It itches and burns!!

[Brandye]

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.

[Brandye]

It seems that no one is reading the lead post in this thread but still raising questions on the forums. So let us expand this a bit into an anatomy lesson. Girls, take your pants off, sit on a towel and get a hand mirror. Guys you can follow along on a downloaded diagram of the female genitals if you do not have a friend available to let you look her over.

First, place your right index finger on your pubic bone. It is the solid center of your mound and is located where the pubic hair from the left and right overlaps. Then place your left index finger on your tail bone or coccyx. It is the end of your spine on the back of your pelvis right at the cleft in your butt. It is actually your tail left over from the days when we hominids had tails for practical purposes. We will be describing what lies along that about 10cm line between your index fingers and about a cm (maximum) on either side; what is there, what it does and how it relates to sexual health.

Just below your right index finger is your clitoris under a hood. The clitoris is the center of sexual arousal and satisfaction and it becomes quite erect when excited. The underside of the hood secretes a lubrication substance that allows it to move smoothly over the clitoris. The hood also provides a place for various things to accumulate forming smegma – a mixture of the various secretions along this female track plus skin cells. This is a white cheesy substance that can smell terribly or have nearly no smell. In great accumulation, it can irritate the clitoris and cause discomfort.

Next in progression is the entrance of the urethra. Primarily, this is the exit point for urine from your bladder. On either side of the urethra are the ducts for para-urethral glands known as Skene’s Glands. They are analogous to the prostate in men and recently have been discovered to, in some women, have ducts into the internal urethra itself. They have no known purpose but are believed by many to account for female ejaculation. They drain something into the pudenda.

Next, as we progress is the vaginal entroitus – the entrance to our female innards. The vagina is constantly draining – sometimes lots and sometimes just enough to leave a smell on your panties at the end of the day. Every time you have a romantic thought, secretions appear on your vaginal walls and this lubrication is what is draining. Additionally, this is where the menstrual fluid and other specifically female drainage occurs. This would include the residue from the mucous plug of the cervix (sometimes intact) emerging to put a spot on your pants sometime about the middle of your cycle and once in a great while a tiny egg may be visible. If the egg had been fertilized it would have implanted itself in your uterus to develop into a baby. Each side of the vaginal entrance are other ducts from the Glands of Bartholin. These secrete a thick, waxy substance that used to be thought of a lubrication. It is too thick and there is not enough for lubricating. We now think these glands are other leftovers from evolution and the substance they secrete was a smelly attractant for males when we were fertile.

We then cross the little isthmus of skin known as the perineum which leads to the anus. The anus passes billions of bacteria each day that need to stay out of the little nooks and crannies that are part of the female anatomy.

The entire tract should be, in a non-parous woman, a light and pretty pink. As we age or have children, much of this will darken in colour to a light brown. Nothing in your girl parts should ever be a bright, angry red.

Continued in next post

[Brandye]

So, what are the potential problems and their indicators? The common infections are either bacterial or fungal. First, urethritis results from bacteria getting into your urethra in sufficient numbers to colonize and irritate the lining of the urethra. It burns when you pee and there is often a frequent urge to pee with little coming out. Sometimes, the area immediately around the urethra will be irritated and bright red. SEX DOES NOT CAUSE URETHRITIS! It does irritate the urethral opening and make it seem worse but the cause is the bacteria that have most likely migrated from your anus. Your urine will have a particularly foul smell. We all know what our urine usually smells like, so this is your baseline. Urethritis does require prescription anti-biotics and an appointment will be required.

Bacterial vaginitus is also caused by bacteria. The first indication is a foul smell. I am not talking about a strong “female odour,” but a truly foul smell. At the end of each day or after exercise, we all have a strong female odor and we all recognize this. The bacterial infection gives a different odour that is very characteristic. Fungal vaginitis (thrush, yeast) can also smell bad but not as strong or characteristic as the bacterial. Baterial vaginitis can be treated topically, with creams, or, sometimes, with oral medication as well. Both meds need a prescription and doctor’s visit.

Yeast infections can be treated with over the counter potions usually next to the feminine hygiene products. The first indicators of these infections are itching and burning of the area around the entrance to the vagina. It also exists in the vagina but you cannot feel that because there are no nerve endings in the vagina. Treatment must be internal as well as external but will be a topical application – either OTC or, in worse cases, by prescription. The inner lips will be angry and red – this extends internally when examined with a speculum.

