Hi I’m Cindi Michaelson, Co-Founder of HER Health Collective and I’m here with Dr. Polly Watson. Dr. Watson is founder of Hormone Wellness MD. She is a board certified gynecologist, North American Menopause Society Certified Practitioner, and Institute for Functional Medicine Certified Practitioner.
I’m so excited to be here with you.
We are going to talk about a topic that I’m going to need a definition for, but I’m sure many moms will already know what this is. It’s called Vaginitis. Dr. Watson, what is vaginitis?
Vaginitis is inflammation of the vagina. What I’m referring to is the tube inside your body and not the labia or the vulva on the outside of the body. We can get vaginitis from a sexually transmitted infection but that’s not what we’re going to talk about today. We are going to focus on more common things that moms in this group might experience such as yeast overgrowth, bacterial vaginosis (which often causes that stinky, fishy odor), and something called desquamative inflammatory vaginitis (DIV).
DIV was initially put out there in the 90’s and so it’s not something that’s usually at the top of a gynecologist’s mind. I wanted to mention it today because I have seen some women who have said, “I’ve had this forever and I’m not getting better.” If we could educate about asking some questions and perhaps getting their health care practitioner to look under the microscope it might be a win for that group that’s having a hard time getting better.
What kind of mistakes do you see women make about treating vaginitis?
I think a lot of times in gynecology, we are practicing science in the middle of a cultural framework, so a lot of times women come in with ideas that maybe culture has taught them or maybe their family’s have taught them, that this part of their body is stinky or smelly or dirty and needs all kinds of special cleaning. I want to be a force to say this part of your body is beautiful and healthy and perfect just the way it is. A lot of the things that women do to “clean it up” are actually disrupting the natural processes that your body has to clean it out on its own.
For instance, when women are douching, we’re pushing germs from the outside world up into the inside world. Our reproductive systems are open systems as women. Things can go through the vagina, through the cervix, through the uterus, out to the Fallopian tubes and then into our abdomen. I’m not really excited about pushing germs from the outside world in.
Vaginal steaming got really popular. I feel that the body is designed to clean itself out on its own. The vagina is naturally very acidic. The pH of the vagina is around 4 and a neutral pH is 7, so that acid medium is going to kill germs on its own.
When we put a lot of soap down there, soap is basic so when women are scrubbing with all these soaps and products (fragrance products are extremely harsh), they’re messing up that acid/base balance that’s trying to keep that clean on it’s own.
What would you recommend that women do wash with?
In general, we don’t need to put soap on the inside of our bodies. We’ve got all kinds of oil glands on the outside in the hair bearing area and that can have a little bit of gentle soap. I would use soap you’d be willing to eat. For example, you can get soap that’s made out of olive oil, goat milk, really basic stuff. When we get into more chemicals and fragrances and deodorized soaps, I don’t feel that’s a good idea for this area.
My favorite soap is so hard to find these days. It’s from Kiss My Face and it’s an Olive Oil soap. They used to have it at Kroger but we don’t have Kroger anymore. I think they have it at Thrive Market. It’s a big bar that you can buy without fragrance in it and it’s green like olive oil. The ingredients are extremely simple. That’s what our whole family used because it’s such a gentle soap.
We don’t need to put soap on the inside. Let’s say you’re the swim team mom and you’re out in the North Carolina heat in a tennis skirt for 4 straight hours and you felt gross. You wanted to go home and get cleaned up. You could take a shower and then sit in a tub of water with a couple cups of plain white vinegar. Vinegar is acidic just like your vagina is acidic, so that would be a completely safe way to clean up.
When a woman has chronic vaginitis, what should she be considering?
When women come in and see me, I’m interested in the whole person approach. I want to know what she’s eating. I had a patient when I was in conventional practice who was eating Skittles at her desk all day long and she kept getting yeast infections.
Yeast likes to eat sugar. If someone is eating a lot of high refined carbohydrate foods, it’s really hard to get the yeast to clean up. We want to evaluate their gut, and their eating habits. Sometimes in the Functional Medicine space, we do a little bit of a deeper dive to see if an individual’s GI tract is colonized with yeast. Do we need to investigate this further with testing?
