I thought I’d begin Medically Fit with a bang and delve straight into something “deliciously icky” (forgive me but physicians are known to be allured by the ‘gross’ and bear psychopathic tendencies). Add to that, here is a topic, which despite being extremely common in prevalence, lags far behind, in awareness and conversation i.e. optimal fodder for me.
Statistics currently depict that Bacterial Vaginosis or BV as it’s known, is actually the most frequently seen disease in women of childbearing age. At a given point it wouldn’t be a stretch to state that 30% of people in a given population have BV. That translates into nearly 1 in 3! And almost all women will experience it once in their lifetimes.
‘Flora’ literally means the micro-organisms that live in a particular region of your body. Vaginal flora is 95% lactobacillus bacteria (don’t get excited because it isn’t the same stuff that’s in your yoghurt). This lactobacillus helps keep the vagina’s pH level within the normal range of 3.8 – 4.5 and ensures the disease-causing bacteria (pathogenic bacteria) is kept in check. BV occurs when the pH of the vagina rises to above 4.5. This happens when anaerobic bacteria (those which thrive in lower Oxygen environments) increase in numbers making the vagina alkaline.
BV usually resolves on its own and causes the affected only mild discomfort. That being said, when symptoms persist, they often cause more than discomfort and are often the sources of embarrassment.
Characteristic signs of BV include a greyish-white, watery vaginal discharge. Some women have reported this to be yellow in colour. The discharge is bothersome particularly because it smells fishy (pun not indended). This discharge often worsens post sexual intercourse and can even cause pain and irritation to the area. It is noteworthy here that BV’s symptoms aren’t unique and often mimic other infections and sexually transmitted diseases (STDs). A correct diagnosis is vital for effective treatment.
The first myth I’d like to dispense with is that BV is indeed NOT caused by poor hygiene but on the contrary by excessive washing (read below ‘the what nots’). Another myth I’d like to dispel with is that BV cannot be contracted from using public spaces like toilets, hot-tubs, swimming pools and touching contaminated objects. Similarly it is NOT transmitted from a man to a woman during intercourse. However, female-female transmission is possible during intercourse.
As mentioned above, BV occurs due to an imbalance of vaginal bacteria. While there is no clear aetiology (cause) for BV, several factors are thought to be linked to its occurrence and these include:
BV is common in women between the ages for 16 to 44 years but can occur in extremes of age too. It tends to develop most commonly after unprotected sexual intercourse.
A risk factor for developing BV is if you’ve had it before, then chances are you will have it again. Evidence shows that more than half the women that are treated for BV experience recurrence within a year.
the How (to diagnose?)
If the BV doesn’t resolve on its own then pay your Gynaecologist a visit. He/she will obtain a thorough history, conduct a pelvic examination and take a swab sample, which is then sent to the labs for testing. In the lab and under a microscope, tell-tale signs of BV are something called “clue cells”.
Another common test that is performed is the Whiff test. Advances in medical science do allow for DNA testing of the BV bacteria but this is not routinely done.
the What to do
‘Take your meds! Properly! Ask your physician when to take them – morning? Evening? Afternoon? Before or after food? Before going to bed? The treatment for BV is a course of antibiotics of which Metronidazole is the most commonly prescribed drug. Metronidazole is known to have side-effects and when they’re too severe, Tinidazole is another drug which is prescribed.
With antibiotics it’s important to remember that antibiotics reduce the effect of the contraceptive pill so be careful and practice abstinence or use barrier contraception (condoms) during your course to avoid an unwanted pregnancy. On the same note, avoid alcohol during the course and up to 48 hours after you’ve finished your last dose.
Topical treatments include vaginal gels and creams in which Clindamycin is the antibiotic ingredient. These gels and creams weaken the effect of barrier contraception i.e. condoms or diaphragms and thereby leave you vulnerable to unwanted pregnancies and STDs.
**Note : Antibiotics can have a side-effect of causing a vaginal yeast infection so go back to your Gynaecologist if you have itching, inflammation or a white, lumpy discharge.
If you’re pregnant and find the telltale signs of BV then consult your Gynaecologist immediately as BV is known to result in miscarriages, uterine infections and even preterm delivery. If you’re about to have pelvic surgery then BV makes you vulnerable to pelvic infections and it must be treated and cleared prior to surgery.
Finally, it is important to be aware that while there isn’t evidence to prove it, it is seen that women with unhealthy diets and lifestyles i.e. sedentary/smoking/alcohol excess tend to have greater risk of contracting BV. Eat well, include plenty of greens and fruits in your diet and limit your refined sugar intake.
the What nots
BV can make you susceptible to reproductive tract infections and inflammations so it is important to follow these do nots :
Smoke – Simply, just do not smoke.
Douche – Douching is a Western concept that involves flushing out the vagina with a solution after a period. This was done with the intention to clean the vagina. In reality, the vagina has evolved to being able to cleanse itself and remain hygienic. Douching greatly alters the environment of the vagina and makes you very susceptible to BV. Similarly refrain from using vaginal deodorants and washing down ‘there’ more than once a day. If you’re still unconvinced then just think back to Mrs Homo Sapien and how often in the wild she bathed/douched. Never! And guess what – she didn’t have BV as often as we do.
Use strong detergents to wash undergarments
Not use scented soaps or antiseptic bubble bath liquids
Here’s an article on the Woman 2 Woman blog which voices the concerns, opinions and advice of another physician and makes for a riveting read – Whither White Discharge
Juggling many roles from physician to writer to pilates instructor to Marketing-PR executive, Dr. Daamini is constantly pushed and inspired to get creative on how to encompass a Retreat into her daily life.