Vaginal infections: 75% of women are afflicted by them at least once in their lives

Gynecologists attribute these ailments to an imbalance in the area’s microbial ecosystem. Among other factors, that disequilibrium is caused by the use of antibiotics or douches that destroy the genital flora

infecciones vaginales
A gynecologist and a patient in an examining room.Anchiy (Getty Images)

The vagina is home to thousands of microbes. It is not sterile. Fungi, bacteria and other microorganisms live in harmony within the vaginal walls to protect the mucosa from attack and colonization by unwanted pathogens. The balance of this ecosystem of vaginal microbiota is necessary for good health, but it is not always stable. The flora is always changing, and at times imbalances can occur that cause uncomfortable vaginal infections. According to the Spanish Society of Gynecology and Obstetrics (Sego), such ailments are common at all ages and 75% of women suffer from them at least once in their lives. Depending on the cause of the infection, the symptoms can range from itching and stinging to dense, foul-smelling discharge. Gynecologists say that, among other factors, these ailments result from imbalances caused by using antibiotics and dangerous douches, which destroy the genital flora.

Vaginal infections are one of the most frequent reasons that women go to the doctor. One in five appointments with gynecologists are made to address them, although the incidence of these infections may be much higher. “Many infections go unrecorded because women self-diagnose [them] and self-medicate,” says María Jesús Cancelo, Sego’s vice president and the editor of a clinical guide for treating such ailments. The gynecologist warns of the danger of patients treating themselves without medical guidance: “[Women] don’t differentiate between the types of infections, and the treatment is different depending on the case. When they self-medicate, they usually use a generic treatment; if they have succeeded [in resolving] the problem, fine; but if not, it may recur.”

A vaginal infection refers to inflammation of the vaginal mucosa and vulvar skin, although it does not always affect both areas at the same time. According to the experts consulted for this article, the cause is usually an imbalance in the vaginal microbiota. Under normal conditions, there is a kind of peaceful coexistence between good and bad germs in the vaginal ecosystem, says Toni Payà, the head of Gynecology and Obstetrics at the Hospital del Mar in Barcelona: “The most frequent [germ] [in the vaginal microbiota] is Döderlein’s bacillus, a lactobacillus that transforms glycogen into lactic acid. Because of lactic acid, the pH of the vagina is acidic, which controls the growth of pathogens. If these Döderlein bacilli are not present, dysbacteriosis occurs; the balance is disrupted and pathogens grow.”

This happens, for example, after taking antibiotics, Payà says: “The amoxicillin you take for a throat infection takes care of the germs in your tonsils but also the Döderlein bacilli. And that leaves a wide open field for Candida fungi, for example.” Other circumstances are also conducive to such illnesses, including immunosuppressive diseases (HIV and systemic lupus, for example) or excessive or inadequate genital hygiene. The Hospital del Mar gynecologist also notes the danger of using douches: “The vagina should not be washed from the inside. This should never be done because you will damage your vaginal flora. If you put soaps in the vagina, you clean a medium that is not aseptic,” he warns.

The most frequent vaginal yeast infections are those caused by the Candida fungus. These usually present with more symptoms, Cancelo says: “There’s discomfort from the inflammation of the mucous membranes, such as burning, itching and stinging. And there’s whitish vaginal secretion in lumps.” Candidiasis vulvovaginitis, which accounts for about 25% of all vaginal infections, is usually treated with antifungal creams; in the event of repeated episodes, oral antifungals are also prescribed. Half of the women who suffer a one episode will have another bout of candida-induced vulvovaginitis. A scientific review says that recurrent infection by this pathogen affects almost 8% of women worldwide.

Bacterial vaginosis is another form of vaginal infection. It is caused by a group of bacteria that do not cause as much itching and stinging but generate increased “yellowish, frothy and foul-smelling” vaginal discharge, Cancelo explains. Although antibiotics can be used to kill the bacteria causing the infection, in this case gynecologists prefer to avoid them in favor of antiseptic preparations like decualinium chloride. “We also encourage the growth of lactobacilli with probiotics,” the Sego vice president adds.

Another type of vaginal infection — which is now rare in Western countries — is sexually transmitted vulvovaginitis, which is caused by a type of protozoa called Trichomonas. “The only thing the woman notices is an increase in vaginal secretion, which is more yellowish [than usual],” says Cancelo. The Sego clinical guide recommends treating the ailment with antiparasitic drugs for both the patient and her sexual partners, “who should be treated with similar regimens…[along with] sexual abstinence until the treatment is completed and…the clinical symptoms accompanying the infection resolve.”

Other vaginal infections include so-called non-infectious vulvovaginitis. These are ailments that “show symptoms, but no germ [is] identified” as the cause, Cancelo explains. Sometimes they are considered allergies, Payà observes; they result from using “non-breathable clothing or perfumed panty liners, which cause allergic reactions.” These irritating substances can cause those symptoms, which present with itching and some discomfort. The solution is repopulating the vaginal flora with probiotics.

As a general rule, experts recommend wearing cotton underwear, using unscented sanitary pads, avoiding douches and, in cases of infection, abstaining from sexual intercourse for the duration of the treatment period.

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