Dr. Stephanie Lam returns to the podcast to discuss vaginal infections and vaginitis, which are very common and, she estimates, affect 20-25% of patients. Dr. Lam and Dr. Fox review common types of infections, what symptoms to look out for, treatment options, and when patients need to schedule an appointment with their gynecologist.
“Burning and Itching and Discharge, Oh My! Vaginitis” – with Dr. Stephanie Lam
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Dr. Fox: Welcome to today’s episode of “Healthful Woman,” a podcast designed to explore topics in women’s health at all stages of life. I am your host, Dr. Nathan Fox, an OBGYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman,” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness.
Steph Lam, welcome back to the podcast. How’re you doing?
Dr. Lam: I couldn’t stay away.
Dr. Fox: Well, you know, this is a thrilling topic. You really wanted to talk about infections and inflammation of the vagina.
Dr. Lam: If I say that 50% of my day could be spent on this topic just seeing patients, it makes me happy to talk about it.
Dr. Fox: Right. It’s a good thing you’re a gynecologist.
Dr. Lam: Yeah. Better than a dentist.
Dr. Fox: Yeah. You’re trained so it’s all good.
Dr. Lam: It’s my sweet spot.
Dr. Fox: People don’t wanna talk about this but as you said, everybody’s got it.
Dr. Lam: Oh, yeah.
Dr. Fox: It is so common. I mean, what would you guess? Like, probably in a given year, 10% to 20% of people are gonna have this or complain to this at least, right?
Dr. Lam: Yeah. I mean, and I think probably even more than that. People try to take care of it at home. They don’t necessarily have a doctor who they see. They’ll buy something over the counter to try to make it better. But yeah. Probably a good 20%, 25% of patients will have something at some point.
Dr. Fox: Yeah. And I think the reason I wanna do this podcast is, A, it’s just lovely to see you obviously and to talk to.
Dr. Lam: Me too.
Dr. Fox: But I think that a lot of people just know symptoms, right. They know I have itching, I have burning, I have discharge, I have pain. Whatever it is. And they see the doctor and they get some treatment and it works or it doesn’t work. But, you know, we don’t think of it in terms of the symptom. We think of it sort of what’s the cause? Is it normal or abnormal and if it’s abnormal, why and what can we do? And sort of…and to give our listeners kind of an insight into that way of thinking so they understand a little better, like, what we’re doing and why we would recommend one thing versus another…because again, people just…they don’t…why would they know these things? They just know what they feel. So, what is it that would bring someone to see you? What is, like, the most common complaint regarding what we call vaginitis? That’s the medical term for it.
Dr. Lam: Right. So, I think in general when someone thinks that something’s wrong, the most typical symptom that they may notice or something that…they either have itching, itching on the vulva area, the outside of the lips as we like to say. They notice a vaginal odor or smell. Something smells off. They feel unfresh. Or if they have a discharge, the thing that people need to know is that every woman will have a discharge and a discharge is normal to some degree. And people have a change in the discharge or their change in secretions depending upon the time of the month and also based upon hormones. But if that discharge or that change in what’s coming out of the vagina has a color to it or it seems to be heavier than normal or it’s tinged with some blood or something like that, that would be another cue that they should probably reach out to the doctor.
So itching, odor, irritation, burning. Those are probably the top four symptoms that I would say that would lead a patient to call the office and say that they wanna be seen.
Dr. Fox: Right. Are there circumstances where let’s say someone said, “Well, whatever. I can deal with the symptoms, this or that.” Where it’s actually not healthy for them or could be dangerous or is this all about really just making them feel better in a sense? Which is valuable. I’m just saying, but is there any, you know, danger or is it just about symptoms?
Dr. Lam: No, I think the vast majority of things that are gonna bother patients are probably, you know, fine. And over time it’s either not gonna get better…it’s gonna bother them so much that they can’t think about anything else but their vagina or their vulva and they’re gonna come in. In a rare case, if patients have persistent itching or irritation or burning, there can be certain dermatologic or skin issues of the vulva that they really should see a medical professional about. Otherwise, it can lead to a precancer such as, like, in sclerosis or, like, in, you know, simplex. Those things can’t be treated with a yeast medication or another medication. Those need steroids.
