Antibiotics & the vagina

Urinary tract infections (UTIs) are common in women and easily treated with (oral) antibiotics, which kill the responsible organism (the ‘bad’ bacteria).  Some women will need more than one course of antibiotics to eradicate the infection; some women will experience recurring UTIs and will need antibiotics every few weeks.

Unfortunately, being non-discriminating, the antibiotics also kill the ‘good’ bacteria – the many protective organisms that live in our gut and the vagina.  Now you can understand the intestinal cramps/diarrhea and the never-welcomed vaginal yeast infection that are commonly associated with taking (oral) antibiotics

The typical result: a vagina that is dry, itchy, and less elastic = more sensitive to stretching and to chafing irritation.  This unfortunate outcome can easily spin out of control and lead to diagnoses such as vulvodynia/vulvar vestibulitis, vaginismus, and dyspareunia.

So, if you develop these conditions after taking antibiotics for a UTI or any other infection, consult with your physician and mention this association.  Your vagina will need restorative care to bring it back to good functioning status.

What’s Dry Sex?

Today’s use of the term ‘dry sex’ refers to rubbing on the partner, also called ‘humping’ – a common sexual practice.

But, did you know that the term has historical roots in the sub-Saharan countries of Africa, where women dry up their vagina of secretions so as to enhance his pleasure? Ouch…

To quote a current article in the South African Journal of Science (read it by clicking here), “The practice of wiping, douching, or inserting substances into the vagina is reportedly common in sub-Saharan Africa.  Intercourse following such vaginal treatment is referred to as ‘dry sex.’  The most common reason offered by women for these practices include the enhancement of sexual experience through sensations of vaginal dryness, tightness or  warming; cleansing of the vagina before or after intercourse; treatment or prevention of STI;  restoration and tightening of the vagina after delivery; or the satisfaction of a partner.  Although the evidence in the literature is inconclusive, it has been suggested that ‘dry sex’ may increas the risk of HIV infection  among women through the sloughing of the vaginal wall during sex, or possible inflammation, ulceration or epithelial damage caused by the insertion of substances in the vagina.”

A Medscape article, Understanding the Scourge of HIV/AIDS in Sub-Saharan Africa , describes, “The main purpose of dry sex is to increase friction during intercourse, enhancing the male’s experience. These practices are destructive and costly in terms of women’s health. The destruction of the vagina’s natural flora facilitates the proliferation of other potentially harmful microorganisms. The lack of lubrication results in lacerations of the epithelial lining of the vagina, creating a portal for HIV entry. In addition, condoms break easily due to the increased friction, exposing woman to sexually transmitted diseases (STDs). In a study of 329 women ages 15-50 attending an STD clinic in Lusaka, Sandala found that 50% of the women had engaged in at least 1 dry sex practice, and about 58% of those women were HIV-positive. The most common methods of dry sex were drinking “porridge,” a suspension believed to cause drying of the vagina (28%); removing vaginal secretions with a cloth (22%); and placing caustic leaves in the vagina (11%).”

It was recently that we blogged about the need for women to protect their (vaginal/sexual) health – Why Suffer in Silence – and here we have another opportunity to reflect on the topic again.

Treat during period?

“I got my period and I need to cancel my appointment…”

Why? Typical replies:

• Because it is gross…
• Because it is messy…
• Because I can’t look at blood…
• Because I am too painful/crampy…
• Because I thought it is the right thing to do…

True, you would reschedule a routine gynecologic exam so that the Pap test can be done when you are not menstruating.  Otherwise, unless you are physically disabled by your period, there is no reason not to keep your appointment.

Conclusion: the vagina works 24/7/365, and bloody discharge does not bother the clinician!

Why suffer in silence?

The body is built for intercourse and women are typically able to handle it just fine.  Still, why do so many women suffer in silence during (painful, unwanted) intercourse, instead of speaking up?

• Is this an inherent trait in women?
• Is the partner at fault?
• Is society to be blamed? Or culture? Religion?

