Women's Bodies, Women's Wisdom (66 page)

Barbara eventually made peace with her losses—her loss of her mother and father, and her loss of her relationship with a brother who is alco holic. She says that she is grieving the “loss of the dream that someone special will come into my life and rescue me from my aloneness.” She is angry that it has taken her so long to realize that no one can save anyone else, she says.

“Now I know that no one can get under my skin and do for me what I must do for myself. I have let my daughter go. I have released her from being my social support and comfort. The aloneness is a new reality that I no longer deny. I will look to embrace special times with others and special times with myself. For I now see myself as a person who does not have to change. I like me. I like the warm, loving woman who peeks her head out occasionally. I will work on showing her off more. I have some wonderful qualities that can be offered to the universe. I’ll be there if you’ll be there.”

Barbara’s body is now healthy. Her six-month checkups and Pap smears all returned to normal. She has become a vibrant, beautiful woman whose entire being radiates health. When she smiles, her smile comes right from her center. Her mask is gone. She is a healed woman.

For Barbara and so many others, the entry points of our bodies have been defiled and denied as part of us for too long. But though we often have pain and shame stored there, we can reclaim the pleasure of these sacred gateways. This journey starts with awareness and compassion.

VAGINAL INFECTION (VAGINITIS)

Almost all women normally have some kind of vaginal discharge. A yellowish or whitish stain on a woman’s underwear at the end of the day, particularly if she has been wearing panty hose or pants, is almost inevitable. Many women don’t know this and often think that they have some kind of infection, but it is quite normal and does not require a visit to a gynecologist. Vaginal discharges of some kind can begin the year before a girl gets her first period. Her gradually increasing estrogen levels stimulate the estrogen-sensitive cells of the vagina and cervix, resulting in an increased production of cervical mucus and increasing the cell turnover rate in the vagina.

A normal vaginal discharge comprises vaginal and cervical cells mixed with cervical mucus. When one looks through the microscope at a smear on the slide, one sees mostly normal vaginal squamous cells. Normal cell turnover of the lining of the vagina can increase when a woman is under stress, so that she will have an increased amount of discharge. But this discharge, too, will comprise normal cells.

Vaginal discharges differ at different times in the menstrual cycle. Many women notice an increase during the days surrounding ovulation; some feel that they have “wet” themselves. Ovulatory flow, or fertile flow, sometimes resembles egg white. Some women have pre menstrual spotting of brown old blood. This in itself is not an abnormality.

Just about every woman, however, is susceptible to a vaginal infection at some point in her life. Both the vagina and the vulva are often involved in this infection. Hence, when I use the term
vaginitis,
understand that the more inclusive term would be
vulvovaginitis
.

Common organisms that produce infection under the right circumstances are chlamydia, Gardnerella, trichomonas, and yeast. The key concept here is “the right circumstances.” The vagina, which normally maintains an acidic pH, is colonized by many different types of organ isms, all of which work together to form a healthy vaginal ecosystem and functioning immunity. Even yeast and Gardnerella can live in the vagina normally.
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When a woman is healthy, these organisms do not cause problems. Only when something in this area becomes imbalanced are these organisms associated with infection.

Almost every type of organism that can cause a vaginal infection when conditions are out of balance can also be found in women who have no symptoms. For instance, some women have trichomonas protozoans, a well-known sexually transmitted cause of vaginitis, present in their vaginas for years with no symptoms whatsoever. Others are incapacitated by the itching and burning the protozoans can cause.

Symptoms and Common Causes

Most vaginal infections make their presence known by a burning or itching sensation, sometimes accompanied by a change or increase in vaginal discharge.

Anything that disrupts the pH balance or bacterial balance of the normal vagina can result in an infection. The time you’re most likely to get a vaginal infection is during or right around your menstrual period, when your mucosal immunity is at its lowest point in the monthly cy cle. The pioneering work of Charles Wira, Ph.D., on mucosal immunity has shown that immunoglobulins A and M are affected by the levels of estrogen and progesterone. These hormonal levels decrease just before the onset of a period, making you more vulnerable to infection. The immune system thus mirrors the emotional permeability of this time in the cycle.
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Some women experience a similar sensitivity to infection after menopause, when both hormone levels and mucus production drop, but this is not inevitable.

Repeated Intercourse over a Short Period of Time

Semen is buffered alkaline fluid, with a pH of about 9. One episode of intercourse with ejaculation can increase the pH of the vagina for eight hours. When vaginal pH is higher than normal for long periods of time, the bacterial balance can be lost. Those organisms that are normally present only in small numbers can begin to grow and cause infection-like symptoms. If a woman makes love with ejaculation of semen into the vagina three times in a twenty-four-hour period, her vagina will not return to its normal pH for that entire twenty-four-hour period. For some women, this is a setup for infection, particularly women who are in long-distance relationships and whose sex lives are sporadic and limited to increased activity over a few days. To prevent problems, you can douche within a few hours of intercourse with Summer’s Eve Medicated Douche, which contains povidone iodine and lowers vaginal pH. Or use a vinegar douche—one tablespoon per quart of warm water. Douching to reduce vaginal pH after sex is meant as a preventative treatment
only
in those women whose vaginitis is triggered by contact with semen. It’s not meant as an endorsement of douching as a standard practice for women.

Chronic Vulvar Dampness

The vulva sweats more than any other place in the body, especially when a woman is emotionally stressed. Thus, wearing restrictive, nonabsorbent, synthetic clothing close to the skin in the vulvar area can be a setup for chafing and subsequent infection. This is especially true if a woman exercises in this type of clothing. Riding a bike or a horse or using a rowing machine in such clothing can also cause vulvar irritation.