Dr. Fox: Right.
Dr. Lam: I mean, so if you have a patient where there’s this persistent spot that’s bothering them or a change in the color or the texture of their skin, something’s growing, then yeah, they should not be taking care of it or kicking the can down the road and come in to get seen.
Dr. Fox: Right. And a lot of people are concerned about, let’s say, sexually transmitted infections, you know, STIs or STDs. Would they present the same way or would they present differently? I mean, if someone has these symptoms, is there a chance that, in fact, it’s, like, a sexually transmitted infection behaving this way or is it very unusual for that to be the case?
Dr. Lam: So, when we look at what patients come in for and for what symptoms, there’s things that are not sexually transmitted and can just be an overgrowth or the change of the bacteria of the vagina such as a yeast infection. There’s fungus. That fungus and why people get yeast infections can be precipitator brought on by antibiotic use, too much alcohol, too many carbs or sweets, wearing wet bathing suit or staying in the clothes that they worked out in for too long. Those are things that could bring on a yeast infection. You can have a bacterial infection that’s not a sexually transmitted disease. Those also are change in the PH. Typically those symptoms…they may notice an odor, an irritation, a burning when they urinate. Typically, not a sexually transmitted disease.
Things specifically like if they notice a blister, a cut, burning, those can be a sign of herpes. Those specifically, they should be seen. I think chlamydia and gonorrhea, change in the color of the discharge or if your partner is complaining of something. So, like, you have to also listen to what your partner is saying or if it’s a new sexual partner and you have no idea, you should come in for a checkup. But those I think are the hallmarks of the major things.
Dr. Fox: Right.
Dr. Lam: And then you have issues, why women come to the doctor in menopause. Once estrogen starts to drop, your vulva and the vagina typically become dry and people can get burning and dryness and those are non-sexually transmitted issues and we can help you with that as well.
Dr. Fox: Yeah, and what you said at the beginning, which is really true about, you know, the bacteria versus yeast or something that’s called candida or fungus. It’s all the same thing. Yeast, candida, fungus are the same thing. Essentially, the way I was…learned it is the vagina is lined by this…what we call a mucus membrane, right. So, it is a membrane meaning it’s a barrier but it’s not like skin where that sort of is very…the histological term is keratinized, right. Skin is a little, like, tougher whereas the mucus membrane is more likely to be inside of someone’s lips, for example. It’s like that…yeah, it’s…
Dr. Lam: It’s sensitive. It really is more subjective to lots…whatever’s going on inside the vagina.
Dr. Fox: It absolutely can be very sensitive but also the environment that’s there because of…sort of it makes this glycogen which is, like, a sugar product. The idea though that there are these bacteria that are supposed to be there, right. The vagina’s not supposed to be a sterile environment. Yeah.
Dr. Lam: It has a PH. It’s supposed to be…if you’re gonna look at acidic and alkaline, there’s certain levels that we’re supposed to have where homeostasis…where you…kinda your happy, sweet spot is.
Dr. Fox: Yeah.
Dr. Lam: And that all can be set off and off balance based upon how we live our lives. And so, you know, I think when we look at our patients here, we really do believe…and it sounds a little hoaky but I truly do believe in the mind, the body, the whole way of how you look at a patient. And so, what you eat, how you treat it, are you drinking enough water, are you taking medications? All of that kinda can set it off a little bit.
Dr. Fox: Sure.
Dr. Lam: So, when patients come in or they call the nurses and they say, “I was on antibiotics for a sinus infection.” And they have some itching or irritation. Those are certain keywords that will lead us to think of what maybe they’re coming in with. But yeah, the lining of the vagina, those cells are very different than the cells on our arms or legs. And they’re much more subjective and sensitive to what’s going on.
Dr. Fox: Since there’s this sort of typical environment that’s there, right, and there’s supposed to be bacteria in there. There’s always a small amount of candida or yeast in there. They live there. They’re supposed to be there. If you mess with that system and they sort of…you get too many of one and too little of the other, right. You get too many yeasts, too little bacteria. If you kill off the bacteria, the yeasts take over and you get a yeast infection. If you kill off the yeast, the bacteria can take over and you get those…
Dr. Lam: The bacteria overgrowth and then that’s when you get those infections associated with whatever it is that you now have an overgrowth of, which is why when you talk to patients or you hear about probiotics or you talk about things that are more of a holistic health approach, how you can even out the PH or the bacteria of the vagina, those are kinda things that can try to improve or decrease the risk of getting recurring vaginitis, or BV, or yeast. And so, people do believe in probiotics. They do believe in yogurt and kefir. They do believe in boric acid, that type of stuff.
