My Vagina Stinks – Why?

What IS “stinky” when it comes to vaginas?

A lot of women show up to my office saying there is a strong odor when they pull their pants down to go pee, or that their partners noticed that it smells different. But what people don’t realize is, that despite what the latest douching ads say, your vagina is supposed to have a bit of an odor.  Our vaginas are home to billions of bacteria and the balance of this bacteria changes constantly, creating different aromas varying from musty and fermented to coppery or sweet smelling. These smell variations are likely a result of your menstrual cycle, your hygiene habits, or just you.

The feminine hygiene industry has convinced us that vaginas should smell breezy fresh and flowery; anything else is unclean.  I’m sure you have seen lots of ads for feminine washes, refreshers and douches. Or you can find hundreds of videos on YouTube about vaginal hygiene routines and see things like steaming or inserting different foods and essential oils. This is nothing new.  Lysol is known today for making cleaning products, but their advertisements from the early 1900s told women that their husbands would leave them unless they washed out their vaginas with it —anything less would be “intimate neglect.”  Women suffered poisoning because of the insecurity the company pushed. Women actually died from poisoning by doing this.

So what smells ARE normal?

One if the most common smells is tangy or yeasty like sourdough bread or Greek yogurt.  This is typically a sign of the good bacteria that dominates the vagina, lactobacilli.  Sometimes this can produce a thin white discharge as well.

Another common smell is a coppery or metallic smell.  This is usually from some blood in the vagina and typically nothing to worry about.  Either menstrual bleeding, some spotting or a little bleeding after sex may be the culprit.  You do not need to see the blood for it to cause a change in the odor.

A third common description is a musty or skunky odor.  Unfortunately, the groin has lots of sweat glands and thanks to that, can smell like body odor.  Your body contains two types of sweat glands, apocrine and eccrine. The eccrine glands produce sweat to cool your body down and the apocrine glands respond to your emotions. These apocrine glands populate your armpits and, you guessed it, your groin. So, stress and emotional turmoil may cause a stronger odor than at other times.

So when should you call the doctor?

Bad vaginal odors are not subtle.  It definitely should not smell like fish or rotting food.  Likewise, some discharge is normal and varies through the month, but you should not have pain or irritation from it.  Those things should be checked out to see what is going on.

For the most part, the vagina is self-regulating.  If someone told you to wash your wool sweater in hot water, you would think they’re crazy.  You should have the same response if someone tells you to put something in your vagina! Though it may be tempting to douche or use a vaginal deodorant to decrease vaginal odor, these products may actually increase irritation and other vaginal symptoms. Vaginas have an odor that is healthy and normal. We need to accept that and not be self-conscious about it with others.

As a final note, I recently read an article and this line resonated with me: “If someone speaks to you about your body with anything but kindness and concern, it is he who has a problem.”

Hiccups In Pregnancy; It’s Not A Seizure!

In the third trimester of pregnancy, all  women will notice the onset of daily hiccups from their babies in utero.  Why is this?  Is it normal?

It is perfectly normal and reassuring of a normally developing nervous system.  The nervous system begins to mature in a fetus around 26 weeks gestation and , as a result, a series of reflexes begin to become apparent in the growing baby by 32 weeks.  The term hiccup (or hiccough) originates from the Latin meaning “to gasp”.  Hiccups are actually a reflex caused by involuntary contractions of the diaphragm and rib muscles that result in a sudden inspiration and closure of the glottis (AKA “voice box”).   These reflexes, hiccups included, persist through the third trimester and generally disappear when the baby is around 3 months of age.

When a fetus has a hiccup, the muscles involved with breathing contract and it is suspected that this exercises the breathing muscles before the baby is born.    As the nervous system is maturing, a fetus will have several episodes of hiccups every day.

So, next time your feel those sudden intermittent little spasms in your uterus in the third trimester, be reassured that your baby is maturing normally and exercising the little breathing muscles in preparation for taking his or her first breath in the first moments of life.

Dealing With Your Period At School

I hate periods – they are a necessary evil in life but I still don’t have to like having my period.

When I was in middle school, I used to feel very anxious about having to open up a pad in the bathroom. It felt like everyone around me would know I had my period because of the sound it made when I ripped it open. My mom, like all moms, told me not to worry about it. She told me that having a period was a normal part of growing up and that if I talked to my friends about it, I would understand that everyone around me was feeling the same way. There was nothing that I wanted to do less than mention my period to my friends…gross.

