Women’s Health

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Missed "Period" (Amenorrhea)

Amenorrhea is the absence or suppression of the menstrual period. It may occur as a result of abnormalities of the female reproductive tract, hormonal problems, or genetic disorder. In college women, amenorrhea can be associated with stress, severe dieting including eating disorders, increased levels of exercise, or illness. The most common cause of amenorrhea is pregnancy.

What causes it?

Amenorrhea may result from the following:

  • Pregnancy
  • Hormonal Contraceptives
  • Breast feeding
  • Hormonal imbalance
  • Excessive exercise
  • Thyroid malfunction
  • Pituitary tumor
  • emotional or physical stress
  • depression
  • malnutrition
  • drugs, such as tranquilizers and antidepressants
  • obesity (especially with rapid weight gain)
  • excessive or rapid weight loss
  • chronic illness (for example, kidney failure, cystic fibrosis, and colitis).

Long lapses between periods, lasting six months or longer, are common with on-going physical stress. This is particularly the case if you have lost a lot of weight, as with anorexia, or you have little or no body fat, as with some women athletes.

How is it diagnosed?

Though rarely due to a life-threatening cause, amenorrhea can be a fairly complicated problem and there is often no quick answer. It takes time and working closely with a provider to diagnose the cause and treat it.

You will need a thorough history and a physical exam, including a pelvic exam. The provider will probably not recommend any tests (such as a blood test to measure hormone levels) unless you have missed three or more periods consecutively or have certain other symptoms.

The absence of a menstrual period is a symptom, not a disease. You may occasionally miss a period and still be healthy.

How is it treated?

The treatment of amenorrhea depends on its cause. If obesity is the cause, an exercise program may restore menstrual periods. Learning to manage stress at school or work and decreasing excessive physical exercise is also helpful.

If hormonal imbalance is the cause, the administration of progesterone for seven to fourteen days every one or two months may correct the amenorrhea. Surgical treatment may be necessary if a woman has tumors or cysts in her ovaries or uterus.

How long will the effects last?

If unusual stress or an illness has temporarily interrupted the hormone cycle, periods should start again naturally, though the duration of amenorrhea is unpredictable.

How can I take care of myself?

If you miss more than one menstrual period, you should see your provider. You should keep a record of the date menstrual cycles start, how long they last, amount of menstrual flow, and any symptoms. You should also alert your provider of all prescription and non-prescription drugs that you are taking, as well as report any family history of the problem.

What can be done to help prevent amenorrhea?

Maintain a healthy lifestyle by following a healthy diet, avoiding cigarette smoking and excessive use of alcohol and drugs. Balance work, recreation, and rest.

Lisa Barber-Murphy, M.Ed., CHES, Revised 11/99; rev. 5/03 Becky Griesse, CHES and Dev Sangvai, MD

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Dysmenorrhea

(Severe menstrual cramps)

In the past, women who experienced menstrual cramps or dysmenorrhea often were told that ‘its’ all in your mind’ or ‘that the pain is not really that bad’. However, today we know that the pain some women experience from menstrual cramps is very real and is caused by prostaglandins.

What are prostaglandins?

Prostaglandins are chemicals which are found in nearly every cell of the body. These chemicals act to regulate the tone of smooth muscles, the nonvoluntary muscles of the body (e.g.: blood vessels, uterus, and intestines). An excessive amount of prostaglandins causes contractions of the smooth muscles.

How do prostaglandins cause menstrual cramps?

The levels of prostaglandins in the body increase as menstruation approaches, with the highest levels at the onset of the menstrual period. Higher prostaglandin levels increase uterine contractions causing cramps and pain. In essence, the uterus squeezes so hard that it compresses the uterine blood vessels and cuts off the blood supply. In addition, some of the excess prostaglandins escape from the uterus into the bloodstream where they may affect other smooth muscles. Thus, prostaglandins are responsible for the headaches, dizziness, hot and cold flashes, diarrhea and nausea that can accompany painful periods.

Do all women have high prostaglandin levels?

Research has shown that women with severe menstrual cramps have considerably higher concentrations of prostaglandins in their menstrual fluid than women without cramps. Significant prostaglandin production occurs only during ovulatory (egg producing) menstrual cycles. This appears to explain why many young women’s cramps begin a year or so after their first periods ‘ it takes tat long for their cycles to become ovulatory, and for significant prostaglandin production to begin.