Dr. Fox: Yeah. Right. Which is also why typically it’s not recommended that women use any, like, cleansing products.
Dr. Lam: Like a douche or something like that.
Dr. Fox: Yeah, because that’s…like, it sounds like a great idea but you’re basically just washing out bacteria that are supposed to be there and you’re gonna end up getting growth of stuff that is not supposed to be there. And so, it’s not a good idea.
Dr. Lam: Yeah, I say leave the vagina alone.
Dr. Fox: Leave it be.
Dr. Lam: Leave it be.
Dr. Fox: Leave it be. So, someone comes to you, a new patient or someone you know has a new complaint and she’s coming to you and essentially, it’s of that ilk, right. I have burning, I have itching, I have discharge. What are the ways that you might evaluate what is causing that? I assume you start just, like, a history, things you can get over the phone or in the office. So, what are the types of questions you might ask her?
Dr. Lam: So first I look at the age of the patient. Two, I ask, are you sexually active. Have you had any new sexual partners? Three, any change in diet, exercise, any medications that you’re taking. Interestingly, we’ve seen in the office more vaginitis and vaginal complaints. Even silly things like peloton and… You know, people now are cycling more than ever, you know. You’re home, you’re COVID, you’re trying to exercise more. They’re cycling, they’re irritated and they’re also staying in wet yoga clothes more than not. So, are they exercising differently? New medications. Are you taking anything different? More alcohol. Have you been partying? Any hot tubs, vacations, wet bathing suits? So, I ask my history. Then I kinda bring the patient in the room. We have them change and then we do a careful exam. You look with the light on. You’re looking at the outside first. In addition, like, what are their complaints, right. So, there are certain buzzwords or trigger things that may lead me in a direction of what I’m thinking. Patient may say, “I have no new sexual partners. I took antibiotics and I have a white discharge. No odor.” That may lead me down the road of thinking a yeast infection.
Dr. Fox: Right.
Dr. Lam: And so, I use that history. I use the things that they’re complaining of and I take a look and then based upon that, I kinda think in my head, “Okay, this is what I see.” And then there’s certain easy cultures or lab tests that we can do in the office. Usually, we’ll do a culture to look for a bacterial infection and a yeast infection. Often depending upon their partner, I may do a culture for gonorrhea, chlamydia. There’s also a culture for trichomonas which is a sexually transmitted disease that also mimics maybe a bacterial infection. And then lastly sometimes we’ll send off a urine culture because urinary complaints can mimic…And then back in the olden days we used to have a microscope and we used to do slide tests and kinda really be more clinicians.
Dr. Fox: Back in the 20th century. The 1900s.
Dr. Lam: Correct. 1996, we used to use a microscope.
Dr. Fox: Back in the 1900s we used microscopes.
Dr. Lam: Correct. Now we don’t. So that’s another way. So basically look, you listen, the wet mount…
Dr. Fox: Right. That was called the wet mount, right? Yeah.
Dr. Lam: And then remember…I’m gonna age you as well. Like, we were…they used to have PH paper that you could take a little Q-tip and use the PH and if the PH was high, you…it gives one thing or no.
Dr. Fox: We don’t do that anymore?
Dr. Lam: Not so much. So anyway, you send your cultures…
Dr. Fox: I’m a retired gynecologist. So, I know of these things but don’t do a lot of treatments for it.
Dr. Lam: So, all over the country you could still be using these things in the office. But nonetheless, if it looks like a yeast infection, it sounds like a yeast infection, it looks like a duck, it quacks, we most likely will treat you for a yeast infection before the cultures come back because why should you suffer. Same thing with the bacterial infection. If it looks like it, we’ll treat it in the office. As far as sexually transmitted diseases, some things are quite obvious. If it looks like herpes, we usually will treat you. And then the things that are non that that may be age-related like menopausal symptoms.
