Besting Bacterial Vaginosis, Part II

By Riva Preil

The diagnostic features of VBD include extreme pain upon attempted vaginal penetration, vestibular pain when touched with a cotton swab, and erythema (redness) in the vestibule.  These are called Freidrich’s criteria.  Treatment includes tricyclic medications (ex. amitriptyline) to alleviate pain, especially in cases of secondary VBD.  Also, antiseizure medications (ex. carbamazepine) and anticonvulsant drugs (ex. gabapentin) have been used to help women with VBD. One should speak with their physician regarding medications and the possible side effects if they think they may benefit from this form of treatment.

Furthermore, physical therapy is a crucial component in treating VBD.  The pain which results from VBD can be viewed as a stressor or assault to the pelvic floor muscles. In response to pain, the muscles in the pelvic floor can tighten and may even spasm as a protective mechanism to prevent further injury.  However, the tightening of the muscles themselves can cause a cascade of problems including formation of trigger points, decreased muscle flexibility, skeletal misalignments, and additional nerve compression.  Therefore, women with VBD should participate in physical therapy to help treat the secondary musculoskeletal dysfunctions.

Vestibulectomy, a surgical procedure performed to remove the irritated and vestibular tissue along with the inflamed nerve endings, should be used as a last resort and only if all the treatments have failed.  The hesitancy surrounding this surgery is due to the fact that nerves tend to have better memories than we want them to have- the brain may still continue to perceive pain even from a severed nerve!  (This is similar to the concept of phantom limb pain, and this is the reason why individuals may continue to feel the presence of a limb even after it has been amputated.)  Therefore, since the initial success rate of vestibulectomy is only 60% (approximately), it should be reserved for individuals who are completely unable to participate in intercourse due to pain (if medication and physical therapy were unsuccessful).  Fortunately, this procedure should not impair areas associated with sexual pleasure, and it has not been shown to interfere with fertility, pregnancy, and delivery.

Besting Bacterial Vaginosis

By Riva Preil

The #1 cause of vaginal complaints in America is due to bacterial vaginosis (BV). BV is due to the vagina becoming less acidic than it should be which creates and imbalance in the various vaginal bacteria. This creates an unpleasant fish odor in the vagina, and it can also result in increased vaginal discharge and itching and/or burning. Pain is generally not associated with BV. BV is best diagnosed through a wet prep, as opposed to a vaginal culture (which does not help in the differential diagnosis of BV).  Doctors often perform a vaginal pH test to assess the level of acidity in the vagina. A pH of greater than 4.5 is considered abnormal. Furthermore, a microscopic analysis of vaginal wall cells can be performed to check for clue cells, bacteria filled cells which are unique to BV.

BV is not considered a sexually transmitted disease, however it is associated with sexual activity with multiple partners has been connected to BV. It is also associated with intrauterine device (IUD) implantations as well as hygienic douching (this should actually be avoided to prevent killing the vaginal lactobacilli which create the necessary acidic environment in the vagina). More than 50% of women with BV actually do not demonstrate any signs or symptoms. BV is NOT the same as a yeast infection, however many women often mistaken BV for a yeast infection, which is usually not accompanied with a foul odor. When women make this mistake and treat themselves with over the counter anti-yeast medication, they will not feel better because the underlying problem, BV, has not been treated. Therefore, it is important for an accurate diagnosis to be made in order to properly treat the problem, especially because BV tends to recur. Although there is currently no cure for BV, symptoms can be managed through medications such as Flagyl and clindamycin. Some women also find the vaginal acidifying moisturizer, Replens, helpful. BV mediation, as all medication, should be discussed with one’s primary care physician. In addition, BV is considered by the pelvic floor muscles as a “trauma”, and it may cause pelvic floor muscle tightness and trigger points. Pelvic floor physical therapy can be very beneficial for reducing the musculoskeletal dysfunctions associated with BV.