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Vaginal Infections: Answers to Frequently Asked Questions
Frederick R. Jelovsek MD
   
Odorless,jelly-like vaginal discharge
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
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.
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
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.
Yes.
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.
Yes. After the graft takes completely, usually about 4-8 weeks, sometimes longer.
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
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.
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
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