How many women are affected by menstrual cramps?

At least 70% of women who have periods suffer from menstrual cramps. Severe pain may be an indication of another serious problem such as endometriosis, uterine fibroid tumors, or pelvic infection. Women with dysmenorrhea should have a pelvic exam to rule out other problems.

What can I do to relieve the pain caused by menstrual cramps?

Since an excess of prostaglandins in the lining of the uterus seems to be one of the major causes of dysmenorrhea, medication that reduces the amount of prostaglandins may be helpful in relieving the pain. For example, aspirin is a mild prostaglandin inhibitor and helps some women. However a more effective prostaglandin inhibitor is ibuprofen.

Are there any side effects associated with ibuprofen?

If you have had a severe allergic reaction to aspirin (e.g.: asthma, swelling, shock or hives), been told not to take aspirin, had an adverse reaction to ibuprofen such as Motrin or Advil, have a chronic medical condition, or take other medication consult your health care provider prior to taking an ibuprofen medication. Occasionally some people experience indigestion, heartburn, nausea, vomiting or diarrhea. Most of these gastrointestinal side effects can be prevented by taking the medication with milk or food.

What if ibuprofen medication does not alleviate my menstrual cramps?

If your menstrual cramps continue to persist after taking the recommended doses of ibuprofen, last longer than 2 or 3 days, do not seem like normal menstrual cramps or become worse, make an appointment to see your health care provider at Student Health.

Are there other methods that may help alleviate my menstrual cramps?

Since women experiencing a wide range of menstrual pain, there is a wide range of options available for dealing with dysmenorrhea.

Some options include

HEAT/MASSAGE A warm bath or heating pad on the lower abdomen and/or lower back back may help promote blood flow to the muscles and relax spasms; back and abdominal massage often feels soothing. NUTRITION Although scientific evidence regarding the relationship between cramps and nutrition is inclusive, some women find monitoring their intake of sodium, sugar, or caffeine helpful. Other women drink more fluid, increase fiber intake, or eat food high in B vitamins. RELAXATION Rest, sleep and relaxation exercises can help reduce the pain and discomfort of menstrual cramps.

Adapted from DYSMENORRHEA, Duke Health Education; Lisa Barber-Murphy, M.Ed.,CHES, Revised 6/00

Rev. 5/03 Becky Griesse, CHES and Dev Sangvai, MD

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Pelvic Examination

The pelvic exam is an important component of preventive health care. It is essential for early detection and, therefore, better management of genital cancer, infections, sexually transmitted diseases, or other abnormalities.

Some women avoid the pelvic exam because they feel embarrassed by the exposure involved or they have heard from a friend that it is an uncomfortable experience. However, the pelvic exam should not be painful or embarrassing. Sometimes it helps to make women more comfortable if they know what will happen during the exam.

When should I have my first pelvic exam?

You should have your first exam when you are around the age of 18 years old or earlier if you are sexually active or have a medical problem requiring a pelvic exam.

How often should a pelvic exam be done?

After the first exam, you should continue to have exams once a year, especially if you are sexually active. A yearly exam will detect an abnormality that may have developed so that it may be treated early. You may also need an exam when you:

  • have itching, redness, sores or swelling in the genital area
  • have an unusual odor and/or increased vaginal discharge
  • suffer from abdominal pain or painful intercourse
  • had sex with a person who might have an infection
  • need a contraceptive method

How should I prepare for the exam?

  • Schedule the exam when you’re not having your menstrual period.
  • Do not douche 24 hours before your visit (douches are not necessary for healthy hygiene).
  • Use a condom if you have vaginal intercourse less than 24 hours before your exam.
  • Write down your questions so you won’t forget to ask them.
  • Be prepared to tell your provider the date your last period started and how long it lasted.

What happens prior to the examination?

Before beginning the pelvic exam, your health care provider will ask for information concerning your medical background and menstrual and contraceptive history. Be sure to mention any genital symptoms you have had and ask questions about any special concerns.

The pelvic examination provides an opportunity to talk with your health care provider about safer sex and/or birth control methods. If you are not sexually active, this is an opportunity for you to become well informed before having to make decisions. If birth control is your primary concern, a contraceptive program will be tailored to meet your individual needs. If you are concerned about sexually transmitted diseases, you can ask your provider to discuss your concerns.

What happens during the examination?

