Published: August 19, 2009 08:44 am      

Environmental changes may lead to problems

DEAR DR. MONA: I am concerned about a vaginal discharge with a bad odor that I cannot get rid of. A few months ago I saw my doctor who said I had vaginitis; I took the medication prescribed and it still comes back. I don't understand and I am frustrated. — Corinne

DEAR CORINNE: A vaginal discharge occurs when there is an infection with yeast, bacteria (bacterial vaginosis), or parasites (trichomoniasis). Like our outdoor environmental ecosystem, your vagina has an ecosystem as well. Changes in this ecosystem may result in an imbalance and overgrowth of normal inhabitants of the vaginal area resulting in this infection.

The common symptoms of these infections include vaginal odor and change in the consistency of the discharge, itching, burning on urination, pain with intercourse, or even some bleeding. If the discharge is caused by a yeast infection, it is usually thick white and burns or itches. This is treated with over-the-counter medications, such as antifungal creams, which are convenient and available easily. If those are not helpful, the doctor may prescribe suppository medication, such as miconazole (Monistat), clotrimazole (Gyne-Lotrimin) and tioconazole (Vagistat). Yeast infections may also be treated with an oral antifungal medication, such as fluconazole (Diflucan).

An infection caused by trichomoniasis is characterized by a yellowish-greenish discharge that may appear frothy. Trichomoniasis is treated with metronidazole (Flagyl) or tinidazole (Tindamax) tablets.

The most common symptom of a bacterial vaginosis infection is usually a grayish-white discharge that gives a fishy odor after intercourse. Bacterial vaginosis is treated by metronidazole (Flagyl, MetroGel) or clindamycin (Cleocin) as tablets or vaginal gels or creams.

Treatment of vaginal discharge depends on what type of infection you have. Therefore it is important to see your medical provider for cultures and examination to assure that you receive the correct treatment. A complete medical history is important to determine the cause of the infection.

For instance, taking antibiotics or using steroids may increase the risk of a yeast infection. Uncontrolled diabetes or hormonal changes may be responsible for some types of vaginitis.

You didn't mention your age, but as estrogen levels are reduced in the aging woman she may develop non-infectious vaginitis. This would be characterized by burning and pain and is known as atrophic vaginitis. This is treated with estrogen, in the form of vaginal creams, tablets or rings.

In some rare cases, vaginal discharge could be related to cervical cancer, or endometrial cancer, especially in women complaining of brownish discharge that could resemble old blood.

You were wondering, Corinne, why this infection has returned. It may be a non-infectious vaginitis caused by a particular soap or deodorant, or from baths, hot tubs, or whirlpool spas. Personal hygiene, such as avoiding irritants, douching, scented tampons and pads, is important in this process. Wiping from the front to back to avoid fecal contamination is also really important. So one thing you can do is to try to change products you use to determine whether one of these is the culprit. You might also wear cotton underwear and pantyhose with a cotton crotch to avoid moisture since infections thrive in this area.

So, if your vaginal discharge is not improved given that you completed your treatment and followed your medical provider's instructions, you should return for more evaluation and testing since there might be more tests or cultures necessary to determine the reason for the infection.



Dr. Mona Alqulali is a board certified OB-GYN.