Vaginal Problems

Excessive or Otherwise Abnormal Vaginal Bleeding

Many women experience this problem at some point in their lives. It is defined as bleeding from the vagina that is not part of your monthly periods or bleeding that occurs during monthly periods but is heavier than usual.

Some common causes in women of reproductive age are the birth control pill, which can cause bleeding between periods; problems with hormones produced by the thyroid, ovaries, pituitary, or adrenal glands; infections, such as sexually transmitted diseases, of the vagina, cervix, uterus, fallopian tubes, or ovaries; and miscarriage or problems with pregnancy. A miscarriage of an early pregnancy can resemble a heavy period that occurs after the woman has missed at least one period.

Bleeding between cycles that does not last long is often due to scars, tumors, fibroids, or other abnormal tissue on the cervix or uterus. Ovarian cysts are another possibility. Regular, prolonged, heavy bleeding is often caused by growths in the uterine lining, or endometrium. These growths may or may not be cancerous.

Perimenopausal women may bleed off-cycle as part of the gradual onset of menopause. Postmenopausal women should see a doctor immediately if they experience vaginal bleeding since benign or cancerous tumors of the ovaries or uterus are more likely causes.

Other potential culprits are injury to the vagina or reproductive tract during rape or surgery, and the presence of objects such as a tampon stuck in the vagina. Bleeding disorders that affect the whole body, such as leukemia and clotting problems, can cause abnormal vaginal bleeding just as they produce bleeding elsewhere. Vaginal bleeding along with fever, abdominal pain, or unusual mucus or other substances coming from the vagina (known as vaginal discharge) may indicate an infection.

UNWANTED PASSAGEWAYS

Fistulas—abnormal passages between organs—are usually the result of injuries sustained in accidents, childbirth, or surgery. These unwanted openings can divert urine into the vagina from the bladder or the urethra (the tube that normally empties the bladder), causing vaginal discharge. They can also develop between the rectum and the vagina. The only remedy is surgery to close the passage.

Your doctor is likely to ask you about your recent menstrual periods and if you've noticed anything unusual about them. You will probably have an abdominal and pelvic exam and, if you are of reproductive age, your doctor will also do a pregnancy test.

Vaginal Discharge

Unusual mucus or other substances coming from the vagina is a common problem. The discharge is often due to infection, and frequently associated with pain, burning, itching, and painful urination. Not all infections are sexually transmitted, so don't assume that vaginal discharge means that you have an STD. There are a number of possible causes:

Inflammation of the vagina. Called vaginitis, this is the most common reason for discharges and is usually caused by infection. There are three main types of vaginal infections, all of which can be treated with oral or vaginal medications. Each infection tends to produce a distinct discharge:

• Thick, white cottage cheese-like discharge, itching, irritated skin—yeast infection, or candidiasis. Women with diabetes and those taking antibiotics are more likely to develop this type of infection. Most women will have at least one yeast infection at some point in their lives.
• Thin, yellow, foul-smelling discharge—Trichomonas, which is usually transmitted sexually.
• Thin, gray or white, foul-smelling discharge—bacterial vaginosis.

Pelvic inflammatory disease (PID). Frequently caused by STDs that infect the cervix, uterus, ovaries, or fallopian tubes, this is the most common and serious complication of an STD and occurs in 1 million women every year. Symptoms include vaginal discharge or bleeding, lower abdominal pain, and fever. Chronic PID can result from one or more infections. The most common identifiable causes are gonorrhea or chlamydia, both of which are sexually transmitted. About 20 percent of women with PID become infertile.

Genital herpes. This infection can produce vaginal discharge if it affects the cervix. The first episode of genital herpes also features fever, itching, headache, and general muscle aches.

Infection of the inside of the uterus. This condition, known as endometritis, is usually caused by STDs, fibroid tumors, cancer, giving birth, or intrauterine devices (IUDs).

A hole in the vagina (connecting the vagina to the rectum or bladder). Because of this passageway, called a fistula, stool or urine can pass through the vagina. The problem can develop after surgery or injury to the area, infection, inflammation, or radiation.

Inflammation of the vagina due to lack of estrogen. As a woman enters menopause, her body produces increasingly erratic amounts of estrogen. This often causes the vagina to dry out and become irritated. The condition is known as atrophic vaginitis and is treatable by estrogen replacement therapy, vaginal creams, and vaginal suppositories.

Other, less common causes of vaginal discharge include pregnancy, genital warts, cancer, and foreign objects in the vagina, such as a tampon that could not be removed.

Your doctor will ask you about the type of discharge and whether it occurs immediately before, after, or during menstruation or sexual activity. You should also expect to undergo a pelvic exam.

A DANGEROUS — AND GROWING — PROBLEM

Cases of genital warts, caused by the sexually transmitted human papillomavirus (HPV), have been increasing at twice the rate of the more widely publicized genital herpes. And these warts can be much more than a minor annoyance: They've been implicated in several types of genital cancer. Following infection, the warts can take up to 6 months to make their appearance. First seen as small, soft, moist, pink or red swellings, the warts then grow rapidly, often developing stems and clustering together to form a cauliflower-like growth. Standard wart medications will sometimes clear up the infection. Frequently, however, the growths must be burned off or surgically removed. For more information on this increasingly common problem, turn to chapter 11, “Coming to Terms with Sexually Transmitted Diseases.”

Genital Warts

Human papillomavirus (HPV), a sexually transmitted disease, is a frequent cause of genital warts. It can also cause outbreaks in the vulva, vagina, cervix, or anal area and is sometimes accompanied by other infections and STDs. HPV is also believed to be a factor in causing cancer of the cervix, vagina, and vulva. About 50 percent to 70 percent of the sexual partners of women with HPV have, or will develop, genital warts.

If you have had several episodes of yeast infection, you should consider being tested for HPV, as HPV may make a woman more vulnerable to this problem. Gonorrhea, chlamydia, and syphilis can accompany genital warts.

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