Apparently, the causes are deeply rooted in the woman’s psyche and include

1. The sense of “I do not deserve any better…”
2. The feeling of “I am the only one who is struggling so I may as well just keep quiet…”
3. The fear of “Partner will leave me if I speak up… I do not want to be alone…”
4. A statement like “In my culture women submit, quietly; speaking up will have negative repercussions…”
5. Some religions where women are expected to be subservient to the husband’s sexual wants regardless of their own feelings.
6. The woman’s inability to say NO, to speak up her preferences!

Regardless of the reason, this suffering will typically lead to a deepening sense of victimization and/or to developing vaginismus.  After all, it is against human nature to be made helpless, hopeless, forced-upon.

Important: the vagina is a hostess to the penis! Its owner – the woman – determines if to invite the penis in, how long it can stay in, and when it is time to leave.  Have you ever thought of that in such terms?  And, did you realize that the thrusting during intercourse is a rapid, powerful physical action inside the vagina, easily felt throughout the woman’s pelvis and body?  Ouch.

Unfortunately, many women will continue to suffer in silence. We hope and pray that enlightenment will come about sooner than later.

About stirrups

During gynecologic exam, the woman is asked to slide down to the edge of the examination table for best visualization of the area and to accommodate the use of the speculum.  This position is medically known as the dorsal lithotomy position.

Stirrups were invented by Bert H Simpson in 1908 and patented in March 1909 – only 100 years ago.  See photo below.

Many women would rather not use stirrups because they cause them embarrassment and much distress.  Are they mandatory?

Apparently not: a 2006 study suggests an alternative to discuss with your doctor: keeping feet on bed.  The study is worth reading.

Vagina, sterile?

Women often believe that their vagina is a sterile environment and that special cleaning methods are needed to keep it as such.  If it were true, then men should have sterilized their penises before penetration, right?

Fact: the vagina is not at all sterile but rather a a host to many type of bacteria, all composing the vaginal flora that promotes vaginal health.

According to Ann S Botasch MD, the composition of vaginal flora changes with age, stress, hormonal influence, general health status, and sexual activity, and disruption of this balance will lead to breakdowns such as irritation, infection, bleeding, etc.

So, ladies — make sure whatever ‘visits’ the vagina is clean and that you keep a balanced vaginal flora, but do not worry about the vagina being sterile.

Voiding & sex

Many years ago it was believed that voiding (urinating) before and after having intercourse will guard against developing a urinary tract infection (UTI) , sending women running in and out of bathrooms in a frantic pace.

But was it urine in the system that caused the infection, or the penis’ rubbing/chafing the underside of the urethra (urine tube)?

Everything that is inserted into the vagina will slide against the underside of the urethra = an anatomical fact.   In some cases, this natural rubbing will cause irritation that may develop into a urinary tract infection, but it has nothing to do with urine that is housed in the bladder!

The most current medical research about this very topic (Recurrent urinary tract infection in women) states the following:

• Many factors thought to predispose to recurrent UTI in women, such as pre- and post-coital voiding patterns, frequency of urination, wiping patterns, and douching have not been proven to be risk factors for UTI.
• Strategies to prevent recurrent UTI in young women should include education about the association of recurrent UTI with frequency of sexual intercourse and the usage of spermicide-containing products.

Ladies, enjoy your sexual intimacy and save the running to the bathroom for when your bladder is full.

Anxious gyno exam

The reflexive reaction during gynecologic exam is to tighten up the pelvic floor (PC muscles) as the clinician is about to ‘go in.’

The physical fact is that the more you tighten up, the more discomfort you will feel.

So, what is the trick?  Minimizing this reflexive reaction.

As you lie there, feet in stirrups, genitals ‘airing out,’ focus not on the exam (it is not your job anyway) but rather on ‘butt down, legs open, vagina welcoming penetration…’  Keep your breathing at meditation rate – no hyperventilation – and keep telling yourself to just ‘whatever it.’  If you can do that, the exam will be quick and easy.

If you and your vagina are on anxious terms, such as with vaginismus, do your best.  If the exam is not doable, seek treatment and then come back as a WINNER!