You will be given a private room in which to remove your clothing, put on an examination gown, and drape your body with a sheet. If the provider is not a female, a female nurse will stay in the room with you during the exam. After your lungs, heart, breasts, and abdomen have been examined, you will be asked to place your feet in the foot rests ("stirrups") at the end of the table. This position makes it easier and quicker for the examination to be done. The health care provider may use a lamp during this part of the examination. You may ask for a mirror if you want to see the exam.

Generally, the examiner will place a hand or arm on your leg or thigh before touching the outer genitals. This is to avoid startling you, in which case your genital muscles might involuntarily contract and make the examination more difficult.

The provider will use a latex glove to examine the entire vulva area. If you are allergic to latex be sure to let your provider know this before they start the exam. After the external genitalia has been inspected, your provider will gently insert a plastic speculum. The speculum holds open the vaginal wall. You will feel some pressure when the speculum is inserted but it is done slowly and carefully. If you do feel tenderness or pain, tell the provider so that the speculum can be adjusted to make you feel more comfortable. You should also try taking deep breaths and relaxing as it is inserted because tensing your muscles will make this exam more uncomfortable.

Once the inserted speculum is opened the wall of the vagina and the cervix will be in view. Cells will then be taken from the cervix and vagina with a small flat stick, a cotton swab, or a small cervical brush. The cells will then be put into a vial with a solution and sent to a laboratory for analysis. This simple procedure, called the Pap smear, allows for early detection of precancerous cells. It is very important to avoid the use of douches, vaginal creams, or vaginal medications for at least 48 hours prior to your pelvic exam because these substances can distort the appearance of the cells to be studies in the Pap smear. Pap tests should also be avoided when you are having your period. With the speculum still in place, your provider may also take appropriate samples to determine the presence or absence of vaginal infection or sexually transmitted diseases.

After gradually removing the speculum, the examiner will do a digital examination. This is also referred to as a bimanual examination because both hands are used – one internally and one externally on the abdomen. The provider will insert two gloved fingers into the vagina and place the other hand on your abdomen, applying slight pressure. The provider may also insert a gloved finger into the rectum while applying slight pressure on the abdomen. This exam permits the detection of any growths, abnormalities, swellings, or areas of tenderness in the pelvic area. The entire exam takes but a few minutes.

What happens after the exam?

You and your provider will discuss the findings of the examination. You’ll be told when to expect the results of your Pap smear. Your provider will also advise you when to come in for your next pelvic exam and Pap smear. Sexually active women should have a yearly exam because of the importance of early detection of infections, disease, and precancer.

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What is the Pap smear?

A Pap smear is done to check for abnormal changes in the cells of the cervix (the lower opening of the uterus). A Pap smear can detect cervical cancer early, while it is still curable. Usually health care providers recommend that women have a Pap smear annually beginning at age 18 or within six months of first sexual intercourse.

What if my Pap smear comes back abnormal?

An abnormal Pap smear result may indicate an infection, a precancerous condition or cancer. However, a Pap smear is just a screening; it is not 100% accurate. It may suggest a precancerous condition when in fact everything is normal. Sometimes it fails to detect cancer that is there. Further testing through additional Pap smears, colposcopy, biopsy or specific STD screening may be necessary to accurately diagnose and properly treat the condition.

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What is dysplasia?

Dysplasia is one term that has been used to describe abnormal cells seen in a Pap smear that may be precancerous. In dysplasia, normal cervical cells undergo a series of changes in their appearance. It is not cancer, although if left untreated it may develop into an early cancer of the cervix.

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Health Needs of Lesbians

All women should follow the same recommendations for maintaining their health. Pelvic exams, Pap smears, and breast self exams are important for detecting problems at an early stage regardless of sexual orientation. Usually, lesbians run a lower risk of getting a STD and various cancers associated with sexual intercourse, however all women are susceptible to STDs and cervical cancer.

Lisa Barber-Murphy, M.Ed., CHES
Revised 6/00

Revised 5/03. Maggie Gradison MD

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Pelvic Inflammatory Disease (PID)

Pelvic inflammatory disease (PID) is a serious infection which can lead to life-threatening complications if not properly treated. PID affects a woman’s uterus, fallopian tubes, ovaries, and/or surrounding tissues. While a number of microorganisms might cause PID, most often it is caused by sexually transmitted diseases (STDs).

Each year an estimated one million women are treated for acute PID in the United States. Young single women with more than one sex partner make up the majority of cases.