An interesting side bar on yeast infection is that the yeast grows well in the human mouth. One patient had a yeast infection which would recur a few weeks after each “cure.” I finally suggested that her husband use a particular mouthwash twice a day. She turned beet red, which I ignored. At her next annual exam she had had no recurrence and we did not talk about that.

We women have several parts that secrete nutrient filled fluids and a major source of bacteria all located along the few square centimeter area described. Urine and semen are both nutrient rich for bacteria. So your natural urine and your partners semen serve to support and encourage bacteria to set up housekeeping. The result is urethritis or vaginitits.

Women make their vaginitis worse through douching. The vagina, indeed the entire pudenda, is a very delicately balanced ecosystem. There is a balance between the good and the bad. Douching removes all the bacteria and fungus – good and bad. If you douche to remove the smell, for instance, you may be successful in the short term but a day or so later, the infection is worse than in the beginning. The only reason I can think of for douching is that you have too many dates too close together! Then, do not use the commercial douches that have perfumes, dyes and unknown stuff. Mix one part white vinegar to two parts tepid water and flush the one guy out before the next. Better he taste vinegar (he won’t) than your earlier date (he will).

The lips and area described can sometimes become irritated because of an accumulation of smegma. It irritates the clitoris and if not cleansed well can irritate the rest of your specifically female parts.

Bottom line (unintended but good pun) is to keep clean. At least twice a day the area described should be thoroughly cleansed with mild soap. Sera recommends Ivory. OK, I recommend clear liquid soap – preferably not anti-bacterial. The clear soap (shampoo is fine) rinses more easily and avoids the irritation from the soap. The antiseptic or anti-bacterial soap adds some chemicals and does no better at cleansing. Wash well; rinse well. I like bidets but they are not generally available in N. America and are less common than they once were in Europe. In the shower is a natural; washing at a sink makes rinsing more difficult.

If your tissues are an angry red, you smell really bad or it burns and itches see, the doctor and do not cleanse more than a surface wash. The doctor needs a collection of the stuff that is irritating you to determine how to get rid of it. Never douche before a doctor’s appointment. I often diagnose by smell as much culture.

[KMB]

yeah I'm having this kind of problem right now, I'm going to see the doctor tomarrow.

I also havn't had my period since October and my periods have never been normal.

I made a topic on that already in here somewhere.

But I'm glad you explained. My nurse also said Baking Soda and taking a bubble bath may help a little.

boy it smells down there too. Earlier today it started burning and itching really bad.

[sera300]

If you have itching & burning...no "bubble baths"...just see the doc. Baking soda???? NO. Just see the doc...don't screw up the result through changing acidity & PH...Are you certain this was a RN not a secretary????

[KMB]

well I went to the doctors and decided not to take a bath or baking soda because basically I thought the baking soda was a little weird.

I got Yeast Infection

and please don't be too hard on me it makes me nervous.

but I'm doing what the doctor told me and I will be fine.

[sera300]

Originally Posted by KMB

well I went to the doctors and decided not to take a bath or baking soda because basically I thought the baking soda was a little weird.

I got Yeast Infection

and please don't be too hard on me it makes me nervous.

but I'm doing what the doctor told me and I will be fine.

Not being hard on you! I found that to be the strangest thing any office would tell a patient! Glad to hear the outcome...last thing you needed was some bacterial infection too!

[KMB]

ok,

yeah I was thinking Baking soda sounds kind of weird to give someone like that.

My school nurse doesn't know a lot about stuff like I have right now obviously.

[Rouge]

I was wondering (I did read the initial posts )

I've had discharge similar to a yeast infection (cheese like), and my partner says I taste mildly sour. The thought of a yeast infection hadn't crossed my mind as I had NO irritation at all. I went to my soctor to get it checked, and I apparently don't have a yeast infection at all! I was tested for all sorts of things that day, but came back negative for everything. I'm a very clean person, and am not sure what this could be.

What could cause this type of discharge along with a sour taste aside from an infection of some sort?

[Brandye]

What we call discharge is often simply a collection of the dead skin and various fluids naturally produced in the area. The best solution, with no problems found by the doctor, is simply a good cleansing before anyone gets near us down there.