Womens Health

Sexual Desire

Frederick R. Jelovsek MD


Why do I have a vaginal odor?

I've got a vaginal odor and I want to know why? I shower on a daily basis, so it's not that I'm not clean. It can't be because of semen, because it's been almost a month since my last sexual encounter. I have been having kidney problems, by chance could this be associated with this odor? What can I do to correct this, RIGHT AWAY?

First you have to be sure the odor is vaginal rather than perineal. To distinguish, wear a tampon for awhile. If the odor mostly goes away then the odor is from vaginal secretions; if the odor persists, it is from oils or bacteria on the outside skin called the perineum.

Vaginal odor almost always comes from the interaction between bacteria and vaginal secretions or semen. If semen is not an issue, then a vaginal odor may be from bacterial vaginosis especially if the odor is "fishy" like. If so, it is best treated with antibiotic vaginal cream or oral antibiotics. See our disease profile on bacterial vaginosis. You will have to get these prescriptions from your doctor. Over-the counter treatments are not ideal but medicated douches may help at least temporarily. We don't recommend them long term but douches such as vinegar-based ones are ok to use for an active bacterial vaginosis. Also at the pharmacy you can get tablets with lactobacillus acidophillus to take by mouth. They help colonize the GI tract to decrease the recurrence of bacterial vaginosis.

Perineal odor is from the oils in the sweat glands and the skin bacteria. If your perineum (vulva) has any irritation, itching or burning then there is a secondary skin infection with opportunistic bacteria. Keeping the perineum clean, dry and non sweaty will help. The sweat oils come from food you eat with more pungent foods and increased fats causing more smell. Dietary change with less fat and meat and spices can help that as well as exercise that depletes the sweat gland oils.

I have absolutely NO skin irritation in that area. I didn't even know this until my sexual partner told me. So, is it best to make an appointment with my GYN? I'm totally stupid to this, I'm sorry! I have no one else to ask these questions to!

Then am I to understand that you yourself do not recognize an odor but only your partner? You may have to see your Gyn but if there is no discharge and you are not aware of an odor, then it may be your partner's perception. There are always "sexual" odors present. They aren't floral but they are not offensive. Could that be what we are talking about?


Vaginal dryness affecting sex

I am a healthy 28 year old female and I have never been able to lubricate when sexually aroused. This has been a lifelong problem regardless of partner or level of arousal. I am easily able to feel aroused and am able to orgasm, but absolutely no lubrication (even with self stimulation). I eat a healthy diet, take no meds, have very regular periods, and honestly have no negative psychological feelings or hang ups about sex. I have consulted 2 OBGYNs and have done a regimen of vaginal Premarin® for several weeks, but it did not help. Neither of the docs had any idea as to what the problem may be. I am a nurse and I can't help thinking that there is a missing medical link here. As I get older, obviously it bothers me more and I find it quite embarrassing. I have been using KY® or Astroglide® for years!! What else could I do or who else could I consult to find out what is going on here? I appreciate in advance any insight you might have.

Vaginal lubrication is due to fluid "sweating" from the dilated blood vessels that occur during the arousal phase of sex. It would be hard to believe that your vaginal blood vessels are not dilating if you can get to orgasm but I suppose it is possible. Is there any chance you so not perspire at all with exercise? If so you may have a condition called anhidrosis. This may be treatable, but only under a doctor's care, using beta 2 adrenergic stimulants such as terbutaline used for asthma.

K-Y® regular lubricant will increase the dryness. For a vaginal lubricant, use the bioadhesive brands such as Replens or K-Y Long-lasting. Also if you are not using condoms for contraception you can use a mineral oil or an essential oil base such as grapeseed oil, jojoba oil or even a vegetable oil like canola. Many women have done well with the commercial products such as Intimate Moisture by Very Private®. I don't think the lubricant is the cause of the problem but it can worsen it.

I assume you are not taking any medications or supplements, and not using douches or any soaps inside the vagina - is that true? Has antything been tried other than the estrogens?

I have not always used lubricants because I wanted to make sure that I still wasn't lubricating on my own. No, I have never tried anything besides vaginal estrogen because my doctor didn't have any other ideas that he thought might work. I asked for a blood test to check my hormone levels, but he said that if my hormones were off, that my periods would not be regular(and my cycle is very regular). I know what you mean when you say it is hard to believe that I can reach orgasm, but that I don't lubricate at all. I thought the same thing and I don't understand it, but I assure you that it is the case! Now I must include that I am somewhat slow to orgasm (as long as 15-20 min.) but that has never really concerned me.

