Healthcast 684 - Questions You Are Too Embarrassed to Ask Your Gynecologist.

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This Blog contains dialogue of a sexual nature

In my 29-year history of practicing gynecology and 23 years of practicing hormone replacement medicine, there have always been a few questions that only the bravest and most comfortable patients would ask me during a well-woman visit or consultation.

During the next few weeks, I will dedicate my blog to those usually unanswered questions, but most probably those questions that women are too embarrassed to ask. The first question is asked in many forms, but the general idea of the question is:” What should I do if I think my vaginal area smells weird?” 

“Smelling weird” is a common description that can imply many things, so I will outline what I ask my patients to gather enough information to provide them with a medically relevant answer.

What does it smell like?

1. Yeasty, like baked bread?
2. Sweaty-like body odor?
3. Sour- like a towel that has been we too long?
4. Musky – like the musk type of perfumes?
5. Urine? everyone knows what that smells like
6. Old people in a nursing home?

OR

7. “Like something is dead in there?”
8. “Like Fish?”

These are the actual descriptions that I have received in response to my question, and they all identify different.

In case some of you are worriers, I will start with the fact that vaginal odors 1-6 are likely due to a minor infection, either an overgrowth of yeast, or the fact that you don’t air out that area at night which makes yeast and bacteria grow in the warm environment between your legs or under the covers. Vaginal odors 7 and 8 are more serious and require treatment. I will first discuss the most important conditions based on their odors. These can be quite dangerous if ignored. Let me start by addressing odors 7 and 8.

Odor # 7. If your vagina smells foul, like “something is dead in there,” you should probably make an appointment with your GYN. It could result from something as simple as a tampon that was “lost” in the vagina, leading to bacteria growing from menstrual blood and semen.  This is a common cause of such vaginal odor. The GYN will need to use an instrument to grasp the tampon and remove it. She will then prescribe an antibiotic to treat the infection that has developed. While there’s no harm in removing it, leaving it in place can lead to a serious pelvic infection. If your doctor doesn’t find a tampon and this odor is confirmed by her, then she will do bacterial cultures and a pap to look for cervical cancer or endometrial cancer. It is important that you don’t ignore this odor.  It won’t get better on its own.

Odor #8. If your vagina smells like fish it is likely an infection with a bacteria called hemophilous vaginalis, or from Trichomonas (“Trick”).

Hemophilus can be caused by wiping back to front (the wrong way), which allows rectal bacteria to enter the vagina. Additionally, Hemophilus can be introduced into the vagina during intercourse. In these two cases, it is not considered a venereal infection– NOT an infection you acquired from your sexual partner.

However, Hemophilus can be a venereal infection that you contract from a sexual partner if he acquired it from someone else and transmitted it to you! The treatment is essentially the same: a medication called Flagyl or metronidazole, taken three times a day for 7-10 days.

If your partner has it too, he needs to take the medication at the same time so you don‘t keep passing it to each other. These infections require examination and testing to receive an antibiotic.

The last possible cause of a fishy-smelling vagina is Trichomonas, a parasite that produces a significant amount of thin, greenish discharge along with a fishy odor. It is sexually transmitted, and both partners should be treated.  He should also have his other contacts treated.

The group of infections in #8 is treatable and curable with medical help. Another quality of Hemophilus and Trichomonas is that if you have nitrazine pH paper and test the discharge with it, it will turn the paper dark blue.  Dark blue means go to the GYN!

We’ll start back up at 1-6 discussing the causes of “funny smelling discharge. ” These are the least likely to be serious infections.

I need to provide some initial information before I discuss the various reasons for vaginal odor. First, there is always a slight odor that is uniquely yours. You shouldn’t try to eliminate all signs of vaginal odor because it results from a combination of yeast, good bacteria, estrogen, testosterone, and progesterone, which help protect your vagina and vulva, the area surrounding the vagina.  Changes in hormones such as pregnancy, menopause, hormone replacement therapy, diet, antibiotics, and dehydration can alter the vaginal smell and discharge.

1. The yeasty odor that resembles baked bread comes from normal yeast present in the vagina. Some women naturally have this odor. It becomes a concern only when it is accompanied by itching and a significant amount of white discharge. These yeast infections can occur after taking antibiotics that eliminate good bacteria.  They may also arise when blood sugar levels are elevated, as seen in diabetics or prediabetics. The pH paper will not change color.  Treatment involves yeast medication, which can be either vaginal or oral, along with oral probiotics and sometimes vaginal probiotics to help restore the good bacteria. If you are diabetic, you may experience yeast infections until your blood glucose levels are normalized.

 

2. Sweaty-like body odor.The vagina can develop body odor from sweat that fosters the same bacteria found under your armpits.  This matter is simple.  Change out of wet swimsuits, wash gently with the same soap you use for the rest of your body, and allow your vagina to dry by sleeping without underwear.

 

3. Sour like a towel that has been wet too long. The ability to detect sour odors is genetically determined. You may not notice it, but your significant other might, or you may smell his clothes that have this odor, while he doesn’t.  Either way, it is caused by bacteria from sweaty, damp clothes thrown into a hamper, allowing fungus and bacteria to grow. For some reason, you then wear these clothes, and your vagina ends up harboring the same jungle of bacteria and fungus.  This one is easy: air out clothes before wearing them, avoid putting on garments that are not clean, and wash these clothes in warm water to eliminate the microbes. You may need a doctor’s visit for diagnosis and treatment.

 

4. Musky -you know, like the musk type of perfumes. A musky smell is the natural scent of fertile women with testosterone, especially when they are sexually stimulated. This is not an infection; it is the normal sexual scent of attraction. This odor usually diminishes with menopause or when you are on the pill and your testosterone levels decrease.

 

5. Like urine. The smell of urine is usually caused by leaking urine, poor wiping, or wearing a pad that absorbs leaking urine. It can precede a yeast infection because urine wetness encourages the growth of yeast. Treating urine leakage is imperative for resolving this issue. Options include surgery, Emsella magnetic pelvic floor strengthener, or a pessary. All of these can be discussed with your doctor when you inform them that you experience this odor consistently.

 

6. Like Elderly individuals in a nursing home? Sadly, nursing homes do have a characteristic odor; it is a combination of urine and cleaning chemicals, but there is something more. Elderly people who lack hormones have lost protective bacteria and exhibit a dominant odor of deterioration. This is what the vagina smells like without hormones and the beneficial bacteria they support. This is a smell that many women ask me about after menopause when they don’t take hormones. The only way to return the odor to normal is to reinstate hormones.

 

If you have other vaginal odors I have not addressed, then send your email questions to [e-mail].  I pray you will trust your gynecologist enough to ask any questions you need to understand your own body. I hope I have provided you with some material to reflect on and compare to help answer your questions.