The Enemy: Vaginitis

Vaginal discharge and its friends—itching, odor, and irritation—need no introduction. When they arrive, you know they’re there. They are some of the most unwelcome guests, and you’ll pretty much do anything to boot them from your bottom. As complaints go, they’re the cause of many calls and visits to the GYN and overall can leave you miserable.

Vaginal discharge usually indicates vaginitis (the medical way of saying “inflammation” or “infection”). Vaginitis is the umbrella term used to describe all the lovely symptoms listed above. And when they’re present, it’s a sure sign that something is off in the vagina. Let us share what these things usually are.

For starters, the vagina is an acidic place (a.k.a. the pH of the vagina is usually about 4.0 to 4.5). Acidity is important because it assists in keeping the bugs away—bacteria and fungus are more fans of a basic environment. When the pH is off and things are skewing in the basic direction, bugs start to flourish.

Anything from menstrual cycle phase to a foreign body to sex to antibiotics can throw things off (a.k.a. the pH) and set the stage for vaginitis. In come the bacteria or the fungus, and out goes your comfort (bacterial vaginosis, candida vulvovaginitis, and trichomoniasis are the most common culprits). When it comes to symptoms, the most common symptoms women with vaginitis complain of are vaginal discharge, itching, burning, redness, pain with intercourse, pain with urination, and even spotting.

It’s important to call your doctor when you get that “things don’t feel right down there” sensation. You should trek to their office for a chat (a good history can tell you more than any test), a pelvic exam, a vaginal plus or minus cervical culture, a pH test, and a close look at the discharge under the microscope. While there are some classic features of different bugs (trichomonas usually present with a greenish-yellow discharge, candidiasis with a thick, white, cottage-cheese-like discharge, and bacterial vaginosis with a thin, fishy-smelling gray discharge), it’s best to make the diagnosis before initiating any treatment.

If the tests come up without a clear diagnosis (which happens in about 25–35% of cases), your doctor will start delving deeper into some of the more unlikely causes (low estrogen, medications, hygienic practices, allergies). Whatever the cause, we may have ways to treat you and end your torture. Whether it is an oral medication or a vaginal cream, we can find the right medication to return the vagina and its pH back to normal.

Vaginitis can be super annoying. It can sideline you from doing a lot of fun things (no explanation needed) as well as some not-so-fun things (a.k.a. working). But you don’t have to suffer in silence. And you shouldn’t rely on self-diagnosis. While your intuition is probably pretty spot on, without a microscope and a pH test, you can’t be certain. Although it is usually bacteria or a fungus causing the problem, it’s important to confirm which one. This will ensure that you get the right treatment and get right back into the swing of things.

Going Long: When the Finish Line May Be Further Than You Think

For all of you runners, swimmers, and cyclists, you know what it takes to prepare for that long-distance jaunt. Aside from what you should eat (#carbLOAD) and what you should wear, how far your legs or arms need to take you is pretty important. Preparation, both physical and mental, is key to crossing that finish line.

The same can be said for individuals and couples going through fertility treatment. Knowing how many rounds or cycles it will take you to reach the finish line (#baby) will help you prepare for the journey. And while this is no straight-up calculation or predetermined training plan, information such as age, ovarian reserve, and fertility history can definitely help us estimate. Here’s how far you might need to go…

There are about 180,000 IVF cycles performed in the US each year. And from these cycles, about 65,000 babies are born. Over the years, the numbers have added up, and nowadays, nearly 2% of babies born each year are a result of IVF. Simply stated, more and more people are doing IVF, and more and more babies are born after IVF. However, the number that is less clear is how many cycles it took each person to get to her personal finish line (a.k.a. a baby).

And while this statistic may elude us, what is pretty evident is that those who hang in there longer (a.k.a. complete more IVF cycles) are more likely to conceive. In fact, a recent Swedish study demonstrated that women who did three IVF cycles had about a 65% chance of pregnancy. This was higher than women who stopped at one or two. And while we are certainly not advocating endless IVF cycles, we are recommending that you go the distance based on your doctor’s recommendations.

If your doctors think you have the potential to push on (you are still making a good number of eggs, you are having advanced embryos transferred, your embryos are passing the genetic screening test), then we recommend that you keep on keeping on. Just make sure that you know how far they think you should go, and in turn, make sure they know how far you want to go.

