Nov 13, 2018

Dr. Jones: So you are thinking of a problem down under. Vulva and vaginal concerns are common, but when do you need to see a clinician?

Announcer: Covering all aspects of women's health. This is the Seven Domains of Women's Health Domains of Dr. Kirtly Jones on The Scope.

Dr. Jones: Most women in their life would have at least one episode of vaginal discharge or vulva itching and burning. It is a very common problem, and they often go together. But one that women don't even talk about, not even with their girlfriends. Though the problem is common and never fatal, it can cause physical distress and mental worry. But ladies don't like to go to the clinic for this, and waiting for an appointment can be difficult. So when do you need to see clinician for vaginal discharge or vulva itching, and when can you wait and treat it with over the counter medications?

First, in the reproductive years between the ages of about 9 to 10 and 50 years, or so, a certain amount of noticeable vaginal discharge is normal. The vaginal walls and cervix produce fluid that keep the vagina clean and makes sex comfortable. Cervical fluid during ovulation can be so noticeable that it's a marker for women who use natural family planning. The fluid is usually clear or milky white, and doesn't have an unpleasant smell. Of course there can be vaginal discharge associated with the menstrual period, which can be red, brown, black, a lot, or a little. But if there is an increase in discharge that's a different color or smell then their might a problem. So when do you need to see a doctor, or a mid wife, or a nurse practitioner, or physicians assistant?

Number one, if you aren't in the reproductive years, girls under 10 and women who are post menopausal who have a new vaginal discharge should be seen and evaluated. Female persons, kids and older women who are outside the reproductive years, don't usually have vaginal secretions.

Two, if you are pregnant. Women who are pregnant have a lot of thicker cervical mucus and vaginal fluid from the pregnancy, but if it's new, and it's changed, you should have it checked out.

Three, if you have a new sexual partner, or you think your same old partner has a new partner. You should get checked. A change in vaginal secretions can be a sign of a sexually transmitted disease.

Four, if you have other symptoms, a fever, pelvic pain, or vulva itching or burning. But let's go on to that last topic. Vulva itching and burning is pretty common, and it can make you perfectly miserable.

Men seem to be able to scratch their nether regions in public, but women can't. And it's always worse at night. The skin on the vulva is like the skin on your lips, very thin and delicate. But we don't put chapstick on the vulva to protect it. But actually that's an idea. But too much time and Lycra on the bike, soap, detergent, lotions, fragrances, and even semen can be irritating to these delicate tissues.

If you don't have a new discharge, and you do have new vulva itching and burning, you can try some simple things at home. No soap, lotions or anything but water for cleaning. Dry off, then apply a thin layer of vegetable oil. Something like Crisco works great and is cheap. It doesn't have any perfumes, or chemicals. Of course you can use a petroleum based product like Vaseline or Eucerin, but going with plant based oils might be better. Of course you can put on the think ointment that you put on a baby's bottom because the problem is the same. If this doesn't work in a week, you should get it checked out.

If you have a new discharge and vaginal itching, and most women assume that it's a yeast infection, and they would be right less than half the time. However, if you've had a yeast infection before, diagnosed by a doctor who looked through a microscope and saw yeast, you can try over the counter yeast medication, which really works for yeast infections, but not for anything else. Home remedies such as vinegar douching or yogurt have not been found to be an effective treatment for anything, and douching can put you at risk of a pelvic infection.

When should you see a clinician? The same rules apply as before. If you are outside the reproductive years, if you are pregnant, if you have a new sexual partner, and if you have pain or if the problem doesn't go away, you should see a doctor. Also, yeast infections and skin conditions caused by allergic conditions, or your clothes, or soap don't have an odor. So, if you have an order then it's not a yeast infection. If you're worried see your clinician.

Okay, well that's just a little bit on a very big topic, but enough for now. Put the information away because it's likely you're going to need it someday. And thanks for joining us on The Scope.

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updated: November 13, 2018
originally published: June 18, 2015

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