The hidden health conditions millions of women suffer from but no-one wants to talk about...
The hidden health conditions millions of women suffer from but no-one wants to talk about...
- Few women have heard of bacterial vaginosis (BV) though it is common
- Unbeknown to many women, it can increase the risk of contracting an STI
- Around 75% of women will also experience vaginal thrush in their lifetime
- Some have recurrent episodes causing itching, pain and embarrassment
- Here, leading experts reveal the causes and various treatments available
By Cathy Watson, Lenka Vodstrcil And Catriona Bradshaw For The Conversation
Published: 12:35 GMT, 10 February 2016 | Updated: 15:25 GMT, 10 February 2016
Imagine.
You are on a two-week walking tour in Thailand and the unthinkable
happens. An episode of vaginal thrush hits like a tsunami.
Every step is agonising and it's hard to resist the urge to scratch your genitals incessantly.
To make it worse, your tour guide is a male with limited English and there is no pharmacy within a day's walk.
This is how Debra (not her real name) described her extreme experience to me at a consultation.
Thrush
and bacterial vaginosis are common conditions with often debilitating
symptoms, yet they are not widely discussed, according to experts (file
photo)
Debra's may sound like an extraordinary circumstance, yet
women with vaginal thrush can suffer extraordinarily, no matter where
they are at the time.
Although most women will have experienced one
or more episodes of uncomplicated thrush that results in temporary
discomfort, some suffer from recurrent episodes.
The persistent physical symptoms of these can be shameful and often debilitating.
UNCOMPLICATED THRUSH
Uncomplicated thrush is common - about 75 per cent of women will have vaginal thrush in their lifetime.
Thrush is caused by a fungal infection (Candida albicans) that lives in the vagina, often without causing symptoms.
Why some women develop symptoms is unclear.
When symptoms do occur, they include itching, burning and a 'cottage cheese-like' discharge.
Three-quarters
of women will suffer from vaginal thrush in their lifetime with
symptoms usually occurring during a woman's reproductive years, experts
say (file photo)
Vaginal thrush mostly occurs during a woman's reproductive years.
It is uncommon before her first menstrual cycle and after menopause (when periods cease), so hormones are likely implicated.
Many have thrush at a particular time of the month, specifically before menstruation.
It also often occurs following a course of antibiotics and is common in women with diabetes.
Medications are available without a prescription so many women treat themselves.
Treatment consists of anti-fungal creams or vaginal tablets, which are put inside the vagina with a special applicator.
There is also the choice of oral tablets, which are more expensive and not recommended for pregnant women.
But it's important that women see their doctor if these treatments don't work or symptoms recur.
Recurrent thrush is when someone is diagnosed with four or more episodes in a year
This is because they may be suffering from an entirely different infection, which requires different treatment.
Although
women can effectively be treated with medications available over the
counter, there are about 5 per cent for whom the symptoms recur or never
go away.
RECURRENT THRUSH
Recurrent thrush refers to four or more diagnosed episodes of vaginal thrush within 12 months.
Because the four episodes have to be identified with a swab test, research into this area is difficult and costly.
Compared with research into uncomplicated thrush, the published studies for recurrent thrush are few and of poorer quality.
No research so far has found a cure that works for all women.
This also means we don't know exactly how long women may go on having experiences of recurrent thrush.
Anecdotal evidence shows episodes can come and go for many years.
For
people like Debra, who forgot to pack 'emergency supplies' before her
trip, recurrent thrush can cause relentless itching, constant pain and
embarrassment.
Some women need to take time off work. Others find their self-esteem and confidence suffers when the condition flares up.
Some
women may find sexual intercourse extremely painful and others have
attributed relationship difficulties or breakdown to the condition.
Many
have reported frustration about seeing doctors who 'fob them off',
advising them to take another course of anti-fungal treatment, or
telling them that they just have to 'put up with it'.
Thrush
is caused by a fungal infection, candida albicans (pictured) that lives
in the vagina, often without causing symptoms. When symptoms do occur,
they include itching, burning and a different discharge
RECOMMENDED TREATMENTS
Some women benefit from long-term treatment, but relief remains elusive for others.
The only treatment of recurrent thrush supported by a large study is 'suppression and maintenance' therapy.
Symptoms
are suppressed with a high dose of anti-fungal treatment followed by a
maintenance dose (weekly or monthly) for up to six months to prevent
remission.
Depending on where someone is based in the world, buying the treatments regularly can add up.
Treatment
is often inconsistent between practitioners. This perhaps reflects the
lack of confidence in available guidelines, based on the above study.
Natural remedies like yoghurt can soothe the itching but there is no strong evidence to support its use
Some
women are reluctant to take anti-fungal medications for long periods,
as they can have some side-effects, including abdominal pain.
Because of this and the expense, many turn to alternative therapies to combat thrush.
ALTERNATIVE TREATMENTS
Although some women may find the folk remedy of yoghurt soothing, there is no strong evidence to support its use.
Some recommend formulations such as aci-gel or vinegar to restore the normal pH of the vagina.
But contrary to popular belief, the vaginal pH of women with thrush is usually normal.
There is no strong evidence to support the effectiveness of yoghurt for thrush.
Other natural treatments include tea tree oil and garlic.
But using tea tree oil can lead to nasty allergic reactions, while garlic can burn.
Sometimes simple remedies such as ice packs applied to the area for up to ten minutes can bring relief.
As alternative treatments, doctors usually recommend cotton underwear and avoiding feminine hygiene products, if possible.