How does it occur?

PID is caused by the spread of microorganisms from the lower genital tract (vagina and cervix) to the upper genital tract.

Pelvic inflammatory disease may occur:

  • from untreated sexually transmitted diseases, such as chlamydia or gonorrhea, or other infections spreading from the lower genital tract into the cervix, uterus and/or fallopian tubes.
  • after a miscarriage, abortion, or childbirth
  • from naturally occurring or sexually transmitted bacteria that travel up the IUD (intrauterine device), which some people use for contraception
  • from douching ‘ women who douche once ‘ twice a month are more likely to have PID

Sometimes the cause of PID cannot be determined.

What are the symptoms?

The symptoms of PID include one or more of the following:

  • pain and tenderness in the lower abdomen
  • abnormally heavy vaginal discharge with a strong unpleasant odor
  • irregular or heavy menstrual periods
  • pain, which may be severe, during sexual intercourse
  • flu-like symptoms such as fever, general discomfort, fatigue, back pain, or vomiting
  • urinary symptoms ‘ burning or pain with urination

Some women have no to mild symptoms. Regular check-ups for sexually active women are very important for this reason.

How is it diagnosed?

The provider does a pelvic exam, in-depth medical history, and may take a sample of vaginal discharge for analysis to determine the cause of the infection.

In some cases, a laparoscopy may be necessary to confirm the diagnosis. A laparoscopy is a minor surgical procedure in which a small incision is made in the abdomen to enable a health care provider to view the internal pelvic structures.

Can PID be cured?

PID can be cured with antibiotics. However, when the infection is cured, there is still the chance that there has been permanent damage to the reproductive organs making it difficult for pregnancy to occur or, in some cases, causing infertility.

How long will the effects last?

If nothing is done to treat the infection, it could be spread to other parts of your body or create an abscess in the fallopian tubes or ovaries which can cause scarring or blocking of the tubes and result in infertility. Surgery may be the only way to correct a blockage in your reproductive system. Call your provider if your condition does not begin to improve within 72 hours after you start treatment or if new symptoms develop.

  • See your provider as soon as you notice any symptoms.
  • Take all medications as directed.
  • Do not have sexual intercourse until you and your partners are cured.
  • Rest and take acetaminophen, ibuprofen, or aspirin for pain relief.
  • If your provider thinks your infection may be caused by a sexually transmitted disease, your sexual partner must be examined and treated as well

What can be done to help prevent Pelvic Inflammatory Disease?

The best way to decrease your risk for PID is to prevent STDs.

The following practices may help prevent STDs:

  • Have just one sexual partner who has sex only with you (mutual monogamy).
  • Use latex condoms to reduce the risk of infection.
  • Abstain from sexual intercourse.

Unfortunately, sometimes there may be nothing you can do to keep PID from recurring.

Lisa Barber-Murphy, M.Ed., CHES, Revised 11/99

Rev. 5/03 Becky Griesse, CHES and Sherry Huang, MD

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Premenstrual Syndrome (PMS)

What is premenstrual syndrome?

Premenstrual syndrome (PMS) is the term used for the physical and emotional symptoms that some women experience during the week or two before their menstrual period. These symptoms may continue during their period. PMS symptoms vary from person to person. Physical and emotional symptoms range from almost unnoticed to severe. Severe symptoms may seriously disrupt daily life.

How does it occur?

PMS is related to hormonal changes during the menstrual cycle. Though the cause of PMS is unknown, it is attributed to an imbalance of female hormones. Research suggests that women who do not have enough zinc, magnesium, Vitamins E and B6, or certain fatty acids in their diets are more likely to have PMS.

PMS only occurs in women who ovulate during their menstrual cycle. Women who are past menopause, pregnant, or taking hormonal contraceptives do not ovulate and therefore, do not have PMS.

What are the symptoms?

Physical symptoms may include:

  • swollen feet or hands
  • bloated stomach
  • tender, enlarged breasts
  • weight gain
  • cramps and lower abdominal pain
  • joint pain
  • skin rash, blemishes, or bruising
  • headache
  • nausea, vomiting, diarrhea, constipation
  • backache
  • sinus headaches or drainage
  • a sore throat
  • changed eating habits, with cravings
  • a cold or asthma

Emotional symptoms may include:

  • irritability
  • anger
  • depression
  • anxiety
  • crying spells
  • tension
  • fatigue
  • difficulty in concentrating
  • nervousness
  • mood swings

How is it diagnosed?