I’ve had women who’ve had vaginitis who actually had a little bit of a parasite. So, looking at the gut can be really helpful.
The other thing that I wanted to mention is desquamative inflammatory vaginitis (DIV). When I was coming up in training, we always got a little swab and looked under the microscope. As healthcare providers have received more and more pressure and less and less time, we are less often grabbing the swab and looking under the microscope. Sometimes practitioners don’t even look, they just proscribe.
Desquamative inflammatory vaginitis (DIV) diagnosis needs a practitioner to take a little swab of the secretions and look under the microscope. They are looking for a lot of white blood cells. DIV usually causes this copious yellow discharge and it’s very difficult to get rid of. I wanted to make sure we discussed it and I provided articles about it so clients were more aware. This wasn’t something that was at the forefront of my mind during GYN training and was really just starting to get described when I was going through training, so it may not be something that is at the forefront of other practitioner’s minds.
Is it something that if you are seeing a General Practitioner or conventional Gynecologist, that you can request to have that testing?
Sure! If they’ve got a microscope in their office then they should be able to use a Q-tip and be able to look under the microscope and see what they’re looking for. Sometimes it may be a little bit of an extra step but I’ll provide information so patients can go in with resources and advocate for themselves.
That’s great information to know and we are grateful for the resources! Dr. Watson, what can we do at home?
First of all, if someone’s in a new sexual relationship or their concerned that their partner has been in a new sexual relationship, you always want to get checked out to make sure we’re not missing something more serious like chlamydia (which is a very fixable problem), or trichomonas or something similar.
If things are OK and you’re having a lot of itching and you’re concerned that you have yeast there are some things that you can do at home. I’m not a huge fan of over-the-counter yeast medications because they typically have alcohol in their base. I was at a menopause meeting and really got into it with a guy from Proctor and Gamble asking, “Why are you putting alcohol in these women’s vaginas?” From his perspective, he was trying to keep a product clean and sterile in the tube as it sat on the shelf for maybe up to two years, so that’s why they were putting alcohol in it.
I don’t want to put alcohol in my vagina! That wouldn’t feel very good. To avoid that, you can use Boric Acid. Boric Acid is a powder and it should not be inhaled because that would be very dangerous but you can get a 600mg Boric Acid capsule and you can put that in your vagina.
If you felt like you had an infection, you were having cottage cheese discharge and it’s itching and uncomfortable, you can do the Boric Acid a couple times in a week and that should clean it up. If it doesn’t then it’s probably time to go see a health care provider.
And you can find that at a health food store?
You could get Boric Acid on Amazon. We’re always concerned about using Amazon for things that we are going to ingest because what if it’s counterfeit. You could also get a prescription for Boric Acid and fill it at a Compounding Pharmacy where the quality control is going to be a lot more reliable. If your healthcare practitioner is comfortable giving you a prescription for Boric Acid, potentially you could take it to the beach with you because if you go to the beach and you’re in your wet bathing suit all day and eat food with more sugar in it, it’s the perfect set up to get yeast. Instead of having your vacation get derailed, maybe you could be prepared and have it on hand to save your vacation.
Great suggestion! Wow! I never knew that! It’s great having you as a resource. As you can tell, Dr. Watson is a wealth of knowledge. Thank you so much for visiting with us!
Dr. Polly Watson is a board certified OBGYN who has been refining her practice of women’s medicine for almost 20 years. In 2007, she chose to focus solely on gynecology. Early in her career, she found that many women felt underserved in busy OBGYN practices which focused on delivering babies. Seeking to serve these women better, she concentrated her practice on menopausal medicine and became a North American Menopause Society Certified Practitioner in 2009. She sought to broaden her skills and attended training from International Society for the Study of Women’s Sexual Health in 2011. Dr. Watson completed the Institute for Functional Medicine Certificate Program (IFMCP) in 2019. She is one of about 1000 providers in the US who has obtained this certification. Dr. Watson owns and operates a private practice called Hormone Wellness MD.
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