Dr. Fox: Yeah. That’s called atrophic, right?
Dr. Lam: Atrophic vaginitis. Then those…
Dr. Fox: Yeah. Steph just smiled because she was so happy I remembered that. Yeah.
Dr. Lam: I did. If it wasn’t a cerclage, that’s right.
Dr. Fox: Yeah.
Dr. Lam: So, for those then you can apply different treatment like estrogen and that type of stuff.
Dr. Fox: Right.
Dr. Lam: So, you know, I think a good history, taking a good look and taking some cultures will give you a lot of information within a couple of days.
Dr. Fox: Right. And it would seem to me that probably of all the people who come in, 90% of them at least are gonna have a diagnosis of a yeast infection, a bacterial infection, atrophic vaginitis or maybe trichomonas or a urine infection. Those would be, like, the least likely in the four.
Dr. Lam: Yeah, those would be the most common and then I would say occasionally we do have people…you know, other skin disorders. People have eczema or psoriasis. You can get those in the vulva area.
Dr. Fox: Right. There’s allergies. Yeah, yeah.
Dr. Lam: Allergies, you know, topical…they use something that’s irritating them. But there’s probably 10 common things, all of which are pretty much…if you see your gynecologist in the office, we pretty much can treat you and make you feel better immediately.
Dr. Fox: Right. And it’s interesting because it’s one of these things where you don’t wanna guess. Like, you wanna get it right because, for example, if it’s a bacterial infection and you…and someone treats it over the phone and thinks it’s a yeast infection, you’re gonna give them something against yeast. It’ll make the bacterial infection worse.
Dr. Lam: Worse, right.
Dr. Fox: You just…like, the yeasts are trying to grow back and you claim or on the flipside, if you think it’s a bacterial infection…
Dr. Lam: Bacterial infection.
Dr. Fox: And in fact, it’s a yeast infection, the same problem. So, you have to, you know…some of the stuff can be done over the phone potentially if there’s no option but it’s a gamble. And you really wanna be checked and have someone take a look because you wanna get that one right. Particularly for those two.
Dr. Lam: It’s also just…I mean, being a woman and, you know, obviously experiencing things, you know, over the last so many years and we’ve all had them, they’re uncomfortable and they really…it’s just…it’s so easily treated if you can just pick it up right away. And once again, if you get it wrong, you’re just gonna overgrow the other bacteria. Then they’re gonna be back in the office and they’re unhappy. And I would say the vast majority are not sexually transmitted like we talked about. They’re easily treated and there’s probably a reason why they were brought about.
Dr. Fox: Yeah. It’s so interesting because I know that, you know, sometimes either…in fact, when I was doing gynecology or even in pregnant women, we’ll do the culture and find out they have sort of both a yeast infection and a bacterial infection. You’re sort of like, “Huh?” Then you realize, “Well, they’re both overgrown.”
Dr. Lam: Sure.
Dr. Fox: And so, then you have to sort of, like, try to treat both but not overdo it and you’re sort of balancing and trying to figure that out.
Dr. Lam: So, what usually happens in those, like…you know, you may have it…once again, women do have, you know, yeast in their vagina. Like, it’s a normal bacteria that does grow, it’s when there’s an overgrowth. So for those patients, you know, if they come out with both and sometimes, I may have treated just one in the office when I saw them, we’ll just call in the extra prescription into the pharmacy or they can use something over-the-counter. But those are rare though to get both. It’s usually one or the other.
Dr. Fox: Yeah. Absolutely. And so, if you’re evaluating someone and you’re gonna treat them…let’s just go through what the treatments would be. So, let’s start with the yeast infection. So, if someone has a yeast infection, what are the options in terms of treatment modalities for them? Not, like, which particular medication that we use.
Dr. Lam: So, you can give a medication orally. So, you can give them a pill by mouth. You can give them…
Dr. Fox: And it usually works after one or two pills, right.
Dr. Lam: One dosage, right. So, there’s a…
Dr. Fox: It’s pretty impressive.
Dr. Lam: There’s different types of pills that you could take but in general the easiest is you can give one pill, one time, one dose. Some people may give it for a couple of days, but in general, it’s a really easy treatment.