Going back to our original metaphor, think of it like this… If someone told you that you had to run five miles and then midway through told you it was actually 10 miles (oops!), you would be pretty peeved. You would probably doubt your ability to go the distance and maybe even decide to bow out before the race was over.

On the contrary, if you planned to do a 10 miler but midway through found out the race was only half that distance, you would feel pretty good. Energized and invigorated, you would kick that race’s butt and sprint to the finish line. Fertility treatment might make you go the distance. While we certainly hope the race is over shortly after it starts, if it goes longer we don’t want to leave you out there on the course without the appropriate gear.

Information, preparation, and participation (a.k.a. a doctor who consults with you after every IVF procedure) will guide you through this often-torturous race. But having a good idea about the course before you start will make each passing mile a bit easier.

When to Cut the Cord

While we can’t tell you how long your kids will hang on to you for support, we can talk a little bit about when to cut the umbilical cord! Delayed umbilical cord clamping has become all the rage these days—almost as popular as those fidget spinners!

What’s all the buzz about delayed cord clamping, and what does it mean?

After your baby is delivered, the umbilical cord (what connects Baby to the placenta, an organ that feeds Baby while inside Mom) is often clamped and cut soon after delivery, usually around 15 to 20 seconds afterwards.

However, studies have shown that blood is still transferred from the placenta to the baby during those first few cries after delivery. As long as Baby is doing okay after delivery, those extra few ounces of blood can give your newborn a leg up on iron and blood stores.

In pre-term babies (those born before 37 weeks), this can mean a better transition to life on the outside, fewer blood transfusions for low red blood cell counts, and a smaller chance of a few other complications of prematurity.

For term babies (those born after 37 weeks), waiting to clamp and cut the cord can also increase iron stores and decrease your baby’s chance of having anemia (low red blood cells) in the first few months of life. Giving your baby a few more red blood cells post-delivery may increase his or her chance of needing therapy for newborn jaundice (think those UV lights newborns are sometimes under), but that chance seems to be small, based on the studies so far.

So, delayed clamping seems to be great for Baby, but what about mom? Mothers seem to do just fine, with no increase in bleeding or postpartum hemorrhage (see our post here) in studies.

How long is long enough? It seems 30 to 60 seconds should be good. Some people like to wait until the cord stops pulsating, but it seems most of the benefit from delaying clamping happens in the first minute of Baby’s life.

Now, what if something happens during your delivery and you can’t delay cutting the cord? Remember, the main goal is a healthy mom and baby. If Baby needs some extra attention from the pediatricians after delivery, that may mean you can’t wait to clamp and cut!

Think of it as one of the first of many compromises you make as a parent. While, of course, we always want to give our kids the best of everything, sometimes we can’t always do things by the book.

Big Girls Do Cry

Showing emotion has too long been viewed as a sign of weakness. “Tough” and “strong” meant holding in how you were really feeling, especially as a mom trying to juggle it all. Fear of being judged or being seen as weak or imperfect prevented us from sharing our emotions. No one wanted to be the odd woman or mom out. But unlike the lyrics of the song most of us know from the Dirty Dancing soundtrack, big girls do cry. Shedding a tear doesn’t make you a wimp or pathetic; it makes you real.

Whether you are the mother of a newborn, a toddler, or a teenager, parenting is hard. And although the problems may change (getting your little one to sleep through the night to getting your teenager to come home at night), tackling them is equally as challenging. It can drive the sanest of us insane! Add to that another child or two, and the tasks don’t double, they quadruple: your head is spinning. Without your Google calendar attached to your hip telling you whom to pick up and when, you would be lost. But sometimes, even the most organized planner, the best parenting books, and the cleanest diaper bag can’t replace how lost you really feel.

Fear of being seen as lesser, imperfect, or subpar makes most of us hold our feelings in. And as the emotions build, so do the walls we put up to hide how we are really feeling. But the walls not only keep our feelings hidden, but they also keep the support of others out. They prevent us from making contact, from building relationships, and from seeking help.

When we share how we feel, our failures, and our fears, we create community. We create connections. We work together. And together, as a unit of women, moms, partners, sisters, and friends, we can stand stronger. Start a movement of honesty and truth by being honest and true with who you are and your fallibilities. You never know whom your words will reach and whom you will inspire.

So, take it from two big girls who frequently cry: crying is not a bad thing. In fact, it’s a pretty good thing. Just find the shoulder of someone you trust when you do. It will make the whole process a whole lot easier!

