Answering Common Questions & Concerns About Vaginal Health

Vaginal health is more often worried about rather than talked or written about.

To open the door to a better conversation, experts from the Kapiolani Women's Center would like to address some common concerns we hear from patients at various phases in their lives.

Younger girls and teens may wonder: Am I normal?

The vulva, or female genitalia at the entrance to the vagina, can vary quite a bit in size and shape. The inner “lips,” or labia minora, are usually asymmetric – sometimes markedly so! – and tissue around the vaginal opening itself (known as the introitus) can have irregular borders.

In rare instances, the labia minora can be prominent and long enough that friction against clothing causes irritation. Sometimes the tissue surrounding the introitus (the hymen) covers the opening completely, blocking menstrual flow.

Both of these conditions can be treated by a gynecologist.

Adult women often worry: Is this discharge normal?

Similar to the vagina, vaginal discharge also has a wide range of “normal,” varying at different times of the menstrual cycle, different stages in life, and among different women. It can be clear or white, sticky or watery or somewhere in between.

Brown discharge often indicates blood, which can be normal before and after a menstrual period.

Brown discharge that persists should be evaluated, as should any change in discharge that is accompanied by pain, itching or irritation.

The following are fairly common infections that can cause a change in discharge:

• Yeast infections can be accompanied by thick, white “cottage cheese” discharge or by a decrease in discharge and itching, burning or labial swelling.
• Bacterial vaginosis is an overgrowth of normal bacteria that can cause an increase in discharge that is sometimes yellow, green or even gray in color. It is often accompanied by a “fishy” odor and sometimes by vaginal itching or discomfort. Because it is a normal bacteria, it does not have to be treated if the symptoms are not bothersome or if they resolve on their own.
• Trichomonas is a sexually transmitted disease that causes a “frothy” or foamy discharge.
• Gonorrhea or chlamydia can cause yellow or green discharge and sometimes pelvic pain and cramping. These conditions can also cause no symptoms, however, so it is important to be screened for these STDs if you have a new sexual partner.

You can minimize your risk of these infections by implementing the following:

• Avoiding unnecessary antibiotics, which can cause yeast infections.
• Controlling your diabetes.
• Using condoms consistently.
• Wearing loose clothing and cotton underwear (or wearing no underwear) that let the vagina “breath."
• Changing out of wet bathing suits and workout clothes quickly.
• Washing your genital area with water only. Soap can irritate the tissue (think of it like the lips around your mouth – you wouldn’t want to use soap on them, right?), douching actually flushes out the normal bacteria that keep your vagina healthy.

Older women may find: Sexual intercourse has become painful.

The decrease in estrogen that occurs normally around menopause leads to vaginal dryness and atrophy, a thinning of the tissue that makes it tear more easily.

Various over-the-counter lubricants can help, as can prescription estrogen creams, tablets or a ring designed to replace estrogen in the vagina while limiting systemic side effects.

It is important that any vaginal bleeding after menopause (defined as one year without a menstrual period) be evaluated by your doctor.

Published on: May 8, 2019