Diagnosis can be difficult and may take several months. Your provider may ask you to keep a PMS journal or calendar and chart your symptoms. Symptoms that consistently appear at about the time of your period are usually related to the menstrual cycle.

Women with severe symptoms of PMS may be diagnosed with PMDD ‘ Premenstrual Dysphoric Disorder. PMDD includes mood-related symptoms that seriously disrupt your life on a regular basis. PMDD affects only 3-8% of women.

How is it treated?

The treatment depends on your symptoms. Some changes in your lifestyle may be helpful.

  • Eat a balanced diet. Less junk food, salty food and chocolate. Avoid alcoholic or caffeinated beverages, as well as artificial sweeteners. Eat meals consisting mostly of complex, unrefined carbohydrates, including whole grains, vegetables and fruit.
  • Develop a regular exercise program – jogging, walking, cycling. Regular exercise will help relieve both physical and emotional symptoms of PMS.
  • Reduce stress.
  • Get at least eight hours of uninterrupted sleep each night.
  • Sometimes multivitamin and mineral supplements are also recommended.
  • Other therapies may include hormone treatments, antidepressant medications, mild tranquilizers, birth control pills, and diuretics to lessen bloating. Before trying over-the-counter medications for PMS, consult your provider.

What can I do to prevent PMS?

Because there are still some uncertainties about the cause of PMS, there is often no reliable way to prevent it. You may be able to lessen the symptoms by following your provider’s recommendations. You should call your provider if you experience severe symptoms or notice that they vary from one month to the next. Treatment may be required if there is a more serious underlying cause for the condition.

Some suggestions include:

  • Regular exercise
  • Balanced diet
  • Reduction in stress
  • Limit caffeine

Lisa Barber-Murphy, M.Ed., CHES, revised 11/99; rev. 5/03 Becky Griesse, CHES and Dev Sangvai, MD

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Urinary Tract Infection (UTI)

Urinary tract infection (UTI) is an inflammation in the urinary tract. If left untreated, UTIs can cause permanent damage. Some are sexually transmitted but most are not.

Urinary tract infection is the result of bacteria that multiply and spread in the urethra and possibly to the bladder or kidneys. These bacteria can cause:

  • Cystitis (infection of lower urinary tract or bladder infection)
  • Pyelonephritis (a more serious infection of upper urinary tract or kidney infection)
  • Urethritis (inflammation of the urethra, the canal that carries urine from the bladder to the outside of the body)

Urinary Tract Infection is more common in women than in men because the urethra is shorter, making it easy for bacteria to spread. (Urinary Tract Infection is more likely to occur in women who are pregnant or have a history of diabetes, sickle-cell anemia, abuse of analgesics, kidney stones, or are immunocompromised.)

Common Causes

  • Sexual activity, especially frequent intercourse
  • Transfer of bacteria from anus to urethra
  • Pressure on urethra
  • What are the symptoms?
  • The symptoms of UTI may include:
  • uncontrollable urge to urinate (incontinence)
  • pain or discomfort when urinating
  • blood in the urine
  • strong-smelling urine
  • frequent need to urinate
  • burning sensation when urinating
  • passing frequent, small amounts of urine
  • pain in the lower pelvis, abdomen, lower back or side
  • shaking chills
  • fever
  • nausea and vomiting
  • perspiration
  • pain during sexual intercourse

How is it diagnosed?

To diagnose a UTI, the provider will review your symptoms, examine you (the exam may include a pelvic exam), and order lab tests including a urine analysis. A urine culture may also be ordered.

If the UTI recurs more than 2 or 3 times or responds poorly to treatment, or appears to be located in the kidney, the provider may order an Intravenous Pyelogram (IVP) or an ultrasound examination of the urinary tract.

How is it treated?

A UTI is usually treated with an antibiotic. A UTI may reappear if you do not complete the treatment as directed.

To relieve pain or cramps, you may want to use a hot water bottle or heating pad on a low setting. Drink plenty of fluids, but avoid caffeine, coffee, alcohol, citrus juices, and spicy foods until the infection has cleared up.

How long will the effects last?

The symptoms of a UTI may last as long as the infection lasts. The symptoms may disappear 24 hours after treatment begins. Your provider may also prescribe a medication to relieve pain.

How can I take care of myself?

