Vaginal Infections: Answers to Frequently Asked Questions

Frederick R. Jelovsek MD

• Odorless,jelly-like vaginal discharge
• Yellow to slightly greenish vaginal secretion
• Vaginal scarring due to sexual assault needs vaginoplasty
• Strong vaginal odor after sex
• Yeast infections after natural or surgical menopause.

This is often normal but different for you. As long as there is no odor, no discolor and no itching or burning, it is not worrisome. It may be a change for you, however. Sometimes medications, hormones, dietary changes etc., just change the amount of vaginal secretions. That's the liquid portion of the discharge. The jelly like quality is sometimes mucous from the cervix. Look for any changes you can think of right around the time the discharge changed.

Yellow to slightly greenish vaginal secretion

More times than not, I have a yellow to slightly greenish secretion from my vagina. These secretions burn the inside tissues of my labia making the entire vulva area swollen and tender to touch. Looking in a mirror, in addition to the irritated vulva, I can see that the skin around the bartholin ducts is fire red. Do you have any guess what this could be? It doesn't particularly itch and has a slightly watery consistency. However, there have been a few times that this secretion has been of a thicker consistency. Please help. I have cotton pads between the lips to keep the moisture off the tissues.

A yellow-greenish discharge is often a trichomonas vaginal infection and sometimes a bacterial vaginitis. You need to see a doctor for diagnosis and treatment; there is not much you can do on your own about it except perhaps use petrolatum gel (Vaseline®) on the reddened area of the labia to protect them from bad irritation until you get the discharge treated.

The inflammation and pain has decreased along with the discharge after I applied compresses of "Tucks" just to the entrance of the vagina and on the vulva. I still have an inkling of pain that radiates somewhat into my back but nothing to complain about. I did notice last night that there was some bright red blood coming from deep within my vagina. Do you think that I need to have whatever is growing cultured or can a doctor tell what's going on from an examination?

Usually an examination, together with possible pH testing (touch a Q-tip to discharge and then to pH paper) and a wet prep (drop of discharge mixed with saline and placed on a slide to look at microscopically), are enough to make the diagnosis.

I'm glad your symptoms are improving but you still need to get it diagnosed. If it is a trichomonas infection or a bacterial vaginitis and isn't treated, it will probably just keep recurring.

Vaginal scarring due to sexual assault needs vaginoplasty

I am worried, hope you can help. About 4 years ago I was violently assaulted sexually. I developed PID after the assault, and over the past four years, scar tissue has been "growing" in my vaginal canal. It is to the point now, that my menstrual flow can barely get through and usually backs up for days at a time. The blood that comes through slowly is usually dark brown and smells awful. My doctor put me on birth control pills to lessen the amount of bleeding but this month it is awful, and I am wondering how long scar tissue continues to develop, and if it is possible for menstrual blood to back up for so long that it becomes dangerous. I was home from work for three days this week lying in the fetal position in tears trying to get some relief from the pain. My doctor put me on Toradol®, but that didn't touch the pain. Besides the cramping pain in my pelvis, my whole abdomen seems to hurt now, especially when I stand up to walk. The pain is also worse after I empty my bladder. I am trying not to eat or drink anything because of the pain after urination. The pain is also worse when my bowels are full. Sorry for the graphic description, but I am hoping you can give me some advice.

It's difficult to know exactly what kind of scar tissue is there and whether it is just vaginal or also involving the cervix which I suspect it is. The overall symptoms sound as if there is certainly blockage to outflow of the menstrual tract. The net result is retrograde flow or backup of menstrual tissue into the pelvic cavity. This produces endometriosis. We see this with congenital obstruction by birth defects and post surgically sometimes after operations or procedures that occasionally cause scarring of the cervix.

Scar tissue can progress slowly over time and it can get worse. I don't know of anything that slows down the process. At a young age, all that can be done is to decrease the flow as your doctor has done and surgically dilate the birth canal periodically. Dilatations for cervical stenosis only last for about 3-12 months.

Your doctor (a gynecologist I hope) may have some other thoughts knowing your specific scar tissue location and situation.

My doctor has suggested vaginoplasty. I guess the MRI I had done showed that the scarring was only in my vagina, but it was 6cm in length. Is that a large amount of scar tissue?

Yes.

I have been trying to find information about the vaginoplasty procedure, but the only information I have found so far deals with male-to-female transsexuals. Do you have any information?

Almost all of these procedures are done in women with congenital absence of the vagina or, to a much lesser extent now, transsexuals. It involves opening up the vaginal area surgically, taking a skin graft from some area that doesn't show much (buttock, lateral thigh) and sewing that skin graft around an obturator (glass, plastic, wood) that is then placed in the vaginal space. It is held there for about 5-7 days until the graft sticks and grows to the tissue. After the obturator is first taken out, it is then worn day and night for quite awhile, just taking it out to clean it. This is done until the skin graft entirely covers the vaginal cavity. The obturator still has to be worn periodically because there is a tendency for scarring to return.

