Vaginal health is not a topic that lots of women are comfortable discussing. Let’s talk about one of the most common conditions that embarasses women…and what online advice is bad idea:

“im suffering from vaginal bacteria or vb. ive been on a course of antibiotics n they left me horribly sick and efected my ibs. ibs is very very minor so it’s not a problem. The problem went away but its back again every month for past 4 mths. it use to show 1 wk before my period very uncomfortable. its not thrush as its exactly the same as my previous issue. i had swabs taken and they confirmed. now the bloody infection is back on day 14 till my period at day 28-30. its sore, wet and smelly. we r trying for a baby n its effecting that as i feel horrible. the warm weather also meand i can smell myself. so what am i going wrong. is it sonething im eating. i have a doc apt on monday what should i be asking?”

This is a great topic. We’ve previously discussed yeast infection and recurrent vaginal thrush infections, but we haven’t discussed bacterial vaginitis. I’m going to talk generally about it, and at the end I’ll finish up with what you should ask your doctor:

What is it? This is an infection that happens when there a change in the type or amount of the normal bacteria in the vagina.

Who gets it? Anyone really. Things that can increase your risk of getting include smoking, changing sexual partners, sex toys that haven’t been properly cleaned after each use, using vaginal washes/douches…as well as putting things in there that shouldn’t go in there, and I leave it there.

How do you know if you have it? Most women don’t know they have it. Others complain of an offensive “fishy smelling” vaginal discharge; that smell sometimes gets worse after sex. Some patients have itching. It shouldn’t cause pain or redness.

What do you do if you think you have it? If you have concerns about your vaginal discharge, ANY abnormal bleeding, or vulvar irritation, talk to your GP. Over the counter treatments are not recommended here, and usually don’t work. Embarrassed about talking to your GP? I could reassure you that your GP has heard it all. What might make it easier? Ask if there is a female GP in your practice, or a GP who has a special interest in women’s health. Be prepared that you may need an exam and swab when you attend; don’ t put any creams or anything else in/on your vagina/vulva before your doctor takes a swab.

How is it treated? It requires antibiotics by pill or inserted into vagina as a pessary or cream. If you have a choice, the vaginal route has much fewer side effects. Your partner doesn’t need treatment.

What does it come back? 30% of women who are treated will have another infection within 3 months, and more than half will have another infection within a year. Some experts suggest that patients who have had 3 infection in a year might benefit from a long term treatment protocol, which is using an antibiotic gel twice a week for anywhere to 3 to 6 months.

Anything you can do to try to reduce risk of it coming back? Don’t use vaginal washes/douches. Make sure you finish your course of prescribed antibiotics, even if you feel better. Bacteria can be trapped under your male partner’s foreskin, and can be a source of reinfection. Treating your male partner though hasn’t been shown to help, but using condoms can help, if that is something that works for you and your partner (though obviously not in the case above if you are trying for a baby)

#Mythbusting: Lactobacilli are the good bacteria of the vagina. However, probiotics (oral or otherwise) have NO role in treating or preventing bacteria or thrush infections of the vagina. Please don’t steam, douche, or place any sort of fruit, vegetable, yogurt, ice or rock (crystal or otherwise) into your vagina. #pseudosciencesucks Vaginal health has been a recent focus of REALLY bad celebrity advice, that ends up trending. Really? I like to think you’re all smarter than that.

Who should get treated? Experts usually recommend that most pregnant women with symptoms should be tested and treated. This is to reduce risk to the baby; experts usually recommend oral antibiotics for these women. If you are worried about this, talk to your midwife/GP.

Interested in vaginal health #mythbusting? American gynaecologist, #somedocs, and columnist for the NYTimes has an informative blog that has a useful search. https://drjengunter.com/ Her political views are at times a bit intense for some, but her expert advice on vaginal health is spot-on.  I cannot recommend her books “The Vagina Bible” and “The Menopause Manifesto” enough.

So, what should you ask your doctor on Monday? After reading the above, is there a risk factor you can discuss with your doctor, such as quitting smoking? If you have had more than 3 infections in last 12 months, is a trial of long term treatment with vaginal antibiotic gel a good choice for you? You were probably sick because the most commonly prescribed antibiotic for this type of vaginitis has a side effect of nausea. Ask your GP for help: Things s/he might suggest are trying an alternative (not alot of choice for this condition though), try a vaginal preparation of the antibiotic, or be prescribed an anti-nausea medication with your antibiotic.

Last question to ask your GP: should you eat more fibre?
Yes, fibre – and here’s why 1) it’s good for bacterial balance in the vagina 2) increasing dietary fibre can be VERY helpful for many patients with IBS. 3) Fibre is crucial to a healthy diet for everyone, and most Irish people don’t eat enough. I can’t explain it better than Dr. Gunter, so head over to her website to read about fibre and your pelvic floor health. Just ignore her obvious obsession with an American cereal named Bran Buds: https://drjengunter.com/…/bran-buds-are-good-for-your…/