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Do You Need An Environmental Protection Plan For Your Vagina?

Whoever was responsible for the design of the female genital area was indeed a poor architect and planner. I believe this ridiculous layout is responsible for about 75% of women who present to my office with some kind of complaint or discomfort “down there”. Looking at it ( and I do) from top to bottom — “front to back” for the average person and “anteriorly to posteriorly” for those of you into the medical jargon — we see how it all makes no sense from the point of view of keeping it all healthy and comfy below the belt.
 First, there is the urethra, from which urine is emitted during urination. A tiny area for sure but it can create a horrible burning discomfort when irritated, inflamed, or invaded with bacteria. Next is the vagina, a muscular tube which (in most cases) leads to the cervix and uterus, though it may end in a blind pouch for some. Moving on, over the skin of the perineum there is the anal opening, whose main but not only function is elimination of solid waste products. All of these areas are in very close proximity to one another, and surrounded by skin, glands, and hair follicles. Each of these spaces naturally has its own environment — organisms and bacteria which live in harmony, creating a healthy individual and well functioning biological ecosystem. However, throw in menstrual periods, vaginal, oral or anal sex, lotions, creams and gels applied in the area, shaving and other grooming activities, and sweat, soaps and perfumes — — and you’ve got a cornucopia of bacteria traveling out of their normal environments and mixing, living and multiplying in areas where they don’t belong!!
 This often results in irritation, discomfort, discharge, burning or pain, which lands someone on my office doorstep. Often, by the time they arrive to see me, they have already attempted to diagnose and treat their problem, by asking a friend, buying something over the counter, using Dr Google (my favorite) or finding some old (sometimes expired) cream or gel in their medicine cabinet from the last time they had this problem and trying that out (since, if it FEELS the same as last time, it must BE the same, right?) Unfortunately, most of these solutions just make the problem worse, and harder to diagnose once they do decide to come in to be evaluated. 
 There are so many things that can be wrong and require treatment and there are almost as many things that can “feel” like something is wrong but truly don’t need medication. When is it important to have an exam? And what could this discomfort be? And why do so many people have what seems like recurrent vaginal infections or irritation?

First, do you truly need an exam?

IF there is any question of an open lesion or a sore spot, and especially if that has never happened before, and even more especially if you have had sex without a condom, I urge you to go get looked at. Open sore areas can be anything from Herpes and other viral lesions, to Syphilis, to infected hair follicles, to cancer. Do NOT self diagnose or slather creams on it. Believe me, knowing is better than not knowing. 
If you are uncomfortable and sexually active, STI testing may be in order. These tests (especially for things like Gonorrhea and Chlamydia) can be done from a urine specimen. Even though there have been some recent studies that say the sensitivity of an actual vaginal swab is a little better than the pick-up from a urine test, the urine test is a perfectly acceptable method of testing for STIs. 
If it turns out that your discomfort is not from a typically sexually transmitted infection, it can be from the aforementioned “mixing” of bacteria that has now been transported and is growing out of its normal environment. There is a certain amount of yeast and bacteria that normally grow in the vagina, but when they overgrow they create yeast (Candidal) infections or BV ( bacterial vaginitis, from Gardnerella, Megasphera, Ureaplasma, Mycoplasma or several other specific bacteria for which there are cultures and specific treatments). All that itches like yeast may NOT be yeast!!
 If it seems that these infections/irritation symptoms keep returning it may pay to take a look at some other things, all of which have a degree of Internet myth and a degree of truth. You cannot completely eliminate yeast infections with an “anti-yeast” diet. But if your diet is high in sugar or if you are a diabetic with poor sugar control, you will tend to have more yeast infections because (A) yeast thrive in a high sugar environment and (B) poorly controlled diabetics tend to have poorer immune function and cannot fight off infections quite as robustly as people without diabetes. If you have an auto-immune disease ( Lupus, HIV, Rheumatoid Arthritis, to name a few), it may also be harder to fight off infections that other people with stronger immune systems have no problem with.
 If you use products in the genital area which contain dyes or perfumes, or if you are spraying perfumes in or around this area, you should stop. They promote the mixing of various bacteria, and encourage irritation. Use plain soaps, or better yet — just water — and don’t use anything up inside the vagina, as a healthy vagina will clean itself (and needs no steaming, food products or other home remedies that have not been recommended by your health care provider). There are good safe lubricants and vaginal moisturizers if needed. Empty your bladder before and after sex (I know — very unromantic) to discourage urinary tract infections. And if engaging in anal sex, be sure to clean prior to vaginal sex so no fecal matter gets into the vagina.
The pH of the vagina should be low — under 5; ideally under 3 for best vaginal health. I test vaginal pH often, and find a high, or alkaline pH in almost everyone who has chronic complaints. A high pH can come from infections, aging, lack of Estrogen, blood, semen and vaginal dryness. A continued high pH can encourage reinfection, even after appropriate treatment. Ask your provider about safe ways to keep the vaginal mucosa in a healthy acidic pH range. 
 There’s not much that most of us can do about our anatomy. It comes in many varieties in terms of size and symmetry, effects of childbirth, age, surgeries and genetics. Knowing that the design is flawed, at least as far as keeping separate environments separate, can go a long way in understanding how to care for and protect your own valuable architectural landscape….

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