Vaginitis, urethritis, thrush, yeast. Hurts, itches, smells, runs. Welcome to womanhood. Each of us will have the discomfort of this family of maladies – some more than others and probably half of us have the required organisms in us at any moment. The symptoms are so similar and discomfort so great that we have difficulty differentiating among them. A secret: We doctors do, too. And to make things worse, some of the symptoms are similar to early symptoms of various bacterial STD’s. Let’s try to make some sense out of ourselves.
The entire pudenda is a perfect habitat for all sorts of little trouble-makers – warm, damp, all enclosed in very sensitive tissues and very near the source of some nasty bacteria. Urethritis is probably the easiest to isolate. It is an infection, usually bacterial, of the small tube (urethra) through which the bladder empties itself. The opening of the urethra is just in front of the vaginal opening. Usually about half way between the clitoris and vaginal entrance and enclosed within the labia. The cause is usually bacteria migrating from the anus and entering the urethra from the “outside.” In sufficient numbers, they cause an infection or severe irritation of the urethra itself. Untreated, they proceed on up to the bladder and cause cystitis. “It burns when I pee.” Is the most telling symptom but because of the way urine leaves our bodies we cannot always be certain that the burning is in the urethra. In the male, there is no question but our stream is impeded by the lips and may be spreading for an inch or so on either side of the urethral opening and it may be our lips that are burning.
Urethritis yields strong smelling urine. Pee in a cup and smell it. This cannot rule out urethritis but a strong foul smell certainly is an indicator of what is there. Urethritis must be treated with antibiotics and you will need a diagnosis and prescription from a doctor. Urethritis is not caused by, but is irritated by, sex. The penis moving in and out is pressing the urethra right behind the vaginal wall. During treatment of either partner for urethritis, a condom is recommended and the antibiotic must be taken completely to the end of the prescription. The symptoms may disappear while there is still infection remaining. If this happens, the recurrent infection will have bacteria resistant to the original treatment.
Vaginitis, yeast and thrush are rather imprecise terms. The infection is either bacterial or caused by yeast spores of many types. The most common are candida (often called thrush) which is present in many of us all the time and which is also commonly found in the human mouth. Yes, oral sex is a source of thrush. No need to pass up those delights unless you are chronically infected. Then, it is a good idea to lay off cunnilingus for a while and see if things improve. With vaginitis, there is usually a thick discharge that is strong smelling. It will usually not cause strong smelling urine. The various fungi (yeasts, thrush) are usually held in balance. The vagina is a very delicately balanced ecosystem. The good bugs keep the bad bugs in check. Being placed on oral antibiotics can upset this balance and result in a thrush infection. Yes, treatment of urethritis can cause vaginitis! Not common but it does happen. Doctors will often treat this empirically – that is they will make a good guess and if that does not work, try something else. This is simply because there are so many organisms that could be causing the problem, so we go after the most common and most easily treated first. You are doing the same thing when you use over-the-counter treatments for yourself. The doctor will, however, run some tests to eliminate the terrible stuff – mostly STD’s – whether or not that is what you are told.
Many women cause themselves trouble with douching. And the adverts about “feeling fresh” do not help. Douching upsets the ecosystem and can actually cause yeast to get out of control And you certainly do not want to douche before seeing the doctor – you will be removing exactly what needs to be found. In my view, the only use for douching comes when you have too many dates too close together!
Vaginitis can also be bacterial in origin. Again enterobacteria (they belong in the intestine) can migrate along the perfect path from the anus right into the vagina. Anal sex, even with care, can draw many of these bacteria right onto that path.
When the entire issue of “it itches down there” is studied it is amazing that not more of us are infected at any time. This is a testament to hygiene and most women in the modern world are pretty careful with this. I love bidets and regret their disappearance from most of the world. If I shower at night, the bidet in the morning; or the opposite, but at least twice a day my bottom is thoroughly cleansed.