Chemical Irritants

Some women develop vulvar irritation through chemical irritants found in scented, softened, and colored toilet paper; bubble baths; and sanitary tampons and pads that contain deodor ants. All women should avoid using pads and tampons that contain deodorants. These tampons can produce vaginal ulcers, and the pads can cause vulvar irritation. No tampon should ever be left in for more than eight to twelve hours at a time. Other irritants can include chem icals in swimming pools and hot tubs, scented douches, and vulvar deodorant.

Emotional Stress

Some women respond to a perceived boundary vio lation with a vaginal infection. Many yeast infections also occur premenstrually, when a woman’s stress is more apt to manifest in symptoms—and when the hormonal milieu is more susceptible as well. They often clear up spontaneously once the period starts.

Antibiotics

After the introduction of broad-spectrum antibiotics in the 1940s and 1950s, the incidence of yeast vaginitis increased dramati cally. Many women can date the onset of their vaginitis to their teen years, when they took antibiotics such as tetracycline to treat acne. Unfortunately, every time we take an antibiotic, we disrupt the natural balance of organisms in the vagina and bowel, and a yeast infection, either full-blown or chronic, can result. In the last decade, while the percentage of women over the age of eighteen has increased by only 13 percent, the number of antifungal prescriptions for women has increased by 53 percent.
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Birth Control Pills

Some women notice more yeast infections on the pill, which may be related to the type of progestin in the pill. Try switching pills or stopping the pill for three months and see if the yeast infections clear.

Diet

Many books have now been written on the connection between repeated courses of antibiotics, a refined-food diet, and excessive yeast growth in the vagina and bowel. Eating a lot of food made with refined sugar and flour can favor the overgrowth of vaginal yeast. Dairy products can also contribute to yeast vaginitis in some women because of their high lactose (milk sugar) content, which favors the overgrowth of yeast in the bowel and vagina. One of my patients developed recurrent yeast infections when she drank an instant-breakfast-type milk drink every morning. The high sugar content of this so-called healthful meal substitute threw off her body’s ability to fight excess yeast growth.

Many conventionally trained physicians don’t look at repeated courses of antibiotics and poor diet as factors in chronic vaginitis. Many women have seen ten or more doctors for their vaginitis and have had every conventional culture and biopsy done without uncovering a definitive cause. Once these women begin to support their bodies’ natural healing abilities through emotional work, dietary improvement, and supplements, their vaginitis problems have often gone away.

Diagnosis

The vast majority of common vaginal infections can be diagnosed by looking at a sample of the vaginal secretion under a microscope and testing it for pH. Some infections, such as chlamydia and herpes, require that a culture be sent to a laboratory for further testing.

Women with chronic vaginitis are suspected to have a condition known as intestinal dysbiosis, or an imbalance of bacteria in the bowel that is often accompanied by an overgrowth of yeast. Women with this condition often reintroduce yeast into their vaginas, even after repeated treatment. This is because yeast in the bowel reinfects the nearby vagina.
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When intestinal dys-biosis is suspected, a special stool culture can be sent to a laboratory that specializes in proper diagnosis of intestinal dysbiosis.
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Alternatively, simply changing your diet and adding probiotics and digestive enzymes is all that is usually necessary. (See “Nutrition,” page 301.)

Treatment

Over-the-Counter Preparations

Many women can treat an occasional episode of vaginal burning or itching with one of the over-the-counter preparations that is now widely available, such as Monistat and GyneLotrimin. If you’ve tried an over-the-counter preparation for a week or so with no improvement of your symptoms, see a health care practi tioner to be certain that you’re not missing something. Once a diagnosis of a vaginal infection is made, the practitioner can prescribe the proper treatment.

Resistant cases of bacterial vaginitis can be treated with vaginal antibiotic creams available by prescription: Cleocin (clindamycin) vaginal cream or MetroGel (metronidazole) vaginal cream.

A trichomonas infection can be treated with Flagyl (the oral antibiotic metronidazole), available by prescription. The side effects from this treatment are nausea and an adverse reaction to alcohol. If a woman has trichomonas and has a sex ual partner, both partners must be treated. Otherwise, they may reinfect each other. A male has no symptoms but carries the trichomonas in his genital tract.

Evidence also suggests that some women have chronic yeast infection even after treatment because they are continually reinfected by their sexual partners.
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In these cases, treatment of the partner is helpful.

Preventing Recurrence

Avoiding the chemical irritants involved in vul vovaginal infections can be very helpful for susceptible women. Women with a history of repeated infections may choose to avoid using tampons for six months. Avoid panty hose when possible, or cut out the crotch. Oral sex has also been associated with an increased risk for yeast infection, as has consuming yeasted bread.

Douching

I don’t recommend douching except for specific symptoms that you are treating or after repeated intercourse to prevent infection. Especially with commercial preparations, douching simply disrupts the normal bacterial flora of the vagina and may actually increase the risk of infection. It is not necessary to “clean” the vagina.

Nutrition

For women with recurrent yeast infections, I recommend the Master Program for Optimal Hormonal Balance and Pelvic Health in chapter 5. I also suggest avoiding all antibiotics. Note that sugar in all forms (including foods that become sugar quickly—including white flour, potatoes, and most processed grains) feeds yeast.

To eliminate yeast in the intestinal tract and rebalance intestinal flora, which will help avoid reintroducing yeast into the vagina, you can use a variety of supplements, such as acidophilus and bifida factor, both intestinal biocultures. One of the best is known by the brand name PB 8; unlike other formulations, it doesn’t require refrigeration. It is available in health food stores.

I recommend two other brands of probiotics—Gastro Flora and Entero-Pro. Many other good ones are also available. Check the refrigerated section of your natural food store. Finally, decrease stress as a way to enhance your immune system functioning.