My doctor also said something about taking a skin flap from my thigh, but how would that work in my vagina? Can people who undergo a vaginoplasty still have sex?

Yes. After the graft takes completely, usually about 4-8 weeks, sometimes longer.

One more question: I never did bleed after I had that really bad pain, but for some reason the pain finally subsided, do you think everything is okay...is that normal, does the blood get re absorbed or something?

As best I can tell from what you've said, there is some obstruction to the outflow of menstrual blood. That is a complicating factor in your case. Most vaginoplasties are in situations where there is not a cervix. I assume you have one, albeit somewhat scarred. That will make the surgery challenging.

Strong vaginal odor after sex

After unprotected sex with my partner, I often have a rather strong vaginal odor for several hours - up to 24 hours. It is of course stronger if we have had sex multiple times in a short period of time. I don't have any infections (my annual physical showed me to be very healthy). While I understand that odor is to be expected, this seems awfully strong and truthfully can kill the mood a bit :-). I have always been told to avoid douches. Do you have any advice for me as to how I can safely (preferably organically) help my body absorb the semen in a less malodorous way?

Odor with intercourse is very poorly studied. In the absence of any vaginal infections, apparently much of the odor can come from the semen. I've included an old abstract that looked at this topic. They recommended a vinegar wash for the sponge and perhaps you could extrapolate that to using a vinegar douche just prior or immediately after intercourse.

Another product that might be useful are any of the spermicidal foams or gels although they may be more of a coverup. There is a lubricant called Trimosan that we use for diaphragms that are left in the vagina for a month at a time. It is basically a deodorizer.

If most of the amines causing odor come from the semen, I would guess that the source is dietary. You might have your partner try eliminating some of the pungent foods or perhaps even eliminating meat for a week or so (good luck, right!) to see if those changes are noticeable.

*****

Studies on vaginal malodor. I. Study in humans.

Obstet Gynecol 1978 Jul;52(1):88-93

Chvapil M, Eskelson C, Jacobs S, Chvapil T, Russell DH

Forty-two percent of collagen sponges tested as an intravaginal barrier contraceptive method developed malodor when retained for 5 days. Only 4% developed odor when the sponge was removed within 24 hours after intercourse, rinsed, and reinserted. While sexually active volunteers found odor in 37% of the sponges, odor formed only in 4% of the sponges worn by sexually inactive users. No difference in the rate of odor formation was found when neutral pH (7.0) and acid pH (3.4) collagen sponges were tested, although we believe that a pH 3.4 is too acid and promotes odor formation. The optimal pH of the sponge should be 4.5 to 5.5. Malodor was efficiently extracted from sponges by washing in acid milieu of tap water and vinegar or 0.1 M acetate buffer, pH 4.0. Alkali extraction procedures were ineffective, and lukewarm water was slightly less effective than acid extraction of odor. At the time of malodor development, the high content of polyamines (putrescine, spermine, spermidine) in the ejaculate decreased to undetectable values. We conclude that the ejaculate is the major source of malodor formation in intravaginally worn collagen sponges. Removal, rinsing optimally in vinegar solution, and reinsertion within 24 hours after intercourse reduces the chance of malodor

Yeast infections after natural or surgical menopause.

I had a complete hysterectomy 4 months ago and have been feeling great. Except I keep developing monthly what seems to be a yeast infection (but without much discharge). It is REALLY aggravating and painful. I see my gyn who prescribes Diflucan(R) (the last time she prescribed 5 to me). My husband has also been treated with the same. Yet, every month here it comes again! Could this be related to my hormones? I am using the Climara(R) patch and have NOT experienced any other problems.

Chronic yeast infections are actually uncommon after the menopause. Most frequently, symptoms like you describe are an irritant vulvitis which is a secondary bacterial or yeast skin inflammation of the vulva. It is not from yeast (candida) from the inside of the vagina. It can be secondary to pads, topical chemicals from soaps, creams or powders, urine leakage, just washing with soap too frequently or too low an estrogen dose.

There are a couple of exceptions to this. If you develop diabetes, a yeast vulvovaginitis can be common after menopause. The other situation is one that dermatologists caution us about and that is the situation in which a woman has yeast organisms on her feet which contaminate underwear as it is put on. the yeast cells seed the vulvar area and if there is any skin irritation, a yeast vulvitis can ensue. There are not good scientific studies that indicate how much of a problem this is but it is good to keep in mind if you continue to have a recurrent yeast vulvovaginitis at any age. A shampoo such as Nizoral(R) used on the feet may help this.

If you are under age 50 and had a surgical menopause, the estradiol dose in even the largest strength Climara® patch may be too low for you. Be sure to have your blood sugar checked and also a vaginal culture to confirm the yeast is from the vagina. If the blood sugar and culture are negative, then you are having an irritant vulvitis which is a different problem. You may want to discuss raising your estrogen dose, using a topical vaginal estrogen such as an Estring® and using good skin care practices to prevent vulvar skin breakdown.

See our patient instruction sheet at:
Instructions for chronic vulvar pain management