sur­able ex­pe­ri­ence could have many causes, in­clud­ing en­dometrio­sis, an in­fec­tion, and ab­nor­mal growths such as fi­broids and ovar­ian cysts. DEAL WITH IT… If the pain is per­sis­tent or there is any bleed­ing, ab­stain from sex un­til you con­sult a doc­tor, who can help shed light on the cause. Be as ex­act as pos­si­ble in de­scrib­ing your dis­com­fort so that your physi­cian can pin­point the un­der­ly­ing cause and pre­scribe the right treat­ment.

Vagi­nal numb­ness

This could be caused by menopause, hor­monal changes or fre­quent bike rid­ing. DEAL WITH IT… If you feel it’s bike-re­lated, in­vest in a padded seat or padded shorts. If you sus­pect it’s due to menopause or hor­monal changes, see a doc­tor.

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