Vaginal Infections: Causes, Treatments, and Prevention Tips

Vaginal infection issues

Hello Doctor, I am 45 years old and have undergone a liver transplant.
Previously, I experienced vaginal infections about once a year, but I haven't had any in the last two years.
However, since last year, I have had four episodes of vaginal infections, and one more in January of this year.
I am unsure if this is related to the pandemic, as I make sure to shower every time I come home, sometimes three times a day.

1.
Doctor, could my excessive cleaning be the reason for my frequent vaginal infections last year?
2.
I had four vaginal infections last year and took antibiotics twice.
In January, I was prescribed a suppository and antibiotics again after testing positive for E.
coli and yeast.
Could this be related to my recent practice of wiping after bowel movements with toilet paper and then washing my buttocks with body wash?
3.
After completing the suppository and antibiotics in January, I still felt discomfort, so I went back to the doctor.
The doctor said my vagina looked normal, but my vulva appeared drier, and recommended a hyaluronic acid lubricant.
However, I have occasionally experienced itching until after the Lunar New Year in February.
Last week, while straining during a bowel movement, I noticed a discharge from my vagina that was clear and milky.
I visited the doctor again last Friday, and he said it looked inflamed but not severe.
He mentioned that my ongoing use of medications and suppositories might have led to antibiotic resistance and advised me to soak in warm water.
I have continued to notice milky discharge, but it only occurs when I strain during bowel movements, and I still experience occasional itching.
Today, I noticed more discharge when straining; should I be concerned that this is worsening?
4.
I wash my underwear by hand and use a hairdryer to dry them before wearing.
After showering, I lightly pat my vulva with toilet paper and then use a hairdryer to dry it.
Is this acceptable?
5.
Due to work, I shower twice a day, and I only wash my vulva with body wash during bowel movements, rinsing with water afterward.
Why have I been experiencing recurrent infections lately? It's quite frustrating.

6.
I purchased a feminine wash specifically for the vulva; is it okay to use it once a day?
7.
Will soaking in warm water really help with the inflammation?

Wenwen, 40~49 year old female. Ask Date: 2022/02/21

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
You have undergone a liver transplant and require long-term immunosuppressive medication, which makes you susceptible to infections.
2.
"Vaginal infections" can cause abnormal discharge, perineal itching, unpleasant odor, burning sensation during urination, increased frequency of urination, and bleeding.
In more severe cases, it may lead to abdominal pain or fever.
The "treatment approach" varies depending on the symptoms and requires proper health education.
It is recommended to visit an outpatient clinic for examination and evaluation by a specialist in obstetrics and gynecology.

Reply Date: 2022/02/21

More Info

Understanding vaginal infections, particularly in the context of your medical history and current symptoms, is crucial for effective management and prevention. Given your background of liver transplantation and recurrent vaginal infections, it is essential to approach this matter with a comprehensive understanding of potential causes, treatments, and preventive measures.

1. Over-Cleansing and Vaginal Health: Over-cleaning the vaginal area can indeed disrupt the natural flora. The vagina has a delicate balance of bacteria, primarily Lactobacillus, which helps maintain a healthy environment. Excessive washing, especially with soaps or cleansers that are not pH-balanced, can lead to irritation and a decrease in beneficial bacteria, making it easier for infections to occur. It is generally recommended to wash the external genital area with mild soap and water, avoiding douching or using harsh soaps.

2. Antibiotic Use and Resistance: The use of antibiotics can lead to a disruption of the normal vaginal flora, potentially resulting in yeast infections or bacterial vaginosis. If you have been treated multiple times with antibiotics, it is possible that you are experiencing a cycle of infections due to antibiotic resistance or an imbalance in your vaginal flora. It is important to discuss with your healthcare provider the possibility of using probiotics or antifungal treatments alongside antibiotics to help restore balance.

3. Symptoms and Discharge: The presence of clear or white discharge, especially after straining during bowel movements, may indicate a few things. It could be normal vaginal secretions, but if accompanied by itching or irritation, it may suggest an ongoing infection or inflammation. If your doctor has assessed that your vagina appears normal but you still experience symptoms, it might be worth exploring other underlying issues, such as pelvic floor dysfunction or irritation from hygiene products.

4. Hygiene Practices: Washing your underwear by hand and ensuring they are thoroughly dried before wearing is a good practice. However, using a blow dryer on your external genital area may not be necessary and could potentially cause irritation if the heat is too high. Instead, air drying or using a clean towel is usually sufficient.
5. Frequent Washing and Infection: Washing twice a day can be appropriate, but it is crucial to ensure that you are not using harsh soaps or cleansers that could irritate the area. If you are experiencing recurrent infections, consider discussing with your healthcare provider whether your washing routine could be contributing to the problem.
6. Use of Feminine Washes: While some women find that using a specialized feminine wash helps them feel cleaner, it is essential to choose products that are free from fragrances and harsh chemicals. Using such products once a day is generally acceptable, but they should not replace regular washing with water.

7. Sitz Baths: Warm sitz baths can be soothing and may help alleviate symptoms of inflammation. They can promote blood flow to the area and provide relief from discomfort. However, they should be used in conjunction with other treatments as advised by your healthcare provider.

In conclusion, recurrent vaginal infections can be multifactorial, especially in individuals with a history of significant medical conditions like liver transplantation. It is vital to maintain a balance in hygiene practices, consider the impact of medications on your vaginal flora, and communicate openly with your healthcare provider about your symptoms and treatment options. Regular follow-ups and possibly consulting a specialist in infectious diseases or a gynecologist may provide further insights and tailored treatment plans to manage your condition effectively.

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