The Ultimate Guide to Vaginal Infections

Experiencing some itching down there? 

Does it hurt to go pee? 

Are you noticing weird discharge? 

If you've had any of these symptoms, you're not alone. Most women experience at least one of these symptoms in their lives. And some, experience them constantly. These infections can be incredibly uncomfortable and affect your quality of life. They may also impact your sex life, fertility and future vaginal microbiome. 

Vaginal Health 101

The vagina should be slightly acidic with a pH between 3.8 and 4.5. Lactobacillus bacteria create this acidity when they 'eat' glycogen, and produce hydrogen peroxide.

The vagina thrives on limited diversity - which means it prefers lactobacillus strains. There are other strains of bacteria like candida, E. coli and gardnerella in the vagina, but they're kept in check by lactobacillus. However, about 40% of African-American and Hispanic women don't have a Lactobacillus-dominant microbiome. 

Certain factors can shift the Lactobacillus-dominated microbiome, causing a pH shift and leading to dysbiosis. When this happens, an infection is likely to happen. Shifts might happen because of your period (drop in estrogen), using pads or tampons, or sexual behaviours. Antibiotic use can also lead to dysbiosis as all bacteria are usually killed off. 

Using products to 'clean' your vagina may also be contributing to these symptoms. A 2018 study showed that:

• People who reported using moisturizers or lubricants had a 2.5x higher odds of reporting a yeast infection, and 50% higher odds of reporting a UTI

• People reporting using gel sanitizer had almost 8x higher odds of reporting a yeast infection, and almost 20x higher odds of reporting BV

• People who reported using feminine wipes, had double the odds of reporting a UTI

• People who reported using baby wipes had 60% higher odds of reporting a UTI

• People who used feminine washes/gels had almost 3.5x higher odds of reporting BV and 2.5x higher odds of reporting a UTI

• People who reported douching that occurred in the previous 6 months had 3x higher odds of reporting a yeast infection, and 2.5x higher odds of reporting a UTI

Yeast Infections

Between 40-75% of sexually active women experience yeast infections! Symptoms include itching, pain or burning - alone or with urination, redness or swelling of the vulva, or increased discharge (white or with a yellow tinge). However, there can be an overgrowth of candida with no signs or symptoms. Vaginal pH is typically normal in these cases.

Urinary Tract Infections

UTIs are common and can recur quite often. E. coli is the most common cause of UTIs, but can happen from other bacteria. 

UTI symptoms include itching, burning or pain with urination, swelling and redness of the vulva, and potentially watery discharge. Vaginal pH is typically normal in these cases.

Bacterial Vaginosis

Bacterial vaginosis is the most common cause of vaginal signs and symptoms. You can tell if you have BV with an over the counter pH kit. 

BV symptoms include an unpleasant 'fishy-smelling' discharge, which may be off-white and thin. This discharge may be present after sex. Your vaginal tissue usually remains normal (no redness or swelling of the vulva).

While recent research has shown that gardnerella isn't always the cause of BV, it can be sexually transmitted by female or male partners. Risk factors include new sexual partners and oral vulvovaginal sex. A study has also shown that gardnerella may be passed from mothers to daughter during delivery, as young girls had gardnerella dominating their microbiome. 

BV can be quite serious, especially if you're hoping to eventually become pregnant. It can increase your risk of STD transmissions, pelvic inflammatory disease - which can specifically interfere with fertility. A study showed that in women with tubal factor infertility, they were more likely to have BV. Women with BV were also less likely to become pregnant when they had a BV-dominated microbiome. 

If you are pregnant, BV might increase your risk of premature rupture of the membranes, premature birth, and postpartum endometritis.

How to Treat

You might book it to your doctor or pharmacy as soon as you feel a tinge of pain. That's completely normal - no one is asking you to be a hero and suffer vaginal pain!

Conventional products (antifungals, antibacterials) are targeted to kill the pathogen, but will also wipe out all the good bacteria (lactobacillis). If you're not reintroducing good bacteria back into the vaginal ecosystem then you're back at square one. And just a side note, some of these over-the-counter products are filled with parabens - which we know can cause unwanted hormonal effects!

1. Stop

This is pretty simple. The 'bad' bacteria must be stopped and killed (harsh, but true). If you've had infections in the past, then you're likely no stranger to antibiotics and antifungals. These therapies kill the bad and good guys. When Lactobacilli are gone, the pH of the vaginal canal will change and can't get back to the 3.8-4.5. 

If you're looking at a natural antimicrobial/antifungal, might I recommend garlic. Cranberry can also be used in UTIs to prevent E.coli from sticking to our cells.

Although not an antimicrobial/antifungal, avoiding sugar (especially in some fruits, dairy and bread) as well as alcohol can prevent yeast from thriving.  

2. Supplement

Don't skip out on this! We need to get Lactobacillus back into the vagina to reestablish the pH.

Before you run to the grocery store and buy some kombucha, you need to make sure you have the specific strain of probiotics. In this case, Lactobacillus rhamnosus GR-1 and Lactobacillus reuteri RC-14 have been extensively researched and shown to be incredibly helpful for urogenital conditions. Many studies have shown benefit of using pharmaceuticals in conjunction with probiotics, so no worries if you still want to take a drug but also want a natural approach.

Your bacteria needs to eat too! Prebiotics are food for bacteria and help them grow and ultimately bring the vaginal ecosystem back into balance. If you don't feed them, bacteria are likely to leave your system faster and may decrease the beneficial effects that you're looking for.

3. Support

If you're experiencing chronic infections, your immune system might need some love. I often include herbs to help your body work its magic:

• Immune stimulants promote immune function
• Urinary antiseptics prevent the growth of the unwanted bacteria
• Urinary demulcents to help soothe urinary tract membranes
• Diuretics increase urinary output (and flush the bacteria out)

You also want to avoid known triggers! That means stopping the sugar, and eating a whole food diet. Tossing the thong, and wearing cotton full-bum underwear. Pausing on the pads, and switching to a cup. 

Final Thoughts

Working with someone who knows what they're doing is a step in the right direction, and a step away from chronic infections. Book an appointment with a Naturopathic Doctor so you can finally stop avoiding the bathroom or sex. 

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References

Kroon, S., Ravel, J. and Huston, W. (2018). Cervicovaginal microbiota, women's health, and reproductive outcomes. Fertility and Sterility, 110(3), pp.327-336.

Crann, S., Cunningham, S., Albert, A., Money, D. and O’Doherty, K. (2018). Vaginal health and hygiene practices and product use in Canada: a national cross-sectional survey. BMC Women's Health, 18(1).