Often we assume our patients know at least the basics about health – especially about things soooo seemingly basic…that we fear mentioning them would offend and make us look like someone trying to teach grandma anything! But there are some instances where I’ve found I have simply assumed too much.
I think the issue of what I affectionately call ‘Vag Care’, is right up there as an example.
Soapy water? Female deodorisers, daily panty liners, re-enacting bad movie scenes with soapy suds sex…what the??? It’s been my astonishing discovery that women of all ages, but especially a frightening majority of younger females (<30 yo), in this time of increasingly unreal ideas about sex and sexuality, feel inclined or pressured to adopt these practices in order to erase all trace of natural odour and healthy discharge. The abnormal has become normalised.
Through this it becomes apparent that these women and many others who don’t necessarily prescribe to those ‘so-called female hygiene’ practices, have almost no understanding of the vulnerable ecosystem that lies within and how to take good care of it. Could this loss of knowledge be a driver behind the increasing rates of both vaginitis (candidiasis, bacterial vaginosis) and treatment resistant presentations reported in the western world? I think it plays a very important part.
Now onto another assumption regarding this issue…
Often we also assume if we send our female patients with vaginitis off to the doctor the necessary investigations will be self-explanatory and universal. Did you know that for a comprehensive work-up of any sort of vaginal itch, altered discharge etc, you need a high vaginal swab for culture (Candidiasis & Trichomonas), a swab for PCR testing (for Chlamydia, Bacterial Vaginosis) and a gram stain (for Bacterial Vaginosis) AND a thorough examination to rule out a non-infectious aetiology such as atrophic vaginitis? Additional tests that may be necessary include the whiff test (what a name I know!) for excessive amine levels and vaginal pH. Check out this great table here for a summary. How many of your patients are leaving with just a lower vaginal swab (and increasingly self-collected) for culture only and consequently evading diagnosis?
As you already know I am a stickler for the right testing and in the case of vaginal health – it’s imperative as many conditions are impossible to distinguish based on presentation alone. BV is the major cause of vaginitis (40-50%), in addition to this, up to 80% of BV can be asymptomatic. If these women are investigated with only a swab culture – BV will be missed.
Vaginal sx and the health of the vaginal microbiome is one of the those scenarios where it’s imperative that we test our assumptions – all of them. And don’t get me started on the rise and rise of synthetic underwear..attractive, dare I say sexy(?), cotton undies for women need to be put on the endangered species list!!
‘Taking care down there‘, is the latest installment in the Update in Under 30 series, in which Rachel summarises new evidence about how to support and maintain vaginal eubiosis, along the way explaining the dramatic rise in vaginal dysbiotic presentations such as Bacterial Vaginosis, Candidiasis and Trichomonas. Covering explicit issues such as, ‘to douche or not to douche’, as well as why, just like in the gut, we need to refocus on a seed and feed approach with less emphasis on the weeding and how. This is a very practical take on recognising vaginal microflora disturbance and knowing how to make lasting sustainable change in women caught in an unhealthy cycle.