Take a Bite Out of This: What Your Teeth Could Be Doing to the Rest of the Body

There may be no bigger hassle than a dental problem. A root canal, an implant, a denture, or a chipped tooth: it’s all a big pain and a big hit to your bank account. And unfortunately, as we age so do our teeth. Just like your ovaries, they have been present for all your bad decisions. The sweets, the “oops, I forget to brush and floss,” and the endless packs of gum have taken their toll. (Trust us, we know, we do it too!) And while it may come as a shock to you, what’s going on your mouth may be a barometer for what’s going on in the rest of your body.

Oral health disorders like periodontal disease (a medical way of saying “gum disease”) have been associated with problems like cardiovascular disease, diabetes, Alzheimer’s, respiratory infections, and even preterm labor. Inflammation in the gums can lead to inflammation in other parts of the body. Picture this—bacteria make their way into the body through the gums. The gums have lots of blood vessels. Blood vessels act like a shuttle transporting bacteria throughout the body. Wherever they land, they bring inflammation. Inflammation in the blood vessels can cause the blood vessels to narrow. Narrow blood vessels cause blood flow to slow down and clots to form. Such clots increase the risk for heart attack and stroke. Because women post-menopause are already at increased risk for heart disease due to age and other medical risk factors, you don’t want to add to it by introducing gum disease and inflammation.

But there is more to the teeth’s story than gum inflammation and bacteria. After menopause, estrogen levels drop. This drop not only causes hot flashes and vaginal dryness but also the loss of bone in the jaw. Bone loss can lead to loose teeth and tooth loss. And unfortunately, when you lose a tooth at 55, there is no tooth fairy—just a lot of dental bills and inconvenience!

On top of the age and decreased estrogen part, medications that are used for osteoporosis have been linked to osteonecrosis (a.k.a. bone decay). And while this is very rare and most often seen in women with cancer who are on high-dose bisphosphonates, it is important to give your dentist frequent updates on your medication list so that your dental work is scheduled appropriately.

To make matters a little more distasteful, menopause and its hormonal fluctuations can also bring oral discomfort. Post-menopausal women report changes in their taste perceptions and dry mouth. And your gums feel it, too. Receding gums and sensitive gums are not uncommon.

Age gets us all over. From your hair and skin to your bones and toes, time takes a toll. Your teeth didn’t want to be left out! To decrease damage, the American Dental Association recommends that you make a trip to see your dentist twice a year. And for your homework, they suggest daily brushing and flossing. Also, limiting sugary foods and things that stick is a sure-fire way to improve your dental health.

So, don’t follow the nearly 35% of US women who did not see a dentist last year. Make an appointment to get those pearly whites (or at this point, some shade of white) checked out. You will be doing your whole body good.

FRIENDSHIP

From the friendship bracelets we made in camp to the BFF necklaces we wore in middle school and the matching outfits we wore in high school (unplanned, we still do this!), advertising friendship has always been the thing to do. You wore your friendship status like a badge of honor, proud to show that you were never alone, and eager to report that you were surrounded by others. But more than the status friendship gave you, it also gave you comfort, it gave you peace, and it gave you reassurance.

You were not alone. Ups and downs, successes and failures, and wins and gains would never be experienced in solitude. You had your crew or your bestie to weather the most unpredictable storm, and that was better than any umbrella, Weather Channel update, or blizzard survival kit.

Truly, MD, is rooted in friendship. Two girls who have known each other for longer than you can imagine who have stood by each other’s sides through the marathons of their careers, motherhood, and everything in between. Although admittedly one runs WAY faster (Sheeva is the real deal out there on the road), we always finish together.

The power of our friendship has allowed us to run the steepest of hills, traverse the hardest of terrains, and push a minute or mile longer than the day before. While we at Truly, MD, may never meet you in person, gab with you on the phone, and share a glass of rosé on a summer day, we are your friends. We are here to break it all down, from the medical topics that make you say “hmm” to the mom stuff that makes you say “ahhh.”

We tell it to you just like your closest GFs would. We use words, phrases, and sayings that your nearest and dearest would employ, but admittedly, we say it with more umph because of our medical backgrounds. Just like your closest companions, we dish about it all and hold nothing back (and like your friends, we can be blunt at times—don’t take offense!). Think of us as a couple of girls in the know who want to welcome you into our community, offer you our friendship, and make you a part of our crew. In the words of Henry Ford, “My best friend is the one who brings out the best in me.”

Let Truly, MD, bring out the best in you!