Introduction

Normal vaginal secretions keep the vagina moist and help to protect against damage or infection. It is usual for people with vaginas (PWV) to have a variable amount of vaginal discharge that is white or clear. This can increase or decrease at certain times depending on your monthly cycle, whether you are pregnant, or if you are sexually aroused or 'turned on'.

Some things, however, can disrupt this normal, healthy balance. Common causes of irritation include antibiotics, clothing, over-washing, or the use of strong soaps, fabric softeners, shower gels or vaginal deodorants. Irritation and any change in vaginal discharge could mean that something is not right. These changes may be:

- more discharge than usual

- an unpleasant smell, often worse after sex

- a change in the colour of discharge

- sore, itchy skin around the genital area

- discomfort when passing urine

- a rash or tiny cuts in the genital area

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What infection can the vagina get?

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PWV can get a number of different vaginal infections. Two of the most common are called thrush (candidiasis), and bacterial vaginosis (BV) -- these infections are not sexually transmitted. If you notice any of the symptoms mentioned in this leaflet, visit your local GP surgery or pharmacy for help and advice. Sexually transmitted infections, such as chlamydia and trichomonas vaginalis

(TV or 'trichs'), can also cause a heavier discharge than usual so it is important to get any change in discharge checked out if you think you might have a sexually transmitted infection (STI).

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Thrush

Thrush is a very common infection. It is caused by yeast, known as candida, which usually lives harmlessly on the skin and in the mouth, gut and vagina. It doesn't usually cause any problems but, under certain conditions, the yeast multiplies in the vagina and causes a number of uncomfortable symptoms. Thrush is not usually transmitted sexually but having sex can irritate the vagina and make the symptoms more obvious. Most PWV will have an episode of thrush at least once in their lifetime. Other factors that can encourage candida to multiply and result in thrush include:

• taking antibiotics (some women develop thrush after taking antibiotics and other medication for another illness)
• using a vaginal deodorant or perfumed bubble bath
• using perfumed fabric softener
• using baby/alcohol wipes on the
• genital skin
• broken skin which is inflamed and irritated
• wearing nylon underwear or tight-fitting trousers (a moist, warm environment helps the yeast to flourish)
• pregnancy
• diabetes.

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Symptoms of Thrush:

• You may notice:
• itching, soreness and swelling around the genital area
• a thick, white discharge
• burning discomfort during sex
• pain when peeing.
• If you think that you may have thrush, speak to your doctor, nurse or pharmacist who can offer treatment on the basis of your symptoms. Testing is not always necessary.

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How to prevent thrush:

• Avoid wearing tights, nylon underwear or tight trousers or jeans.
• Avoid using perfumed soaps or bubble bath, vaginal deodorants and disinfectants.
• Stop using a perfumed fabric softener when washing towels and underwear.
• Consider washing with a soap substitute --- your pharmacist can advise what is best for you.
• Avoid using alcohol/baby wipes on your genital skin.
• After going to the toilet, always wipe from the front to the back to avoid transferring germs to the vagina.
• If you develop thrush when you use antibiotics, it may be worth asking your doctor to prescribe treatment for thrush at the same time.

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Treatment:

Treatment for thrush is usually simple. A cream can be applied to the affected area to relieve the itching and soreness, and women may be given special tablets (known as 'pessaries') to insert directly into the vagina. You might also be given

a tablet to take by mouth. Some creams that are used for the treatment of thrush can weaken latex condoms, contraceptive diaphragms and caps. You will not pass thrush on to a partner if you have sex when you have an episode, but sex may be uncomfortable, so you may want to avoid it for a few days.

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Bacterial Vaginosis

Bacterial vaginosis occurs when bacteria that normally live in the vagina multiply and cause symptoms. This may be triggered by using perfumed bubble bath or soap, vaginal deodorants, a strong detergent or fabric softener for washing clothes, underwear or towels, or smoking. The exact cause is, however, unknown. Although BV is not sexually transmitted, having sex can cause BV to develop because the semen in the vagina may alter the acid level which helps the bacteria to multiply and cause symptoms. People with penises can't catch BV.

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What are the symptoms:

Often there aren't any symptoms. You may notice a change in the normal discharge from the vagina. This discharge could be white, heavier than usual, and have a fishy smell which can be more noticeable during and after sex, and during periods.

Treatment for BV is usually simple. There are a number of different types of antibiotics available --- a cream to use in the vagina may also be given. A non-antibiotic gel can also be bought from your pharmacist.

Some creams can weaken latex condoms, diaphragms and other forms of contraception. Ask the person giving you the cream if this applies to your treatment. They will give you advice about other forms of contraception that may be available and suitable for you to use when you are being treated.

Always tell the doctor or nurse if you are pregnant or think you might be, or if you are breastfeeding. This may also affect the type of treatment you are given.

Female partners do not need treatment unless they also have symptoms. Partners with penises do not need to be treated.

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