I am pretty well versed on all of the different lubricants on the market, and have tried nearly every one. I just want to figure out a solution so I can function without them rather than finding one that works better than the others! I have gone for at least a year without sex, and during that time I never used a lubricant, and I would self stimulate but still no natural lubrication. What are some of the other things that you think I could try? Is it possible that it could be a hormonal component even with regular periods? Oh yeah, I also wanted to confirm that I am not on any meds, and have only taken the pill once for about 4 weeks(that was 2 years ago), but no difference. I have not taken any birth control since then. Funny thing is, I have been an OB nurse for 3 years and I have no idea what is going on with my own body!! Thanks again for your help, I truly appreciate it.

I think this problem will require working very closely with a physician who is interested in helping you solve this. If I were working with someone who had what you have so well described, I might include the following:

  1. serum hormones - testosterone, estradiol, TSH to make sure they are not abnormal even though I agree that it is unlikely that they are abnormal.
  2. trial of Viagra as used for arousal disorder. Not much evidence about this yet but would give a trial of about 3-4 uses to see if it makes a difference. Basically it causes more and longer engorgement of the pelvic vessels.
  3. if any suggestions of decreased estradiol or increased testosterone, might consider an Estring as delivery of a constant dose of estradiol to the vaginal epithelium.
  4. correct any thyroid hormone abnormality
  5. consider a trial of a beta 2 agonist such as an albuterol inhaler used for asthma. Note this would be quite experimental so needs to be done working closely with a physician.

Thank you for the suggestions. I feel better already now that I have at least some potential options. I will make an appointment to see my OBGYN and discuss all of this with him. Will certainly let you know if I have any success. Thanks again!


Vaginal odor after withdrawal from sex

I have a vaginal odor, not on the exterior, but deep within me. We don't smell anything, until he removes himself from within me... what would this be caused from? I went to the doctor a month ago, and he diagnosed BV (bacterial vaginosis), but he put me on a prescription and I THOUGHT the problem was handled. Obvisiouly it's not. Thank God it's been the same trusting partner!!!! Please tell me what could be my problem.

There are probably still some of the same bacteria in the vagina and when mixed with semen, odorous amine chemicals are released. Condom use would prevent that or a least make a diagnosis for you that that is the cause of the odor. In other words if you use a condom and the odor goes away, then it is the interaction between the semen and the bacteria or the semen itself that is causing the odor.

There are not very good over-the-counter treatments for bacterial vaginosis. Temporarily you can use a vaginal douche before intercourse to reduce the number of bacteria and thus the amount of odor. In the long run, though, douching can continue to favor the growth of BV. You should call the doctor's office and see if you can get another prescription for the Metrogel Vaginal® or see if the doctor made the last prescription refillable. They may want you to come in to be seen but most offices will refill that if you have been seen recently. If it keeps recurring, you may need to take oral metronidazole on an acute and then a chronic basis. I would suggest trying the douching and condom use first until you have gone another month without the odor after sex. Then stop using the condoms if you have other protection. Then stop using the douching about 3-4 weeks later if you are still symptom free.


Can the herb feverfew affect orgasm?

I started using the herb feverfew in January to see if it would help my migranes. The brand was Natrol and I took one 380 mg capsule of dried whole feverfew plant powder a day. I heard that you need to take it for a few months before it would have any effect. I was still getting severe menstrual migranes every month despite alternative treatments of vitamins etc. The feverfew did not seem to be helping so in May I discontinued it. Lately I have been having problem reaching orgasm. I am able to get there, however it takes a longer time than it used to and there is reduced sensitivity. I seem to need to use my pc muscles where before it didn't seem to matter if I used them or not. I recently read about an article in the May 1994 issue of the British Journal of pharmecology that said that feverfew showed the inhibition of smooth muscle contractibility in a time dependent,nonspecific and irreversible manner. Since vascular tissue is smooth muscle tissue could this be why I am having this problem? I have no problems getting aroused and the desire is always there, but it seems to be much more difficult to reach orgasm than before. This problem started in early May and I stopped taking the feverfew a week later.

I cannot say if this is an effect or not. As you are aware from looking at scientific articles, the work about smooth muscle has been done in rabbits mostly and we do not know of any effects like this in humans. The fact that you took the dried preparation goes against the permanent effect as indicated in the abstract reference below, because the effect has been shown to be with freshly extracted feverfew, not dried preparation (R).

I would not rule out however that this can be a cause. You will have to wait and see if the delayed time to orgasm reverts to normal within a week or two of stopping the feverfew. I still would doubt very much if it could ever be a long term effect beyond 6 months to a year. You may be the first person to describe this and I would be interested if any other women taking feverfew have noticed this.


Vaginal pain and bleeding after intercourse

I am 23 and have been having sex for a few months. The last time I had sex, which was three days ago, I experienced heavy bleeding during and after intercourse as well as pain during intercourse. I am not due for my period till next week and I am very confused about why I am still bleeding and there is still pain.

There is no way to answer this without your having an exam to see if the bleeding is in the vagina or from the cervix versus uterine bleeding that was induced by intercourse.