Because I hated the sound that pads made when I opened them, I started piling toilet paper on top of my pad so I would just have to change the toilet paper instead of having to change my pad. This is NOT a good idea. Pads are made in a special way that makes them extra absorbent; toilet paper is not. One of the tips that I give to my patients is to open the pad at home (to get that sound out of the way). Most pads have a little piece of tape on the outside that will keep them closed and clean once they have been opened up. If someone had given me this advice when I was in middle school, I think things would have been easier.

The other tricky thing for me was…where do I put this pad? I didn’t want to carry it in my pocket in the event it fell out. At my school, we weren’t allowed to carry backpacks or purses so I didn’t really have any great options. One of my friends (see, I did talk to someone about my period) suggested putting it in my lunchbox. This is a great suggestion because I was able to stop at the bathroom on my way to lunch without anyone knowing anything!

Young women and parents often ask me when girls can start using tampons. Once you start to have your period, you can start using a tampon. There’s no specific age that I’d recommend starting tampons. They come in different sizes (just like pads) depending on how heavy your period is. It’s important that you use the smaller tampons for lighter days and the larger tampons for heavier days. Many girls feel that tampons eliminate some of the anxiety of having your period at school because they are smaller to carry. Some tampons are the size of your pinky finger (which includes the applicator) so they can easily be carried in the palm of your hand.

When I reflect back on middle school and the first months of having my period, I think my mom was probably right. I was not the only middle-schooler worrying about my period. I think it would have been helpful to talk to my friends about their period woes over potato chips and chocolate.

I (Think I) Have a Yeast Infection…

After practicing gynecology for more than 15 years, I know that if you can treat a vaginal infection without having to call your friendly gynecologist, you’ll do that 10 out of 10 times.

With all of the over the counter (OTC) products available, it is tempting to head to your pharmacy.  However, more often than not, you’re treating the wrong thing.

Often women presume all vaginal itching, irritation, and/or discharge is caused by a yeast infection.  This presumption is FALSE.  Yeast is not the most frequent cause of vaginitis — bacterial vaginosis (BV) is.

Yeast infections

Most patients who have any type of vaginal discharge immediately think that they have a yeast infection.  Yeast infections are more common in women prior to menopause.  The most common symptoms are vaginal itching (sometimes on the external skin and sometimes inside the vagina) and a white, cottage-cheese like discharge.  Many of my patients think that having a white discharge means that they have a yeast infection.  This is NOT true.  White discharge, even if it appears cottage-cheese like, is common and does not mean that you have a yeast infection.  If you have itching along with the discharge, it is more likely to be a yeast infection.

So, you’re hanging out in the feminine hygiene aisle, looking at all of the different options for your presumed yeast infection.  There are 1-day, 3-day and 7-day treatment options.  Which one should you pick?

Effectiveness:

For a true yeast infection, effectiveness is reported to be in the 70% range.  Effectiveness is lower for the one day, a little higher for the three day and highest for the 7 day dosing.   I know it’s tempting just to get it over with in one day but I find that patients who use the 1-day OTC treatment often end up in our office 3-4 days later with persistent symptoms.

Safety:

These medications are considered safe.  As with any medication, side effects can occur.  The most common side effects are burning and irritation and sometimes abdominal cramping.

However, with self-diagnosed “yeast”, the OTC treatments are less effective because many of these infections not actually caused by yeast and therefore the OTC treatments won’t work.

Bacterial vaginosis (BV)

As previously mentioned, BV is the most common cause of vaginal infections.  It is caused by an imbalance of bacteria in the vagina and causes and overgrowth of bacteria.  Bacteria is a normal, healthy, part of the vaginal flora.  However, if it overgrows, it can cause a gray, watery discharge that frequently has a fishy odor.  Some women note itching or burning in the vagina with BV (therefore it is often mistaken as yeast).  There is nothing over the counter to treat BV – DO NOT grab that douche – it will only make it worse!  A quick visit to the gynecologist can confirm the diagnosis and get you set up with a prescription to treat BV.

