American Medical Association Family Medical Guide - American Medical Association [596]
Bacterial vaginosis occurs most often during the reproductive years, although women of all ages are susceptible. The infection is usually not serious, but if not treated can increase the risk of infection after pelvic or vaginal surgery. In pregnant women, the infection can increase the risk of preterm labor and delivery (see page 529).
Symptoms
In many cases, bacterial vaginosis causes no symptoms and is diagnosed during a routine pelvic examination. If you have symptoms, you may notice that you have more vaginal discharge than usual or that your vaginal discharge is milky with an unpleasant, fishy odor that is worse after sexual intercourse. Other symptoms include itching or burning in or near the vagina.
Diagnosis
Some women mistake bacterial vaginosis for a yeast infection and try to treat it with an over-the-counter product. If you have symptoms of bacterial vaginosis or if you tried to treat a yeast infection with an antifungal vaginal medication and it did not clear up, see your doctor. The doctor will make a diagnosis of bacterial vaginosis based on a number of criteria. Because the doctor needs to test your vaginal secretions to make a diagnosis, do not douche or use vaginal creams or suppositories for a couple of days before you see the doctor.
Treatment
To treat bacterial vaginosis, doctors usually prescribe an antibiotic vaginal gel or cream that a woman inserts for 5 to 7 days. Oral antibiotics such as metronidazole are sometimes prescribed. For severe or recurring cases, a doctor may recommend oral antibiotics for both the woman and her sex partner.
Vaginal Yeast Infection
A yeast infection is the overgrowth of Candida albicans, a type of fungus that is normally present in small amounts in the vagina. If conditions in the vagina change and become more favorable for the fungus, it grows excessively, displacing the harmless bacteria that normally keep the fungus under control.
Using feminine hygiene sprays, douching, or taking antibiotics can kill the helpful bacteria in the vagina and allow the fungus to proliferate. Hormonal changes that occur when you are pregnant or taking oral contraceptives can also change the conditions in the vagina and allow the fungus to overgrow and cause an infection. Women with diabetes are especially susceptible to yeast infections.
Yeast infections are common—three quarters of all women have yeast infections at some time in their life. To prevent yeast infections, wear cotton underpants and avoid exposing your genital area to unnecessary chemicals, such as those in feminine hygiene sprays or powders, bubble baths, or deodorant tampons or sanitary pads. Do not douche.
Symptoms
Vaginal yeast infections cause an unusual thick, white discharge; itching and irritation of the vagina; and swelling and redness of the vulva. You may experience some mild vaginal tenderness or discomfort during intercourse.
Diagnosis and Treatment
To diagnose a yeast infection, your doctor will take a sample of your vaginal discharge for analysis in the laboratory. The usual treatment for a yeast infection is an over-the-counter antifungal drug most often taken in the form of a vaginal suppository or cream. A single-dose antifungal tablet also is effective against yeast infections but can produce adverse reactions when taken with some other drugs. Also, antifungal tablets do not relieve the irritation of the vagina and vulva as quickly as the cream or suppository does. Using the vaginal suppository or cream for about a week usually clears up the problem. If you have repeated yeast infections, your doctor may want to check your blood sugar levels for diabetes and may recommend tests, such as an HIV test (see page 910), to try to determine why your immune system defenses are weakened.
Vaginal Hygiene
Most doctors think that washing the area around the vaginal opening (including the minor and major labia, urethra, and clitoris) daily with unscented soap and water is the best way to keep the area clean. Do not use deodorant sprays, which are unnecessary