Studies done in healthy asymptomatic women indicate that most of them have both aerobic and anaerobic bacteria in the vagina. These include lactobacilli, streptococci, staphylococci and anaerobes like Bacteriodes spp. and Peptostreptococcus. Women with a normal Lactobacillus predominant vaginal flora have lower concentrations of pathogenic (disease-causing) bacteria in the vagina.

A vaginal infection may occur when there is a change in the normal healthy balance of organisms in the vagina, which allows the disease- causing bacteria to predominate. An infection may also occur as a result of excess growth of yeast cells or the presence of a sexually-transmitted infection (STI).

A change in the normal vaginal discharge could be a symptom of a vaginal infection. The three commonest causes of a vaginal infection are:-

1. Bacterial vaginosis ­ an imbalance in the normal vaginal flora. Not sexually transmitted.

2. Candida (Yeast) infection ­ not a true infection but an overgrowth of yeast organisms

3. Trichomonal infection ­ a true STI caused by a protozoan

Symptoms of a vaginal infection include:

• increase or change in the vaginal discharge
• vaginal redness, swelling or ulceration
• vaginal itching or pain
• pain or bleeding with intercourse
• burning with urination
• Other conditions that may cause a change in the vaginal discharge are:
• sexually transmitted infections like Chlamydia, Gonorrhoea, Genital warts or Herpes
• an infection of the cervix (cervicitis)
• antibiotic treatment
• a non-infectious vaginitis caused by common vulval irritants.

COMMON VULVAL IRRITANTS

Hygiene products - soaps, gels, bath oils, bubble baths, douches, perfumes, deodorants, hair removal products and sanitary pads

Medicaments - disinfectants, preservatives in creams, antifungal creams, topical antibacterial agents

Lubricants and contraceptives ­ spermicides, condoms and diaphragms

Physical objects ­ sanitary pads, tight clothing, synthetic underwear, toilet paper.

Any lady experiencing the above symptoms should see her doctor for evaluation. Simple in-office diagnostic tests may be done to differentiate the normal discharge from that due to a vaginal infection. It is important to note however that most women who have an STI may be asymptomatic, that is, they may not notice any change in the vaginal discharge. For this reason and in an effort to avert the complications of an untreated STI, it is recommended in some countries that all sexually-active persons under 25 and those over 25 with a new sexual partner in the past year be screened for STIs, in particular for Chlamydial infection.

This is a very sensible precaution for us here in Jamaica where studies indicate that the incidence of Chlamydial infection in the population is very high.

VAGINAL HYGIENE TIPS

• wear loose clothing
• wear cotton underwear
• do not douche
• avoid perfumes, perfumed soaps and vaginal deodorants
• avoid bubble baths
• be careful to wipe after defecation from front to back and not the other way.

Dr. Clive Anderson is a Dermatologist.