In the Media

It’s time for a ‘vagina dialogue’ with your doctor

by Marge C. Enriquez, Philippine Daily Inquirer, April 24, 2018

Discussing female reproductive health or a “vagina dialogue” between a patient and her doctor is one of the most vital yet neglected areas of maintaining well-being. Aesthetic gynecologist and feminine wellness advocate Annebelle Aherrera has been educating women on the importance of vaginal health.

She explains that women should be familiar with the female reproductive system which consists of the uterus, ovaries, cervix and fallopian tubes.

“This intimate part is the expression of one’s femininity. It ensures a woman of her reproductive capacity, from childhood to childbearing years,” she says.

It starts with knowing the vagina, the muscular tube that runs from the vaginal opening to the cervix. Serving as an outflow track, it is the organ where blood from menstruation is discharged, the opening for child delivery and the means of excretion of urine.

“There is life and activity in the vagina, this closed narrow muscular tube that runs from the vaginal opening to the area of the cervix or opening of the womb. It is equipped with a dynamic ecosystem that allows the secretion of small amounts of discharge to keep itself fresh, like a self-cleaning machine.”

A healthy vagina is dependent on a more acidic pH, which runs between 3.8 and 4.3, Dr. Aherrera says. It is rich in naturally occurring good bacteria, particularly lactobacilli, that helps maintain the normal pH level and fend off infections and growth of other organisms.

She underscores that the pH of the vagina changes through the course of a woman’s lifetime, from youth and childhood to reproductive and menopausal years. It is dependent not only on the lactobacilli but on female hormones, particularly estrogen.

“Estrogen moistens the vaginal cells and ensures its role as a food substrate for lactobacilli to feed on, resulting in the production of lactic acid. The more lactobacilli are present, and feed on these cells, the more lactic acid is produced. Therefore, this maintains the acidic pH. Any disruption in this ecosystem may result in inflammation, vaginal infection and vaginal dryness,” she says.

Frequent complaint

Dr. Aherrera reports that vaginal discharge is the most frequent complaint from her patients, regardless of age. For menstruating women, the prodigious use of pantyliners has been contributory to causing vaginal irritation and infections.

“Ideally, it is recommended to use pantyliners during the ‘light’ days—when menstrual flow has significantly decreased. However, to use it as a daily wear may result in skin discoloration, marked dryness and inflammation. Prolonged use may lead to chronic itchiness and recurrent infections.

“Women do not realize that these pantyliners keep the vulvovaginal (external) area moist, allowing spread of any discharge coming from the anus into the vaginal area. Furthermore, it creates an environment that is less acidic and therefore disrupts the ecosystem of the vagina. The best advice for women who perennially wear pants, stockings and liners is to keep the intimate area well ventilated,” she says.

When frequent users of panty liners complain of vaginal discharge, she advises them to change their underwear more frequently instead. The most important thing is to address the causes of discharge, which vary according to the conditions.

“If it presents as a fetid foul-smelling discharge, even without the benefit of laboratory tests, it could be due to lack of the naturally occurring ‘good’ bacteria. The curd-like, milky, itchy discharge is more of a yeast infection,” she says. Yellowish and greenish discharges could mean some form of other bacteria or sexually transmitted infection.

To determine the type of vaginal infection, a gram stain and culture of the vaginal discharge are important laboratory tests. In cases of recurrent vaginal infection, probiotic lactobacilli vaginal tablets are a mainstay.

Women in different stages of life come to the gynecologist for different concerns. Dr. Aherrera quotes 2017 Philippine statistics, saying that the female population from 0 to 65 years and above comprise nearly 50 percent of Filipino women. They are broken down into age groups:

0-14, comprising about 17 million women (16.4 percent). These are infants, young girls, tweeners and pre- and post-pubescent girls. Mothers, educators and health personnel have important roles in their growth and development.

15-24, comprising about 10 million (9.4 percent) These are the teenagers, young adults including college graduates with active hormones.

25-54, comprising about 20 million (18.4 percent) These are childbearing women, housewives, career women, women in midlife, premenopausal women. They are aggressive and have the purchasing power to do anything for themselves.

55-64 years and 65 and above, comprising more than 5 million (6 percent) These are postmenopausal women.

Self-cleaning organ

“There are a few patients aged 15-24 that seek consultation. These are the teenagers, young adults with raging hormones who need to be guided appropriately. These ladies start seeing their gynecologists in their early 20s when they become sexually active. The most common complaint is discharge, which is either due to sexual activity or douches which trigger changes in the vaginal pH,” she observes.

Since the vagina is a self-cleaning organ, it is not advisable to douche. It may spread bacteria from the anus into the rest of the female reproductive system (cervix, uterus, ovaries and fallopian tubes).

Moreover, Dr. Aherrera points out the importance of using the correct vaginal wash that is pH correct (3.8 to 4.3) to ensure the acidic environment and overall vaginal health.

She notes that as the body that winds down its biological clock, the vagina is most vulnerable before and after menopause. Women experience vaginal dryness due to decrease of estrogen.

Even if women in their 40s and 50s are still menstruating, they complain of vaginal dryness due to decrease in estrogen levels.

“Women in their childbearing years or premenopausal women (40-50) who are still menstruating may complain more of vaginal dryness than vaginal discharge. This is due to the decreased estrogen levels. In postmenopausal women (beyond 55), the complaint of vaginal dryness becomes more frequent,” Dr. Aherrera says.

“Sadly, these are women who feel aging is part of the biological breakdown of one’s body. They accept that youth has left them. Life just goes on as a journey in discomfort,” she says.

On the vital role of estrogen, Dr. Aherrera explains, “The vaginal cells are moistened by estrogen, which becomes the food substrate for the lactobacilli that’s naturally occurring in our vagina. When estrogen breaks down into glycogen, the latter is the food for your lactobacilli which, in turn, feeds on your glycogen, your estrogen’s lined cells. The byproduct is lactic acid. The more estrogen you have, the more lactobacilli it can feed on. Increased production of lactic maintains that pH.”

Dr. Aherrera recommends topical application of estrogen cream inside the vagina or insertion of vaginal tablets containing estrogen and naturally occurring lactobacilli as first line of treatment after a thorough, detailed history and gynecologic examination.

All told, Dr. Aherrera says each patient will require individualized treatments.

“Not all patients are the same. That’s why to me, vaginal health is very crucial. There’s no one permanent treatment. You have to see the overall picture. What is their social history, sexual behavior patterns, socioeconomic status? It is time to be cognizant and define a holistic perspective of wellness as a woman goes through the different phases of her life cycle—childhood, adolescence, adulthood, pregnancy, pre-and post-menopausal phases.” –CONTRIBUTED

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