Seeing
a health professional who understands the complexities of this
condition can be helpful, along with setting realistic expectations
about management.
Some hospitals have specialised vulval disorders clinics that women can attend with a doctor's referral.
It
is impossible to predict how long persistent thrush may last for
individual women, but the good thing is most will respond to long-term
therapy, and it will eventually ease.
WHAT IS BACTERIAL VAGINOSIS?
Few have heard of bacterial vaginosis (BV) although it's a relatively common condition.
Symptoms include a watery, milky discharge and fishy odour coming from the vagina.
Women
with BV are more likely to get sexually transmitted infections (STIs) –
such as chlamydia, gonorrhoea and herpes – and to transmit or acquire
HIV.
Women with BV are more likely to get sexually transmitted
infections (STIs) – such as chlamydia, gonorrhoea and herpes – and to
transmit or acquire HIV. It can also lead to miscarriages (file photo)
They are more likely to develop pelvic inflammatory disease, a painful condition that can result in infertility.
Pregnant women with BV are more likely to suffer miscarriages and deliver premature and low birth-weight babies.
Studies have shown women's self-esteem, sexual relationships and quality of life suffer significantly from this infection.
Women have reported BV symptoms make them feel embarrassed, 'dirty' and concerned others may be able to detect their odour.
Women have reported BV symptoms make them feel embarrassed, 'dirty' and concerned others may be able to detect their odour
Many women with BV symptoms think they are experiencing thrush, and commonly report being treated for this.
But BV doesn't cause itching and there is often a noticeable fishy odour.
Improper treatment for this condition leads to persistent symptoms, frustration and distress.
WHY BV IS HARD TO TREAT
Bacterial vaginosis is caused by groups of bacteria.
This makes it different from other genital infections, such as chlamydia and gonorrhoea, where one bacterium is responsible.
While
the cause of BV remains the subject of ongoing research, we do know
there is a marked disruption of the vaginal bacterial community in women
with BV compared to those with a healthy vaginal state.
BV is associated with a decreased number of good bacteria, known as lactobacilli, and an increase in bad bacteria.
Lactobacilli dominate the healthy vagina, fighting bad bacteria and other other disease-causing agents.
Latest
research into the bacterial profile of the vagina has suggested that as
well as this imbalance, women with BV have a bacterial biofilm on their
vaginal wall.
Pregnant women with BV are more likely to suffer miscarriages and deliver premature and low birth-weight babies (file photo)
This is a kind of network and scaffolding of bacteria that cause cells to stick to each other.
The
biofilm blocks the body’s defence mechanisms and protects bacteria
against antibiotics which have difficulty penetrating the biofilm.
Current
treatment guidelines include seven days of either oral antibiotic
tablets or the insertion of a vaginal antibiotic cream for seven nights.
These antibiotics have 80 per cent to 90 per cent cure rates one month after treatment.
But more than half of treated women get BV back again within six months.
Bacterial vaginosis is caused by groups of bacteria, pictured, although why it occurs is still the focus of much research
No
other treatment approaches (longer antibiotic regimens, combinations of
different antibiotics or supplementing antibiotics with probiotics to
try and restore the healthy vaginal bacterial balance) have resulted in a
sustained, long-term cure.
This is likely due to the bugs causing BV persisting after treatment or because women are being reinfected by their partners.
SEXUAL TRANSMISSION
Trials
between 1985 and 1997, where males were treated alongside their female
partners, didn’t consistently reduce BV recurrence rates.
These trials have since been shown as flawed and inconclusive.
Now there is mounting evidence to suggest sex is strongly linked with the acquisition of BV and its recurrence in treated women.
Studies have found women with male sexual partners who didn’t use condoms were consistently more likely to have BV.
And women who have been treated and then re-exposed to the same partner were more likely to get their BV back.
Studies
exploring bacterial communities on the penis have found BV-linked bugs
under the foreskin and at the end of the urine tube.
These were more common in men whose partners had BV than in those whose partners didn’t.
In African trials, female partners of circumcised males were found to have less BV than those of uncircumcised males.
Despite
men not having associated symptoms, the data support the hypothesis
that in treated women, sex with an untreated partner may be
re-introducing the BV bugs responsible for high recurrence rates.
Other
studies have shown women with female sexual partners were more likely
to develop BV if they had more partners or a partner with BV.
Experts
say there is mounting evidence to suggest sex is strongly linked with
the acquisition of BV and its recurrence in treated women
WE NEED A CURE
The current state of BV treatment is unacceptable.
Despite
mounting evidence of sexual transmission, treatment of male and female
partners of women with BV is not recommended by international
guidelines, based on the trials two decades ago.
There are few
conditions where doctors know that more than 50 per cent of patients
will be back with symptoms within six months.
This characteristic of BV highlights the importance of finding the cause of high reinfection rates.
Failure
to find a single organism responsible for BV and the difficulty in
establishing whether BV is sexually transmitted have all been
significant barriers to making progress with a cure.
Experts are hopeful a cure will be found for BV but say a combination of approaches may be needed
A
number of treatment strategies must be explored, include conducting
well-designed clinical trials of partner treatment to see if eradicating
the bacteria from women and their partners simultaneously (as we do
routinely for STIs such as chlamydia) improves the cure rate.
Drugs that disrupt biofilm are highly experimental, but will also be subject to clinical trials over the next few years and may prove essential in the fight to eradicate BY.
Read more: http://www.dailymail.co.uk/health/article-3439090/The-hidden-health-conditions-millions-women-suffer-no-one-wants-talk-about.html#ixzz408vd7d76
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