Vaginal health

Most women will experience some form of vaginal issues within their lifetime such as thrush, BV or AV. But what are the differences and what are the risk factors for these conditions?

Vaginal Thrush is a common infection caused by an overgrowth of candida albicans (yeast). We harbour yeast naturally in our guts and a small amount within the vagina, but problems occur when these begin to increase. Reasons for increased yeast can be from antibiotic use, stress which impacts hormonal balance and can alter the vaginal pH and microbial balance, diet, lifestyle, or compromised immunity.

Thrush can cause symptoms such as
● Sore and itchy vagina / vulva.
● Soreness, burning and redness around the entrance to your vagina (vulva)
● Slight swelling of your vaginal lips (labia)
● An odourless discharge that has a thick cottage cheese-like consistency.
● Pain during sex.

Bacterial vaginosis is a term to describe dysbiosis, an imbalance of the natural balance of
bacterial flora within the vagina (increase in harmful bacteria and lower levels of protective bacteria such as lactobacilli) and is not caused by increased yeast/candida.

BV can cause symptoms such as
● Watery discharge
● A strong fishy odour
● Itching, burning or pain in the vagina
● You may also experience burning when urinating

Anything that can disrupt the microbiome balance within the vagina can cause symptoms of BV such as different sexual partners, or multiple partners, not using a condom, antibiotic use, diet and lifestyle including smoking and alcohol. BV can increase the risk for future STIs as the imbalance of vaginal bacteria allows the potential for other vaginal pathogens to gain access to the upper genital tract. BV also increases the presence of enzymes which reduce the ability of leukocytes to fight infection and increases the release of endotoxins that can stimulate cytokine and prostaglandin production within the vagina.

Aerobic vaginosis (AV) is an overgrowth of aerobic, enteric bacteria, causing variable levels of vaginal inflammation and deficient epithelial maturation. It does have similar characteristics to BV in that there are lower levels of beneficial bacteria such as lactobacilli, but the symptoms can be a little different
● Increased foul smelling discharge ( not fishy)
● Increased vaginal pH
● Increased inflammation within the vagina which may display small erosions or
ulcerations
● Discharge is yellowy/green and thick
● Dyspareunia (pain during sex)

AV can occur from antibiotic use, unprotected sex, menstruation as it can also alter the vagina's pH and stress can impact hormone levels which can also alter the vaginal pH.

We also know that with all of the above, menopause can be a risk factor for developing them.
During Menopause, oestrogen levels decrease, affecting the lactobacillus colonies. This can then increase the pH level, the dryness in the vagina increases, causing changes in the microbiome.

Fortunately, there are many ways we can support these and work to prevent infection. We also test the vaginal ecology 

If you've been struggling with any of the above get in touch and we can discuss our approach and how we can help you. Book a discovery call. 

References:
Greenbaum S, Greenbaum G, Moran-Gilad J, Weintraub AY. Ecological dynamics of the
vaginal microbiome in relation to health and disease. Am J Obstet Gynecol. 2019
Apr;220(4):324-335.

Russo R, Karadja E, De Seta F. Evidence-based mixture containing Lactobacillus strains and lactoferrin to prevent recurrent bacterial vaginosis: a double blind, placebo controlled, randomised clinical trial. Benef Microbes. 2019 Feb 08;10(1):19-26.
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Verstraelen H, Swidsinski A. The biofilm in bacterial vaginosis: implications for
epidemiology, diagnosis and treatment: 2018 update. Curr Opin Infect Dis. 2019
Feb;32(1):38-42. [