If you have the symptoms of UTI, follow your provider’s treatment. In addition:

  • After using the bathroom, always wipe yourself from the front to back to prevent germs in the anal area from getting near the urethra
  • Keep the genital area clean.
  • Try not to postpone urination for long when you feel the urge.
  • Empty your bladder completely when you urinate.
  • Urinate after sexual intercourse.
  • Wear all-cotton or cotton-crotch underwear and pantyhose.
  • Change underwear and pantyhose every day.
  • Drink plenty of fluids.
  • Avoid strong soaps, douches, antiseptic creams, and feminine hygiene products (sprays, powders).

Adapted from UTI; Health Education;
Lisa Barber-Murphy, M.Ed., CHES; Revised 6/00
Rev. 5/03 Becky Griesse, CHES and Dev Sangvai, MD

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Vaginal Infections

What is normal for the vagina?

The vagina has no true glands. Its secretions come from the uterus, cervix, Bartholin’s Gland and vaginal wall lining. The normal discharge is transparent or cloudy white and somewhat filmy. Generally, the discharge has little odor and causes no irritation. Every woman has some vaginal discharge, but women vary in the amount and consistency of the discharge. Sexual activity, age, the time of the menstrual cycle, general health and nutrition may cause variations in the vaginal discharge. The vagina of a healthy women contains various organisms (including bacteria) which are necessary to keep the vagina healthy.

What is a vaginal infection?

When the normal balance of these organisms in the vagina is upset, one or more "resident" organisms can multiply out of their usual proportions resulting in an abnormal vaginal discharge. If you notice a change in the color, quantity, or odor of your usual discharge and/or develop itching, consult your health care provider. Not all itching indicates the presence of infection; sometimes breakdown of the vulvar skin can mimic a vaginal infection.

What is bacterial vaginosis and vaginitis?

There are a variety of terms used to indicate problems in the vulvovaginal area. The "itis" in vaginitis indicates an inflammation (redness and swelling) of the tissues of the vagina. Trichomoniasis and yeast infections are two common causes of vaginitis. Bacterial vaginosis also results in infection but not in inflamed cells.

Is a vaginal infection serious?

Vaginal infections are generally not very serious. One out of every two women will have a vaginal infection at least once in her life. Most will suffer nothing worse than a temporary annoyance.

What causes a vaginal infection?

Three major infecting organisms–bacteria, trichomonas, and monilia (yeast) cause vaginal infections. There are other types of infections of the vagina, including sexually transmitted diseases (STDs), but usually when health care providers say you have a vaginal infection they are referring to one of the above. Chemicals in commercial douches, vaginal sprays, and spermicidal foams, gels, or condoms can sometimes cause a "noninfectious" vaginitis. Certain factors such as poor diet, lack of sleep, increased stress, oral antibiotics, or presence of another disease (such as diabetes) or infection may also make the vagina more susceptible to infection. Intercourse without enough lubrication and tight fitting clothing or damp/wet clothing may irritate the vagina and open a pathway to infection.

How do I know if I have a vaginal infection?

Now that medications to treat yeast infections are available over-the-counter, women may be able to treat their own symptoms. However, the symptoms of vaginal discharge and itching are often signs of other health problems. It is essential that you know what the abnormal discharge means before you self medicate. Irritation or persistent deviation in color (normal discharge is clear or slightly milky, and often yellows when dry), odor or consistency should always be checked by a health care provider.

How can I protect myself from getting a vaginal infection?

Minimize the chances of getting a recurrence of your infection by completing all of your medication.

Follow the rules of good hygiene:

  • Wear clean underwear. Some infectious organisms thrive in hot, moist environments, especially those created by nylon panties, tight jeans, wet bathing suits, and panty hose. So, if you’re troubled by recurrent vaginal infections you may want to wear cotton underwear. Skirts and looser pants may also be advisable. Also, change sanitary pads often when menstruating.
  • Avoid the problem of getting bacteria from your rectum into your vagina by always wiping front to back after a bowel movement.
  • Do not use commercial douches, deodorant tampons, or other perfumed products that touch the vulvovaginal area. (Douches are not necessary for healthy hygiene).
  • If you suspect a vaginal infection, avoid sex until your problem can be diagnosed and treated.
  • Make sure your partner does not have a discharge or sores in the genital area.
  • If you are sexually active with men, always use a condom to lessen the risks of sexually transmitted diseases.
  • If anal intercourse is followed by vaginal intercourse, always change condoms in between.

