An embarrassing female issue

It is an annoyance, discomfort and sometimes embarrassment to women. Some women are even afraid to discuss the problem with their doctors. It is vaginal discharge. Some amount of vaginal discharge is normal for women and the quantity, colour and consistency changes throughout the month in women, with regular menses.

Normal discharge may appear clear or white and contains surface cells from the cervix and the vagina, water, certain normal bacteria and various chemicals. Lactobacilli are important bacteria found in the vagina of women that help to maintain a normal vaginal acidity and inhibit the growth of abnormal bacteria.

Burning and itching

While women with what they consider to be excessive vaginal discharge assume that they have an infection, this is not always the case. Stress, pregnancy, ovulation and being excited sexually can increase the quantity of vaginal discharge. However, changes in the amount of discharge, as well as symptoms such as burning, itching or a bad odour, may suggest an infection.

Bacterial vaginosis (BV) followed by Candida vaginitis (yeast infection) are two of the most common vaginal infections. Contrary to common perception, neither of these infections is sexually transmitted, although BV is sexually associated. Symptoms of BV include a heavy flow of discharge with a fishy smell.

Women are at a higher risk for BV if they are younger, douche, have a new sex partner or multiple male sex partners, are economically disadvantaged, are lesbian women with female partners with BV, or if they share sex toys without first cleaning them. Stress such as financial stress, being homeless and feeling unsafe can also raise a woman's risks for BV.

Although BV is relatively easy to treat with oral or vaginal antibiotics, some women get frequent recurrences which are much more difficult to control. Fortunately, new research has demonstrated promising results in managing this condition.

Candida albicans

Yeast infections (vulvovaginal candidiasis) are most frequently caused by the fungus Candida albicans, but a small percentage are caused by other members of the Candida species. This fungus is normally present in many women, but certain factors may cause an overgrowth and lead to the infection.

These factors include the use of antibiotics, hormonal changes such as those experienced in pregnancy and around the time of menstruation, and low immunity, for example, in cases of HIV/AIDS or being treated with steroids. Women taking oral contraceptive pills are not at higher risk of yeast infections. Oral sex and having sex for the first time are also associated with an increased risk of yeast infections.

Symptoms may include itching, pain with intercourse, burning, soreness or irritation and a thick white discharge. However many women may not have any obvious discharge. Like BV, oral or vaginal therapy is equally effective in treating yeast infections. However, a significant percentage of women have what is described as complicated vulvovaginal candidiasis, and they need prolonged treatment.

Dr Monique Rainford is a consulting obstetrician and gynaecologist; email: ourhealth@gleanerjm.com.