FEMININE INTIMATE CARE The role of the pharmacist Dr Trudy Smith
Vaginal Health Vagina sensitive area Just like GIT, also contain flora Vaginal flora Maintain healthy ph (4.5) Lactobacilli (aerobic) Automatic cleansing system Eliminate exfoliated epithelial cells Rids of pathogenic bacteria (normal discharge)
Unsettling FACTS Vaginal discomfort - NOT often talked about Ladies use soap & feminine hygiene sprays for everyday freshness Often misdiagnosed & treated with no success Self-treatments often abused as doctors diagnosis very embarrassing & invasive Douching is used as treatment
Triggers to vaginal flora & ph changes Contraceptive pills HRT s (hormonal replacement therapies) Menopause Pregnancy Locia (flow that follows child birth) Male ejaculate Stress Humidity Diabetes Antibiotics Bubble bath Soap Douching Feminine hygiene sprays Artificial sweeteners & sodas
Main causes of Vaginal Discomfort Vaginal infection Bacterial vaginosis Candidiasis Vaginal dryness
Bacterial Vaginosis Candida Bacterial infection (bad bacteria overgrowth) DISCHARGE: Smooth White, grey, yellow Irritation, itch, swelling Foul odour (often referred to as fishy odour) Odour more noticeable after sexual intercourse Yeast infection (Candida overgrowth) DISCHARGE: Lumpy White Redness, itch, burning sensation No odour present Pain when urinating or with sexual intercourse
Bacterial Vaginosis image
Bacterial vaginosis (BV) Not a STI Overgrowth of pathogenic bacteria Less of normal lactobacilli (aerobic), and more anaerobic organisms Gardnerella vaginalis main cause High recurrence rates 30% within 3 months 80% within 9 months Nearly 50% of BV = asymptomatic
Bacterial vaginosis (BV) susceptibility to HIV (females) transfer rate of HIV from female to partner susceptibility to STI s females (herpex simplex virus, Chlamydia, Gonorrhea) Risk of PID Risk of pregnancy complications: Early miscarriage Late spontaneous abortions Premature labor Preterm birth
BV - Triggers Use of soap / bubble bath Wearing synthetic underwear / tight clothing Hormonal treatments (HRT s, contrac pills) Sexual intercourse Spermicides Medication (AB)
BV Risk increases New / several sexual partners Smoking Douche IUD
Misdiagnosis often lead to trial & error Metrogel Flagyl Clindamycin Destroy good vaginal flora Relapse rate very high We need to restore vaginal flora, restore ph and prevent relapse (probiotic pessary)
Candidiasis image
Candidiasis AKA Thrush A yeast infection (Candida albicans very common) Candida is naturally occurring (GIT, vagina, mouth, skin) Alkaline ph overgrowth of Candida Thrive in warm, moist environment with good sugar supply Candidiasis complicate weight management
Candidiasis causes & risk factors Antibiotics Contraception IUD / pill Diabetes Diet Douches Soap & fragranced products (sprays, bubble bath) Sexual intercourse Tight clothing A compromised immune system
Use Of OTK medication Of patients who self diagnosed: Vulvovaginal candidiasis 33.7% Bacterial vaginosis 18.9% Mixed vaginitis 21.1% Normal 13.7% Other diagnoses 10.5% Trichomonas vaginitis 2.1% Women with a previous clinically based diagnosis of vulvovaginal candidiasis were not more accurate
Recurrent Vulvo vaginal Candidiasis Candida is common >75% of women Defined as Four or more episodes of vulvovaginal candidiasis in 12 months Candida albicans is responsible for 90% of vulvovaginal candidiasis 10% corresponds to C. glabrata and C. tropicalis Pregnant women are classified as complicated and require at least & days of therapy
Candidiasis Treatment options Douching (betadine douche) Antifungals (Fluconazole, Clotrimazole, econazole) Topical oral Yogurt Dietary changes for severe Candidiasis Gentian violet Boric acid Probiotic vaginal pessary- Gynogaurd pessaries
Vaginal dryness image
Vaginal dryness Symptoms of vaginal dryness: Itching Burning/soreness Stinging Irritation Painful intercourse
When is it a problem Discomfort Leads to infection (BV/thrush) if left untreated During intimacy
How big is the problem Menopause (starts at average age of 51) 40-60% of women affected due to estrogen drop Women spend 1/3 of their life in post-menopausal state Around 17% of women aged 18-50 experience vaginal dryness (even before menopause) Common in pregnancy / breast feeding / hysterectomy ( estrogen)
What causes vaginal dryness Hormones low estrogen: causes thinning of vaginal lining, less elastic & more fragile Menopause Hysterectomy / pregnancy / breast feeding HRT s, Contraceptive pills Change in vaginal ph Douche, Stress Certain meds (anti-depressants, diabetc etc. ) Soap, washing powder, bath chemicals
Drugs that cause Vaginal dryness Ovral Ortho-Cyclen Depo-Provera Halcion Xanax Ativan Calcium channel blockers Beta-blockers Prescribed and over-the-counter cold and allergy medications
Treatment Vaginal oestrogen Lubricants
Types of estrogens Estriol (E3) Produced in pregnancy Estradiol (E2) produced by non pregnant females Estrone (E1) produced by postmenopausal women
Vaginal Health and local estrogens Vaginal atrophy a problem Local estrogen cream improves Overactive bladder symptoms Not clear if stress incontinence improved Oral estrogen therapy is not effective Low dose Estrogen may not be enough for vaginal dryness Local estrogen decreases the incidence of UTI Archer D.Efficacy and tolerability of local estrogen therapy for urogenital atrophy Menpause 2010 ;17;1; 194-203
Vaginal estrogen cream Silastic vaginal ring- E3 Vaginal cream conjugated equine estrogen, synopause E3 Mucoadhesive vaginal tablets estradiol E2
Lubricants GynaGuard lubricating Moisturizer Gel Lubricating and Moisturizing properties Supports ideal ph (4.5) Cranberry extract (prevent UTI s) KY Jelly Messy Drys out
What women do wrong! Use fragranced hygiene products Wipes Sprays Washes Use soap / bubble bath Wash with face cloth / sponge Douche Use treatments that leads to relapse Treat with OTC meds
GynaGaurd 3 products to cleanse: GynaGuard essential wash GynaGuard ultimate wash GynaGuard sensitive wipes 2 products in the treat category: GynaGuard Comfort gel GynaGuard Vaginal Capsule
Happy Vagina A healthy happy vagina is important to a healthy women Educate our daughters Culture if problem persists Encourage showering and using a vagina friendly soap