Dr. Fox: Right.
Dr. Lam: You can give a vaginal suppository or a cream. They have an applicator that you squeeze the cream or…inside the vagina. Those you can buy over the counter at any pharmacy and then there’s also a prescription. Those can come in a one-day treatment, a three-day treatment, or a seven-day treatment and the different days just equal how strong the medication is at one given time.
Dr. Fox: Right. And the prescription ones tend to be the same medications, yeah. Sometimes the difference is the prescription ones will include a little bit of a steroid in it which is not…it doesn’t help the infection but it helps with the symptoms.
Dr. Lam: Inflammation and symptoms, right. It’ll take the edge off of…decrease the inflammation.
Dr. Fox: Right. And sometimes also what’s interesting is someone might wanna take the pill but they can also get the cream sort of, like, externally just to, like, get, you know, relief quickly. So yeah.
Dr. Lam: And there are patients who do not like the suppository, right.
Dr. Fox: Right.
Dr. Lam: Because they may put it inside. It feels drippy. It feels like…just they’re…it’s moist. They don’t wanna have to wear a pantyliner. The pill works equally well. But if you take the pill, you may not get that symptomatic relief immediately. And if you give them a cream just for the outside of the lips, you can give it to them twice a day for five to seven days. They’ll feel immediately better within 24 hours.
Dr. Fox: Yeah.
Dr. Lam: So, I usually ask the patient, “You know, how do you normally like to take your medication? Would you prefer pill by mouth or would you prefer a suppository?” And then I also ask them like, “Okay, well, let me think what brought this on.” If it was an antibiotic and they’re done with the antibiotics, they should be fine. If their diet’s been really crappy or they’re not eating well or drinking a lot of alcohol, usually then we try to look at it from a holistic perspective. Maybe you need to change these things. But in general, pill and vaginal or external cream are the most possible…most, you know, popular. And then typically we also may consider…if they don’t wanna take anything, you could try probiotics or yogurt or something. It may take a little longer.
Dr. Fox: The yogurt is something they consume?
Dr. Lam: You could do orally or there are people who do…if you’re really more naturopathic, you could try to place it vaginally.
Dr. Fox: And is there a particular yogurt or just any yogurt?
Dr. Lam: I don’t advertise brands. You know, whatever.
Dr. Fox: Wait, we should get, like, Yoplait to sponsor us.
Dr. Lam: Right. I would have to imagine you would have to be…if we’re doing this…no, I don’t care. I guess it would have to be low sugar and more of the plainer Greek yogurt.
Dr. Fox: Hey, if anyone out there works at Dannon and wants to sponsor us…
Dr. Lam: We don’t want blueberry and no strawberry but plain would be just fine. So, there are people who believe in that.
Dr. Fox: So that’s for yeast infections. What about for bacterial which is sometimes called BV?
Dr. Lam: BV.
Dr. Fox: Right, okay. So bacterial vaginosis, which is another fancy word or phrase. So how would you treat that?
Dr. Lam: Same idea. So, everything can either usually be given by pill or you can give them a suppository or a cream that goes inside the vagina. Usually for BV treatment, oral pills, there’s two different major brands, one of which you cannot drink alcohol with. The other one is less impactful for alcohol. Typically, they both run for about five to seven days of how often you take it. Then there’s the vaginal…
Dr. Fox: So, based on your social calendar, you may choose one over the other. All right.
Dr. Lam: Correct. And then you’ll be back for the yeast infection, of course.
Dr. Fox: Yeah.
Dr. Lam: And then the other choice, vaginally…
Dr. Fox: And potentially a positive pregnancy test.
Dr. Lam: That’ll be good for you. Then for the vaginal, they come in five days. Sometimes you could do seven-day and those also are in the suppository family.
Dr. Fox: Got it. Okay. So that’s for bacterial. And then other things like trichomonas which is actually a sexually transmitted infection. The first two are not. Yeast infections, bacterial vaginosis are not sexually transmitted. But the trichomonas is and that’s something that…it’s typically treated with a pill, right?
