American Medical Association Family Medical Guide - American Medical Association [597]
The vagina cleanses itself by secreting a mucous discharge that flows downward, removing bacteria, old cells, and any menstrual blood that is present. Normal vaginal discharge is minimal, is either clear or white and sticky, and has a mild odor. The discharge dries as a yellowish stain on your underpants. The consistency and volume of the discharge may change when you ovulate, producing mucus from the cervix midway between menstrual periods. Infections of the vagina and cervix can produce more plentiful, thicker vaginal secretions that are often foul-smelling and cause redness, dryness, flaking, itching, and irritation.
Douching is neither necessary nor recommended because it rinses away the beneficial bacteria normally present in the vagina that protect against infection and washes away secretions that can help doctors diagnose infections. Removing the bacteria and secretions, which are part of the vagina’s natural self-cleaning system, may actually prolong an infection. (It is also important to understand that douching is not a method of birth control.) Some douching preparations can irritate the mucous membrane that lines the walls of the vagina. In some women, these preparations can cause allergic reactions.
If you have a foul-smelling or unusual vaginal discharge and you think you may have a vaginal infection, see your doctor. He or she will perform a pelvic examination and take a sample of your vaginal discharge for testing. Do not try to treat yourself by douching.
Cancer of the Vulva
Cancer of the vulva—the external, visible part of the female genitals—is a rare cancer. The most common site of cancer of the vulva is the labia majora (outer lips of the vulva). Most women with cancer of the vulva are over age 50, although it is becoming more common in women under 40. Infection with the human papillomavirus (HPV; see page 480) is the most likely cause. Cancer of the vulva tends to grow very slowly and is highly curable when diagnosed at an early stage. If the cancer has not spread to the lymph nodes, the overall survival rate after treatment is 90 percent.
Symptoms and Diagnosis
Cancer of the vulva starts as a small, hard lump in the skin, which gradually breaks down on the surface to form an ulcer (open sore). The ulcer has thickened, raised edges and may ooze or bleed from the center. The ulcer gradually enlarges and, if it is not treated, will eventually spread to other parts of the body.
If you have any lump or ulcer on your vulva, your doctor will perform a pelvic examination and take a small sample of tissue for examination under a microscope (biopsy) for cancer cells.
Treatment
Treatment for cancer of the vulva depends on the stage of the cancer. If the cancer is in its early stages and is present on only the surface of the skin, the doctor will probably remove it surgically. If the tumor has invaded the deeper part of the vulva but has not spread to nearby tissue, the doctor will surgically remove it, along with surrounding skin and nearby lymph nodes. Radiation therapy (see page 23) may be given after the surgery if the cancer has spread to the lymph nodes.
Cancer that has spread to nearby tissues requires surgical removal of the entire vulva (and possibly the lower colon, the rectum, or the bladder), followed by radiation therapy. The doctor may recommend chemotherapy (see page 23) along with the radiation therapy.
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Hormonal Disorders
Hormones are chemical messengers that are produced by a network of glands called the endocrine system and released directly into the bloodstream, which carries them to organs and tissues throughout the body. A hormone circulating in the bloodstream affects only the target organs or tissues for that hormone. Together with the nervous system (see page 665), the endocrine system coordinates and controls many essential body processes. For this reason, a problem in any part of the endocrine system can affect many body functions.
The endocrine system