If you think you have a vaginal infection, do you absolutely need to see your gynecologist?  It’s usually a good idea to get to the root of the problem and get started on the most effective treatment.  However, if your symptoms are not recurrent, you do not have a new sexual partner, you have no vaginal odor and you don’t have diabetes or immunosuppression, you can give an OTC treatment a try.  If your symptoms are not straight forward or you’re just not sure, it is best to see your provider.

If any OTC product fails, then it would be recommended to be seen by a provider.

What Is That Falling Out Of My Vagina?

Pelvic organ prolapse (POP) occurs in as many as 40% of women, most commonly after age 40. One of the most common first symptoms is a bulge protruding from the vagina. Typically one’s first reaction to this is terror, but don’t worry, there is no need for panic.

POP is the result of a laxity of muscles, ligaments and connective tissues that support organs such as the uterus, bladder and rectum. POP, therefore, can be the result of one or several organs, all of which may or may not cause symptoms. The most common symptom is that of a bulge coming out of the vagina, which can rub against the underwear and cause irritation and bleeding. Other organ specific symptoms include:

  1. The uterus: The uterus is normally supported by the utero-sacral ligaments as well as other connective tissues. A prolapsing uterus often can feel like one is sitting on a lump.
  2. The bladder: Usually a soft bulge at the top of the vagina. It can be associated with incontinence, difficulty urinating or a pressure sensation.
  3. The rectum: This is a bulge that comes from the backside of the vagina. It can be associated with difficulty getting a stool out. Commonly, women will describe “splinting” which is putting fingers in the vagina to push the stool out of the rectum.
  4. The small bowel: This is the least common of the prolapses, and represents a “true hernia” or a fascial defect in the upper vagina. It is most commonly associated with a soft bulge and can happen after hysterectomy as well.

The cause of POP is usually a combination of factors. Genetic predisposition is common. Trauma (most commonly from childbirth, especially large babies) plays a role. Increased strain on pelvic organs is also a common factor. This includes jobs that require heavy lifting, obesity, or smokers, particularly with a chronic cough.

Treatment options range from behavioral modifications or exercises (for mild prolapse) to pessaries to surgery.

A pessary is a device that one places in the vagina and pushes the organs into their normal positions. (On a historical note, the original pessary was a potato, which rapidly fell out of favor as it tended to grow roots. The next rendition of pessaries was yarn dipped in wax and molded. This was the style used for thousands of years until the invention of rubber.) Pessaries come in numerous sizes and shapes. A good pessary is one that a woman doesn’t feel when it is in, stays in place and corrects all of her symptoms.

Surgical correction is specific to the prolapsing organ(s). Surgery is most commonly done entirely through the vagina and requires a one night’s stay in the hospital. Gynecologists are well versed in all treatments for POP and I would encourage anyone with prolapse to discuss it with their gynecologist.

ZITS! Learn The Technique For Proper Popping!

First of all, I don’t like using technical terms for zits and describing the medical jargon associated with skin care. I like to speak English. If you want me to behave like a professional with professional language, forget about it. I did that in school. I’m in the real world now speaking in real world language. I can give you an example of being proper…”So, I see you have a pustule on your left cheek. Please don’t extract it without using the proper protocol first. If you don’t you will end up with post-inflammatory hyperpigmentation and this could last several months”. Whatever. This is what I’m going to tell you, “You have a white volcano on your cheek. You need to pop that sucker. If you don’t do it the right way, you will end up with The Big Dipper on your face for a few months.” Now, let me teach you the right way to pop a zit.

First of all, ONLY attack the ones that are white…that have come to a “head”. These are ready to explode. The other ones you can attack are blackheads, but only the ones that are ready. Blackheads are ready when you can feel the surface of the blackhead. It may feel rough to the touch. Some are still slightly stuck under the skin. Don’t touch those. They don’t want to play yet. So the first thing you do is take some fine grit sandpaper and lightly go back and forth over the zit. Then, take a dab of bleach and rub it in over the sanded areas. Bahahahahahahahaha!!!! Just kidding. The best time to pop a zit is after you shower, or you can take a really warm towel and lay it on your face for 5-7 minutes. This allows our skin to open the pores and be more pliable. This will make popping easy and you shouldn’t end up with purple dots from squeezing all over your face. Now, take the skin and gently stretch apart the pore. This helps create that doorway for the pus to escape. Next, mound the skin up on either side of the zit like a hill with the pads of your fingers and gently wiggle in an up and down motion to pry out the bugger. It should come out with hardly any effort. If it’s being stubborn, try the mound and wiggle from another direction. Our pores are all different and have different openings. They don’t go straight down into the skin like a tunnel. Some are slanted. Keep working it until you figure out the direction. If you’re not having any success after a few attempts, STOP!!!! The volcano is not ready to erupt. Leave it alone. I know this is hard, people. This is when we start to get violent.