Dr. Lam: You could do a pill and typically the recommendation is…there’s certain number of pills that you take for a certain number of days but the recommendation is in oral form. And for that in particular, typically, I would say there’s some consideration of whether you should bring the patient back. And for that one in particular, if you do test positive for trichomonas, your partner should…or if you have a significant other, they should be tested and treated for that as well.
Dr. Fox: Right. And then for women who it’s not infections but it’s like you said, something either topical in the dermatology department, is that something you would treat or would a dermatologist treat?
Dr. Lam: We see a lot of women who come in for different vaginal complaints whether it’s redness, chaffing, age-related type of complaints. Usually, we’ll start with taking a look. We’ll rule out cultures. We’ll send cultures if it all doesn’t come back and we think that they’re either menopausal or that it could be a skin…like a skin disorder, dermatologic issue. You actually often can biopsy the skin just like you would biopsy a mole or something on the skin. You can biopsy the tissue. The pathologist will come back with a firm diagnosis. And then for many of those, typically, we give steroids, and the steroids can either come in an ointment or a cream. The ointment typically I think absorbs and sticks a little bit better than…you take it for a longer period of time. That’s not, like, a three or five day. Those are much longer treatment courses. And then you follow up with a maintenance. If it’s for estrogen related, like a menopausal woman, you can give a topical or a vaginal estrogen. Typically, it’s every day for about two weeks and then you can drop it down to twice weekly and those patients will get a huge improvement right away.
Dr. Fox: Right. And do you ever see women who have these complaints and it turns out in fact it’s something like a foreign body, like there’s a condom and they’re irritating or a tampon or something? Because that…I mean, you read about those, and does that actually happen?
Dr. Lam: I would say, yeah. I mean, we had one probably about a month ago and another one probably a month before that. That’s just me. Somehow, they come in threes also. If a patient who’s menstruating and uses tampons…the major complaint for those patients is, “I have this odor.” It’s specifically an odor. It’s not even itching or burning. It is just a funky, very, very fishy, very strong smell. And sometimes they’ll say, “I can’t remember if I took out my tampon or not.” And usually, on exam, you’ll find the tampon. It’s easy to remove and also very easy to treat.
Dr. Fox: Got it. Now I wanted to talk about just a couple of unique populations. So, you spoke about women who are menopausal and one of the main reasons they’re unique is in addition to everything they can get, there’s this idea of lower estrogen and so sometimes you’ll treat them with estrogen. What about in younger patients, so either teens or preteens? I assume you treat some of them and maybe not the very young ones, obviously but is there anything different about that population in terms of what you think might be going on or how you might treat them or is it very similar?
Dr. Lam: We typically will see or we’ll have sometimes moms who call about their teenager, younger patients, and pediatricians often sometimes get the first set of calls. Like, the mom will call the pediatrician saying, “My daughter’s really complaining of this itching and irritation.” And we’ll see it with really younger kids. They touch themselves, you know, and their hands could be dirty or they’re just touching themselves in general. First introduction to tampons, same idea. They may have a foreign body. Sports, not changing their underwear often enough. Sometimes when they wipe, they’ll get toilet paper stuck right inside and then they just didn’t quite realize it. But the same thing. You could take…even if they haven’t been sexually active and they’re comfortable coming into the gynecologist, we can gently take a look or take a peek and you can even take a small Q-tip because that’s how much of the cultures are obtained. You could place it just inside. They usually feel comfortable. Sometimes they can introduce it themselves.
Dr. Fox: Right. Meaning not a speculum, not a full exam. Yeah, nothing like that. Yeah, yeah. Just the Q-tip, yeah.
Dr. Lam: You’re not introducing anything but something the size of a Q-tip and you can culture it or even take a look. And those young girls will also have the same idea. They’ll say, “I have a white discharge. It’s really itchy.” And those typically…it’s easy enough on exam or they may have taken antibiotics for strep throat, that kinda thing. And those can be easy enough for a yeast infection or a bacterial infection. Nothing usually more than that.
Dr. Fox: Right. Okay. And then the last population I wanna talk about…and this is where I can chime in as well is pregnant women.
Dr. Lam: Yeah.
