ASK DR AMERSON: How Do I Know Something is Wrong Down There?

"I was told that some vaginal discharge is normal, but when should I alert my doctor? What are some warning signs indicating that something wrong's going on down there?"

I love this question - as it should be universal, to all women, regardless of age, race, creed or color.  So, to begin with the proper foundation of understanding: all openings in the human body (except the urethra & anus) produce some protective fluid or mucous.  We have control over the muscles affecting urination and defecation, so that these "openings" are not actually "open" until we voluntarily relax these muscles. It is this muscular control which protects from bacteria and other things foreign to the human body. 

As for all other openings - our eyes produce "sleep", which is a fluid that dries into mucous; our nose produces mucous; our ears produce wax; our mouth produces saliva; the vagina does produce a normal discharge after menstruation beginning at puberty. Prepubertal girls have a female reproductive system which is inactive, and their vaginas are closed.  In this age group, any and all discharge is concerning and should be evaluated by a health care professional. 

At puberty, our female reproductive system "awakens" (regardless of becoming sexually active or not) and we begin the constant production of female hormones. These hormones change the vagina's texture, elasticity, and moisture in preparation for sexual activity and childbearing. The production of a noticeable discharge varies amongst individual women. Therefore, the first principle of becoming a woman is know thyself.  Some women have some discharge daily. Others will notice discharge only at certain times in their monthly cycle.  While others may never have noticeable discharge (although it is present in the vagina & could be observed in a pelvic examination).
 
Normal discharge has no odor or irritation.  The color is white to eggshell, and when dry it may flake (in panties or pubic hair for example).  Symptoms which can be concerning include any change from normal for an individual woman, swelling or redness of the outside vulva, itching or burning of the vulva or vagina, greenish/bubbly discharge, odor (most commonly "fish-like"), painful/overly sensitive outside vulva, and very heavy discharge. It is important to note here that women will most commonly have no symptoms of sexually transmitted disease. Most of our symptoms of infection are related to changes in the vagina's normal pH balance. Many things trigger these changes, including hygiene (which must change after puberty), sexual activity, dietary habit, medications, illness (such as diabetes), hormonal change and changes of metabolism. 

If a woman is uncertain about whether her vaginal discharge is normal, she should schedule an appointment with her health care provider and have her personal information (about the regularity of her menses, recent sexual activity, use of products to clean her body & clothing, new or recent medications, and change in diet) written down and ready for discussion.
 
Finally, here are some key "do's & don't's" to maintaining good vaginal health:

*Take probiotics daily or regularly (these healthy bacteria promote good health while preventing harmful bacterial growth in the vagina and digestive system). I suggest a chewable form of acidophillus. Yogurts contain probiotics as well.

*Wipe from front to back always when using the toilet to prevent bringing bacteria near the anus towards the vagina and urethra.

*Use protective covering on publicly used or unfamiliar toilets.  While sexually transmitted diseases (STD) are categorized as such because they require "body heat" to be transmitted, many other infections can be transmitted to exposed genitalia.

*When it comes to bodies of water & vaginal infection, it depends! Chlorinated pools and the ocean are safe. Hot tubs are generally safe unless you have cuts/scratches/open wounds of genital skin, immune compromise (due to illness or simply "you are sick").  Women in menopause can be vulnerable because they have stopped making the hormones that cause protective discharge, yet the vagina does not reclose (to its prepubertal state).  Do not swim in rivers or lakes because they can accumulate the bacteria that may trigger infection.

*Do not place food or fragrance in your vagina for any reason. This includes vaginal douches with fragrance.  While occasional (not more than monthly) douching is okay, women should only use natural products (i.e. baking soda or vinegar) with water.  While this is a common West Indian culture passed on through generations for good vaginal health, women unfamiliar with douching should not make their own, but rather purchase it pre-prepared to avoid the irritation of use of too much of the natural products.

*Develop a consistent habit of condom use with sexual activity. Many generations of women were allowed to develop the belief that monogamy protects us from STD, we now know better.  Nine out of ten adults have been exposed to HPV.  There are enough different types to be infected with a new one every time you have a new partner.  The vaccine does not protect against them all.  Women have no symptoms of chlamydia or gonorrhea.  And, semen itself (which has a pH that is very different from that of the vagina) can trigger the development of a non-sexually transmitted infection. I am very sad to report that, as a practicing gynecologist, I have noted that married women are more likely to use condoms than single women. This is because many single women are using other forms of birth control; so, they mistakenly believe themselves to be "covered".  False! The prevention of unintended pregnancy and the prevention of infection are two entirely different things.  

*Do not "hold it" when you have to urinate.  Bladder infection is  more common amongst women than men.  Cranberry juice and drinking (at least 1 liter) water daily both help to prevent bladder infection.  A healthy bladder & a healthy vagina are very closely linked; and women often cannot distinguish which is the source of irritation "down there".  Health care providers can send cultures, of the vagina and of the urine, to detect infections that may not be immediately apparent.  You can request that this be done during your visit.

*All sexually active women should be regularly tested for STD as a part of their preventive women's health care.
 
Still,
Dr A

*** Submit any and all health related questions to info@teendiaries.net, put Ask Dr A in your email's subject line, and I'll respond to your questions anonymously!

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Dr. Afriye Amerson is a member of the American Medical Association and the Medical Society of New Jersey. She is currently the assistant attending at the Department of Obstetrics and Gynecology at the Hackensack University Medical Center, and the founder of La Doctora’s Angels, an awareness campaign on umbilical cord blood banking. Since 2001 she has also been in private practice at Prospect Women’s Medical Center in Hackensack, New Jersey.