Get Well Wednesday: What's Up 'Down There'

Dr. Afriye Amerson has been in private practice for fourteen years. In 2001, after completing her residency, she joined a group practice which had been in existence for over fifty years in Bergen County, New Jersey. She became a partner in the practice and built an ever-growing patient base for the next nine years. Dr. Amerson launched a solo practice in January 2010.

By 2011, Dr. Amerson coined the term “Platinum Families” to embrace and celebrate those families into which she delivered over three children. Although her eldest patient recently turned 101 years old, she serves a broad and diverse age and ethnic diaspora of women.

Dr. Amerson is an active advocate of women’s health. She has spoken at many schools, after-school programs, churches, health fairs and events on topics from women’s health, maternity, sexual education to community health improvement and self-esteem building. She was a featured speaker for the Essence Magazine’s ‘Women Changing the World Leadership Summit’ in 2008. She

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has been a featured expert on many television and radio shows, including an Emmy award-winning story on postpartum depression. Dr. Amerson educates all of her patient families and is a community leader in Cord Blood banking. She was honored by the NJ State blood bank for this leadership.

What normal vaginal discharge should look and smell like: 

So, to begin with the proper foundation of understanding: all openings in the human body (except the urethra & anus) produce some protective fluid or mucous.  We have control over the muscles affecting urination and defecation, so that these “openings” are not actually “open” until we voluntarily relax these muscles.  It is this muscular control which protects from bacteria and other things foreign to the human body.

As for all other openings – our eyes produce “sleep”, which is a fluid that dries into mucous; our nose produces mucous; our ears produce wax; our mouth produces saliva; the vagina does produce a normal discharge after menstruation beginning at puberty.  Prepubertal girls have a female reproductive system which is inactive, and their vaginas are closed.  In this age group, any and all discharge is concerning and should be evaluated by a health care professional.  At puberty, our female reproductive system “awakens” (regardless of becoming sexually active or not) and we begin the constant production of female hormones.

These hormones change the vagina’s texture, elasticity, and moisture in preparation for sexual activity and childbearing.  The production of a noticeable discharge varies amongst individual women.  Therefore, the first principle of becoming a woman is know thyself.  Some women have some discharge daily. Others will notice discharge only at certain times in their monthly cycle, while others may never have noticeable discharge (although it is present in the vagina & could be observed in a pelvic examination).

Normal discharge has no odor or irritation. The color is white to eggshell, and when dry it may flake (in panties or pubic hair, for example). Symptoms which can be concerning include any change from normal for an individual woman, swelling or redness of the outside vulva, itching or burning of the vulva or vagina, greenish/bubbly discharge, odor (most commonly “fish-like”), painful/overly sensitive outside vulva, and very heavy discharge.

It is important to note here that women will most commonly have no symptoms of sexually transmitted disease. Most of our symptoms of infection are related to changes in the vagina’s normal pH balance.  Many things trigger these changes, including hygiene (which must change after puberty), sexual activity, dietary habit, medications, illness (such as diabetes), hormonal change and changes of metabolism.

If a woman is uncertain about whether her vaginal discharge is normal, she should schedule an appointment with her health care provider and have her personal information (about the regularity of her menses, recent sexual activity, use of products to clean her body & clothing, new or recent medications, and change in diet) written down and ready for discussion.

How to maintain good vaginal health:

Take probiotics daily or regularly (these healthy bacteria promote good health while preventing harmful bacterial growth in the vagina and digestive system). I suggest a chewable form of acidophilus. Yogurt contains probiotics as well.

Wipe from front to back always when using the toilet to prevent bringing bacteria near the anus towards the vagina and urethra.

Use protective covering on publicly used or unfamiliar toilets. While sexually transmitted diseases (STD) are categorized as such because they require “body heat” to be transmitted, many other infections can be transmitted to exposed genitalia.

When it comes to bodies of water & vaginal infection, it depends! Chlorinated pools and the ocean are safe. Hot tubs are generally safe unless you have cuts/scratches/open wounds of genital skin, immune compromise (due to illness or simply “you are sick”).

Women in menopause can be vulnerable because they have stopped making the hormones that cause protective discharge, yet the vagina does not reclose (to its prepubertal state).  Do not swim in rivers or lakes because they can accumulate the bacteria that may trigger infection.

Do not place food or fragrance in your vagina for any reason. This includes vaginal douches with fragrance. While occasional (not more than monthly) douching is okay, women should only use natural products (i.e. baking soda or vinegar) with water. While this is a common West Indian culture passed on through generations for good vaginal health, women unfamiliar with douching should not make their own, but rather purchase it pre-prepared to avoid the irritation of use of too much of the natural products.

Develop a consistent habit of condom use with sexual activity. Many generations of women were allowed to develop the belief that monogamy protects us from STD, we now know better. Nine out of ten adults have been exposed to HPV.  There are enough different types to be infected with a new one every time you have a new partner.  The vaccine does not protect against them all. Women have no symptoms of chlamydia or gonorrhea.

And, semen itself (which has a pH that is very different from that of the vagina) can trigger the development of a non-sexually transmitted infection. I am very sad to report that, as a practicing gynecologist, I have noted that married women are more likely to use condoms than single women.

This is because many single women are using other forms of birth control; so, they mistakenly believe themselves to be “covered.”  False! The prevention of unintended pregnancy and the prevention of infection are two entirely different things.

Do not “hold it” when you have to urinate. Bladder infection is  more common amongst women than men. Cranberry juice and drinking (at least 1 liter) water daily both help to prevent bladder infection.  A healthy bladder & a healthy vagina are very closely linked; and women often cannot distinguish which is the source of irritation “down there.”

Health care providers can send cultures, of the vagina and of the urine to detect infections that may not be immediately apparent. You can request that this be done during your visit.

All sexually active women should be regularly tested for STD as a part of their preventive women’s health care.

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