Dr. Fox: And so pregnant women can get all of these. Obviously same symptoms. And for some pregnant women, they actually get it more commonly, right. They can. But in others, they think they have something, because in pregnancy, like you said, everyone has a discharge and it can change and in pregnancy frequently increases. Like, that’s a normal change with pregnancy. So many women will say, “I have, you know, more discharge and more discharge. It’s unusual.” And we’ll examine them, we’ll check and it’s a normal healthy discharge of pregnancy. It’s just something women aren’t used to, obviously.
Dr. Lam: Right, I think in pregnancy specifically we would err on the side of wanting to see more often than not because we don’t wanna miss something that may be impactful, right? So, the patient says that they have an increase in discharge but they may not know if it’s liquidy or not liquidy, right? We want you to come in and make sure you didn’t break your water or something weird going on. But in general, due to the hormones and there’s such a surge obviously in hormones in pregnancy that directly impacts how they have a discharge. And once again, I think my major questions to patients when they say, “I have an increased discharge.” And that’s why they’re coming in. “Well, are you itchy? Are you burning? Are you having any other complaints just besides the discharge?
Dr. Fox: Right.
Dr. Lam: And usually if it’s just discharge, it’s not color, it’s not change in tint, it’s nothing different, vast majority of those, you can say that it’s completely normal. But I do end up doing the cultures more often than not. I do take a thorough exam. We do do a speculum exam. We take a peek. Not often do we have to do an internal exam and take a feel for the cervix or something but we usually look in culture.
Dr. Fox: Yeah, and in pregnancy the…you know, a yeast infection is annoying but not dangerous in pregnancy. One of the differences…if it’s a urine infection, there’s…we’re more likely to send urine cultures in pregnant women because sort of the tenet is in nonpregnant women, if there’s bacteria in the urine but they have no symptoms whatsoever, you don’t treat it because it’ll come out eventually. But in pregnant women, we would. Right, so even if someone has no symptoms whatsoever and there’s bacteria in the urine over a certain amount, we treat it. So, I have a very low threshold for sending urine culture in pregnant women. Bacterial vaginosis, there’s some debate about whether that’s impactful or not in a bad way in pregnancy. In some high-risk women, it may be associated with preterm birth, particularly your water breaking early.
Dr. Lam: Right, and we screen patients accordingly. Like, if you had a high-risk birth, we typically will screen you ahead of time to see if you do…if you’re a carrier for bacterial vaginitis or vaginosis.
Dr. Fox: Yeah, yeah.
Dr. Lam: And so, I think in general for pregnancy, we probably end up leaning more towards treating for more things than not.
Dr. Fox: Right.
Dr. Lam: In a regular, young, healthy patient who is not pregnant, your body actually is fairly efficient. You know, it will fight off many, like, low lying infections whereas in pregnancy you’re not quite so sure you’ll end up treating more than not.
Dr. Fox: Right. Exactly right. Overall, it’s just, you know…the important takeaway and I think your explanations were fantastic is that very common, right. It’s probably wise to see somebody to figure out what you have to make sure that if you’re gonna get treated, you get the right treatment. Many of these can go away on their own but frequently won’t. It’ll just get worse and annoy you more. And the treatments are safe, pretty easy, and effective.
Dr. Lam: Effective.
Dr. Fox: And I think that that’s a really good lesson. And again, there are other things that can cause it besides just a yeast infection so don’t think it’s always a yeast infection. That’s why you should get checked out.
Dr. Lam: If you know what kinda has been leading up to what’s bothering you right now, right. You have a new sexual partner or you took something antibiotic-wise, you kinda know your body. If you’re not someone who’s prone towards an infection and something happened and there was a change, well, that’s a little different. If you’re someone who’s more prone towards yeast infections, then you may not necessarily need to jump on it and call right away. If you’re prone to them, maybe there’s other things we can do preventatively. But in general, yeah. I think if you’re unsure, you’re not feeling well, it’s so easy. You call, you can get an appointment the same day. Come on in. We’ll just check you.
Dr. Fox: Yeah, awesome. Steph Lam, thank you.
Dr. Lam: As always, thank you.
Dr. Fox: Thank you for listening to the “Healthful Woman” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s healthfulwoman.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at firstname.lastname@example.org. Have a great day.
The information discussed in “Healthful Woman” is intended for educational uses only and does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.