If the bleeding is from a cut in the vaginal skin from the entrance of the vagina anywhere back to the cervix, you must hold off intercourse until that completely heals (2-3 weeks). Then resuming intercourse may require using vaginal dilators to gently increase the elasticity of the vaginal skin.

It is not common that intercourse can induce an early menses, but it certainly is heard of. It should straighten out over the next month or two.


Irritant vulvitis versus vulvodynia -- how can I tell?

How can you differentiate between irritant vulvitis (caused by say a laundry detergent) and a secondary yeast infection (caused by lots of antibiotics) and vulvodynia? Does vulvitis that doesn't heal properly turn into vulvodynia?

With a recurrent or secondary yeast infection of the vagina, the yeast metabolizes glycogen (sugar) in the vaginal cells to alcohol. When alcohol gets on the vulvar skin, it burns and irritates it. If you wear tampons to prevent the discharge from getting on to the vulva and the pain lessens or goes away, then the main problem is a recurrent yeast infection. Also, vaginal yeast cultures will show heavy growth.

With an irritant vulvitis, vaginal yeast cultures are generally negative, and pain does not improve with tampon use. If the vulvitis is constant, it is by definition vulvodynia which merely means vulvar pain. Vulvodynia is a constant, chronic condition which has different etiologies such as chronic yeast infections, a contact dermatitis (irritant vulvitis) but a large category is unknown cause. Vulvar vestibulitis which is an inflammation or the glands of the vestibule skin is actually a very less common cause of vulvodynia but an important one because it is a persistant disease refractory to manytreatments.


Decreased libido and vaginal dryness on the birth control pill.

I am 30 years old and never had a problem with vaginal dryness or decreased libido. I don't know if its this new birth control pill Ortho-cylen® that I've been on for 2-3 months? I have tried tri-phasic pills and they make me VERY VERY MOODY. Should I try a pill with lower progesterone and higher estrogen? Will that help with either problem?

In general, a lower pregestin and higher estrogen pill is a good choice because progesterone contributes both to moodiness and vaginal dryness. Estrogen does the opposite. So a lower progestin potency pill with more estrogen is a good choice. Orthocyclen® should be good to decrease moodiness. It has a low progestin to estrogen potency ratio compared to other pills.

The dryness started after being on the Ortho-cyclen® but I also had several reacurring bacterial infections within that time with several treatments that didn't work (Flagyl®,Cleocin®, Metrogel®). My doctor said the infection could have been from a hormonal change from that pill. So my doctor gave me Estrace® estrogen vaginal cream to apply at the vaginal opening to calm the glands. Funny, I haven't had a bacterial infection since! However I do still have the dryness. I didn't have the dryness problem prior to this birth control pill. I was on a tri phasic pill prior to the Ortho-cylen® but again the tri phasic made be crazy.

The dryness you are having is probably not a pill effect. While it could be, Orthocyclen® should be a good pill to not be dry. I would look for other causes of the dryness. Specifically, the normal vaginal bacteria may be disrupted from the episodes of vaginitis. Acidophilus supplements on a daily basis may help this. Another cause, especially if the dryness is most noticeable with sex, is the decreased desire or lack of arousal during sex. In other words, that can be the primary problem and the dryness just a secondary problem.

I think some hormonal thing has taken place. So to wrap this up if a Tri phasic pill makes me crazy and the Ortho-cylen® MAY give me vaginal dryness what should I do?

Temporarily use a vaginal lubricant both with and in between sex.

As far as decreased libido, I didn't have this problem at 20. Now I'm 30 I could care less. Its not my boyfriend by any means, he's wonderful. What can increase libido???

To increase libido, you have to look at the causes of decreased libido and then try to get rid of the cause. I do not know what is the cause in your case so you will have to be your own detective in figuring it out. The most common causes are (in descending order of frequency in my opinion):

  1. stress, fatigue
  2. fear of pain with intecourse (due to dryness or other conditions causing pain
  3. medications, especially antihypertensives and mood affecting drugs
  4. anger with partner (many times subconsciously)
  5. generalized depression
  6. adversion to partner's sexual technique or body habitus, odor, habits etc.
  7. decreased estrogens, especially after menopause

There are of course other causes and decreased libido can be made up of more than just one cause. Can you identify any of the above which might be playing a role in your case?

If you are really sure none of the above apply to you, you might try one of the herbal preparations such as the Arginmax® for Women which has a basis in scientific studies as effective.



Do vaginal lubricants affect trying to conceive?

We have been trying to get pregnant for the past 6 months. I'm almost 34. I am quite educated on the whole process, but have read conflicting reports about using lubricants when TTC. We have been using Astroglide, and some people say that's okay, others say otherwise. Anyone have an accurate source, or do we just not really know? I'm not too interested in using actual eggwhites, as was recommended in Taking Charge of your Fertility.

I cannot speak to Astroglide® but Baby Oil® (mineral oil) and canola oil appear not to affect sperm motility whereas K-Y® jelly does (R).


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