RAISING A DAUGHTER
V- PROBLEMS YOU NEED TO KNOW ABOUT
Vulvas and vaginas can be affected by a number of health conditions; some of these produce noticeable symptoms and others do not. Although we’ve mentioned most of these conditions, we want to briefly highlight them here (for more detailed information about vulvovaginal health and medical conditions, we recommend checking out The V Book and, of course, speaking with your healthcare provider).1
Although yeast, or candida albicans (the scientific name for a common type of yeast), are normally found even in healthy vaginas, over-growth of yeast can cause uncomfortable or even painful symptoms for women. As we mentioned earlier, if you suspect you have a yeast infection, we recommend checking in with a healthcare provider by telephone or in person for advice before treating yourself with over-the-counter medications, which can sometimes cause more harm than good.
Bacterial infections and imbalances of the vagina are common reasons why women visit their healthcare providers. Most are easily treatable. However, bacterial vaginosis (BV)—a condition in which the normal, healthy balance of the vagina is disrupted and certain bacteria seem to overgrow—is one condition
that remains a challenge for many women, their partners, and their healthcare providers. Although some women who have BV are easily treated and never seem to experience a recurrence of their symptoms, other women have recurrent episodes of BV. Common symptoms of BV include itching, pain, burning, vaginal discharge, and genital odor (sometimes the odor is strongest after intercourse). According to the Centers for Disease Control and Prevention (CDC), BV is the most common vaginal infection among women who are of childbearing age.16 Women who struggle with recurrent BV may be best helped by meeting with a vulvovaginal specialist who focuses on infections like BV (find one through issvd.org).
Genital warts are caused by certain strains of the human papillomavirus (HPV). They are usually small and painless. Some healthcare providers recommend a “wait and see” approach to genital warts, as they often do not cause discomfort and frequently go away on their own. Other times, treatment (which can include the use of a topical cream) is recommended. If you have been diagnosed with genital warts, ask your healthcare provider for his or her recommendation. As part of monthly vulvar self-examination, check on the status of your warts: if they increase in number or size, bring this to the attention of your healthcare provider. Don’t be afraid to ask your healthcare provider for their thoughts on biopsying the warts to make sure they are indeed warts and not something else. Also, Gardasil (an HPV vaccine) protects against two strains that cause many cases of genital warts.
Genital herpes is caused by the herpes simplex virus and, like HPV, can be passed on during oral sex, vaginal sex, or anal sex. Genital herpes lesions can be very painful, perhaps particularly during the initial outbreak. Fortunately, antiviral medications are available that can reduce the frequency and severity of outbreaks.
Vulvodynia is a term that, according to the National Vulvodynia Association, refers to “chronic vulvar pain without an identifiable cause.”
Women may experience pain that’s limited to the vulvar vestibule, which is the area around the vaginal opening. This type has been called vulvar vestibulitis syndrome or localized or provoked vulvodynia. A second type is called generalized vulvodynia and refers to pain at other parts of the vulva, such as the clitoris, labia, and/or vestibule. Women with vulvodynia may experience nearly constant pain or sporadic pain. Other conditions such as allergies, STIs, and genital skin disorders typically need to be ruled out before a diagnosis of vulvodynia is given. Unfortunately, women with vulvodynia often see a number of healthcare providers before receiving a diagnosis.
My experiences with vulvar vestibulitis have really influenced my feelings towards my genitals. I could either choose to be ashamed about this and feel bad about myself for not enjoying vaginal penetration, or I can accept that’s how my genitals are and work with alternative forms of sexual expression while working on exercises to help me relax my vestibule muscles (such as biofeedback).
—ALANA, 22, Indiana There are also a number of skin disorders that can affect a woman’s genitals.
One of these is a condition called lichen sclerosus (LS), which can affect women (and men) of all ages and can also affect nongenital skin. Women with LS often have white areas of skin on their genitals and may experience genital itching. With treatment (which often consists of topical creams), LS symptoms can often be managed. If a woman does not receive treatment, her vulvar skin may become more fragile and easily torn, and vaginal penetration and intercourse may become uncomfortable or painful.
Although not a v-problem per se, being hypersensitive or allergic to semen can certainly affect women’s vulvas and vaginas (as well as have other health effects). If you experience genital irritation, burning, itching, or pain following unprotected intercourse with a man, or other forms of contact with his semen, try having sex with a condom the next time. If you don’t have similar reactions, you might want to ask your healthcare provider about the possibility that you have a seminal allergy or sensitivity. Although rare, some women have severe allergic reactions to semen. Certainly, if you notice any health concerns during or after sex with a partner (such as difficulty swallowing or breathing, or breaking out in hives) seek emergency medical care. This is a relatively new area of research, so semen allergies are not well understood. Some women appear to be allergic to the semen of any man they have sex with; others seem to be allergic to the semen of only a particular man. Still, other women who have never experienced any reactions to men’s semen suddenly develop sensitivities or allergies following a hormonal change, such as giving birth or going through menopause.
Finally, although rare, it is possible for women to develop cancer on their genitals. Early signs of vulvar cancer (spelled “vulval cancer” in the United Kingdom and Australia, among other countries) can include chronic itching as well as lumps or bumps on the genitals. This is challenging, as many non- cancerous conditions have similar symptoms. With early detection and treatment, vulvar cancer has a high survival rate. Performing vulvar self- examination can aid in the early detection of vulvar cancer and other conditions, such as vulvar intraepithelial neoplasia (VIN, considered a pre-cancerous condition of the vulva). Both vulvar cancer and VIN are linked to HPV. Cigarette
smoking also appears to increase the risk of vulvar cancer and VIN. Although vulvar cancer and VIN used to be more often considered conditions of older women, an increasing number of young women have been diagnosed with vulvar cancer and VIN over the past decade.