What happens next is the fingernails start participating. And then we squeeze the crap out of it and leave claw marks on our faces. I’ve clawed my own face. Claw marks occur when you’ve had a bad day and you don’t care if you look like you can connect the dots on your face the next day. You just want it out. I will explain what happens when the volcano doesn’t want to erupt yet….

So you start squeezing the crap out of the zit, determined you’re gonna win. It’s starting to get redder and swollen. You look like you punched yourself in the face. What is happening under the skin that you can’t see is a family reunion. The attacked zit gets weak under the skin from claws above the skin and starts to break its pore walls. The infection seeps into the surrounding pores and then they get contaminated. It’s like someone sneezing all over everyone when they have a cold. Now, all the surrounding pores are infected and you end up with a breakout. Voila! Now you have a pizza face. It’s all your fault. I told you how to squeeze properly. You just don’t listen do you?

I know we all perform bathroom surgery. Even I do. I’ve become smarter about it though. Respect your zits. Don’t EVER try and squeeze those painful, hard, red ones!!! Those are cysts and they are angry! They are deep in the skin. They need to be left alone. The body will fight it in time, and it may go away or it may come to the surface. You can cause serious damage to your skin if you attack those. If you have a lot of those, I suggest you see a Dermatologist. Those angry cysts are out of my realm. They need the big guns!!

I hope I’ve helped you learn a new trick. I’m not against popping zits. Just be mindful and careful and all will be good 🙂

HPV – Is It An STD?

The human papillomavirus or more commonly known as HPV is a virus that is spread by skin to skin contact.  There are over 200 types of HPV, some HPV strains are the cause of the common plantar wart and common flat warts.  Other strains of the HPV virus are associated with genital warts and precancerous/cancer on areas of the cervix, vagina, vulvar, anus, oral pharynx (back of throat), and penis.  Common HPV types which are associated with these anogenital conditions are HPV type 6, 11, 16, and 18.  Anogenital HPV is now considered the most common sexually transmitted infection (STD).  Approximately 80% of sexually active women and men have been exposed to HPV in their lifetime.  One can be exposed to the HPV virus anytime in their lifetime but the most common time for initial exposure is during the first decade of becoming first sexually active.  Often times HPV infections are transient and can come and go, it is when the virus remains for prolonged periods of time and the body does not clear the virus is when  one is put a risk for HPV related cancers of the cervix, vagina, vulvar, anus, oral pharynx, and penis. 

Anogenital HPV infection is primarily transmitted by genital to genital skin contact.  It can also be transmitted thru anal genital contact and oral genital contact.  Ways one can help reduce their risk of contracting HPV is limiting the number of sexual partners, and being in a monogamous relationship.  Condoms can lower your risk of getting HPV, but the condom does not cover all the areas of the genitals where the virus can be present, so they are not completely effective.   The HPV vaccine can help protect both male and females from the 9 most common strains of anogenital HPV, which will help prevent HPV related cancers.  This vaccine is recommended beginning at ages 11-12, but can be given up to age 45. 

So in conclusion to the question, Is HPV and STD?  The answer is the anogenital HPV strains are an STD and they are the most common STD there is. 

The “Heart & Soul” of Dr. Katlyn Viglianco

While Dr. Katlyn Viglianco has been with the practice for a couple months now it recently came to our attention that a fabulous article was written about her “Heart and Soul” by her previous “family”: the CAMC Health System.

Before she left, Viglianco was recognized for her constant care and leading by example, every day. The person nominating Viglianco said she consistently went above and beyond during her residency. Below are some examples from the nomination:

  • Whenever there was an emergency situation on the unit, she did everything she could to help not only the patient, but the nursing staff as well.
  • She stayed at bedside with nursing staff waiting on patients to be transferred to an ICU.

To read the full article, click here.