Lisa Barber-Murphy, M.Ed., CHES, Revised 11/99; rev 5/03 Becky Griesse, CHES and Dev Sangvai, MD

Vaginal Discharge: What Could Your Symptoms Mean?

Discharge Itching Possible Cause Treatment
Heavy discharge that is thin and runny and tends to be creamy white, yellow, or grayish green in color; with a noticeable unpleasant odor or "fishy" smell. None to mild. BACTERIAL VAGINOSIS (BV): BV, also known as nonspecific vaginitis, hemophilus vaginalis, and gardnerella, is the most common cause of vaginal symptoms among women of childbearing age. BV occurs when the normal bacteria which dominate the vagina are replaced by an overgrowth of other bacteria. The reasons for the reduced presence of normal bacteria and the increase in new bacteria is poorly understood. The issue of whether BV is sexually transmitted has not been definitely determined, although the history and age of the women indicate that sexual transmission is likely. Requires a health care provider’s diagnosis; treated with antibiotics.
Thick, white discharge that may resemble cottage cheese. Moderate to severe. CANDIDIASIS (Yeast): Candidiasis, also known as monilia or yeast infection, is caused by a fungus. Yeast exists naturally as part of a normal, healthy vagina. Among the factors which may trigger an overgrowth of the yeast are recent treatment with antibiotics, oral contraceptives, menstruation, wearing tight underclothes, or sexual intercourse. After initial diagnosis by a health care provider, occasional bouts may be self-treated with over-the-counter vaginal creams or suppositories. For frequent yeast infectious, you should see a health care provider.
Moderate to heavy thin, foamy discharge that may be yellowish green and may have an unpleasant odor. Urination may be frequent and painful. Sex may also be painful. Mild to severe. TRICHOMONIASIS: Trichomoniasis caused by a microscopic parasite and is usually transmitted sexually, but can also be passed on by moist objects, including towels, washcloths, and bathing suits. Requires a health care provider’s diagnosis; prescription of antimicrobial pills or creams for you and your partner, so that you don’t reinfect each other during intercourse.
Thin, watery discharge or no change at all Mild to severe itching and/or burning. IRRITATION OR ALLERGIC REACTION (to soaps, spermicides, perfumed douches, or lubricants). If a health care provider’s exam doesn’t detect an infection, you may have an allergy or sensitivity. Stop using suspect items; try cool soaks.
Note: It is not uncommon for women to have more than one organism causing vaginitis, such as BV and Trichomoniasis together.

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Women’s Health Procedures And Examinations

What are screening and exams for women?

Pap Test

Usually physicians recommend that women have a Pap test (a cervical smear) annually beginning at age 18 or within six months of first sexual intercourse. A Pap test is done to check for abnormal changes in the cells of the cervix (the lower opening of the uterus). A Pap test can detect cervical cancer early, while it is still curable.

Breast Self-Exam (BSE)

Beginning in their 20′s, women should be told about the benefits and limitations of BSE, and that it is acceptable for women to choose not to do BSE or to do it occasionally. BSEs are to focus on general breast health as opposed to cancer detection. Women who choose to do BSE should receive instruction and have their technique reviewed on the occasion of a periodic health examination by a provider.

Clinical Breast Exam

A clinical breast examination (CBE) is an examination of your breasts by a health care professional, such as a doctor, nurse practitioner, nurse, or doctor’s assistant. For this examination, you undress from the waist up. The health care professional will first look at your breasts for changes in size or shape. Then, using the pads of the fingers, the examiner will gently feel (palpate) your breasts.

Women aged 20 ‘ 39 should have a clinical breast exam every 3 years by their health care provider and annually for women aged 40 and older.

Mammogram

A mammogram is a procedure in which very low-dose x-rays are passed through the breast to detect signs of breast cancer. Unfortunately, the technique is not very accurate for women less than 35 – 40 years old.

Breast cancer is the second leading cause of death from cancer for women (after lung cancer). Women should follow these guidelines of the American Cancer Society:

  • Women aged 40 and older should have a mammogram and clinical breast exam every year
  • Women whose mother or sister had breast cancer should talk to their providers, who will instruct them in careful surveillance.

Becky Griesse, CHES

Sources:
American Cancer Society Guidelines for Breast Cancer Screening: Update 2003;
CA Cancer J Clin 2003; 53:141-169

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