Category: Gynecology

It may seem embarrassing to talk about, but vaginal discharge is a completely normal part of the female body. Normal vaginal discharge helps keep the vagina healthy and clean by maintaining the wetness of the vaginal tissues and shedding old cells. You may notice changes in your discharge during ovulation, breastfeeding, or when you’re sexually aroused. Discharge also changes consistency during different times of your cycle. Still, concerns about vaginal discharge are one of the most common reasons for booking an appointment with your gynecologist. To help provide some valuable information from the comfort of your own home, here is your guide to vaginal discharge.

What’s Normal

A healthy vagina produces discharge as a way to “self-clean.” The discharge that is considered “normal” ranges from clear to white in color. The consistency and amount of discharge may also vary. Typically, normal discharge consistency ranges from watery to sticky, like an egg white. It’s normal to have some amount of vaginal discharge every day and for the amount to increase or decrease depending on where you are in your cycle. When it comes to smell, it can vary from orderless to pungent to metallic. Now that we’ve established the baseline of what’s considered healthy vaginal discharge, here are some of the abnormalities you should be aware of. 

What’s Abnormal

A Fishy Odor

A strong, fishy-smelling odor is typically associated with Bacterial vaginosis (BV). BV occurs when there is a decrease in the normal bacteria in the vagina. When this “good” bacteria decreases, it can lead to an infection. If your discharge has a strong, fishy odor that worsens with your period or during sexual intercourse, set up an appointment with your doctor. Bacterial vaginosis is easily treated by antibiotics and is not an STI. 

A Severe Itch

Yeast infections are one of the most common vaginal conditions, and symptoms include an intense burning and itching sensation. In addition to the itch, you may also see a thick, white discharge with a cottage cheese-like consistency. Fortunately, there are many over-the-counter antifungal medications available to treat yeast infections. For reoccurring yeast infections, your provider can make personalized recommendations to decrease the frequency. 

Pain

Heavy vaginal discharge that is accompanied by pain could be a sign of an STI, like gonorrhea, chlamydia, or trichomonas. This pain typically takes place in the belly or it occurs during sex. If you are experiencing heavy discharge and pain, set up an appointment with your provider to get tested and receive treatment. 

An Unusual Color

As we previously mentioned, normal vaginal discharge is clear to white in color. You may also notice reddish discharge during your period. If your discharge is green, yellow, or gray, however, this could be indicative of an STI. 

How to Maintain Vaginal Health

At the beginning of this blog, we mentioned how the vagina is a self-cleaning machine! You don’t need to clean the vagina manually. We recommend rinsing with water or allowing soapy water to run over the vagina. There is no need to scrub, and it’s best to avoid any perfume soaps, lotions, or sprays. You should absolutely avoid douching, which can lead to infection, by removing the healthy bacteria from the vagina. Unless specifically recommended by a doctor, many of the products on the market aimed towards vaginal cleanliness are not necessary. If you are experiencing recurring infections, try wearing cotton underwear and loose-fitting clothing to allow the area to breathe. 

Contact an OB/GYN

At Green Valley OB/GYN, our physicians are here to answer any questions you may have regarding your gynecologic health. There is no issue that is too big or too small for us to address. If you have questions about vaginal discharge or any other condition, our staff is here to help. To set up an appointment, contact us online or by calling (336) 378-1110.

Vaginal yeast infections are a pretty common condition that a lot of women must deal with. While having a yeast infection is an annoyance and can cause unpleasant symptoms, it is not usually a serious condition that causes lasting complications. Many women can effectively treat symptoms and resolve the infection themselves using over-the-counter medication, but what if that doesn’t work. When should you call your OB/GYN when you have a yeast infection?

What is a Yeast Infection?

Vaginal yeast infections are fungal infections that affect the vagina and vulva. The vulva is the exterior tissues surrounding the vaginal opening. It is estimated that 3 out of 4 women will experience at least once in her life, but many women have more than one. It is usually not serious and can be treated easily.

Sometimes the condition is referred to as vaginal candidiasis because candida albicans is the fungus responsible for most cases. The vagina always has a mix of different yeasts like candida as well as bacteria. When there is no infection, the vagina naturally balances these fungi and bacteria. There are even bacteria called lactobacillus that prevent yeast overgrowth. 

If things are out of balance, then an overgrowth of candida can occur or the fungus will penetrate deeper vaginal cell layers. This overgrowth and penetration lead to a yeast infection, which causes discomfort and other unpleasant symptoms.

There are several things that can contribute to or cause yeast overgrowth, including:

• Antibiotics, which can kill too much of the lactobacillus bacteria in the vagina
• Uncontrolled diabetes
• A weakened immune system, due to chronic or acute illness or certain medication
• Increased estrogen levels caused by hormone therapy or birth control
• Pregnancy
• Douching or the use of scented feminine products
• Exposing the vulva and vagina to wet or moist clothes for an extended period, including bathing suits or sweaty workout clothing
• Wearing tight-fitting pantyhose or underwear
• Wearing underwear without a breathable cotton crotch

Symptoms of a Yeast Infection

The symptoms of a vaginal yeast infection may be mild, moderate, or severe depending on how bad the infection is and your individual reaction to it. Some women experience only some of the below symptoms and have only mild discomfort, while others can have a different combination of symptoms and more discomfort. Common symptoms of yeast infections include:

• Itchiness and irritation in the vagina and the vulva
• Redness and swelling in the vulva
• Vaginal pain and/or soreness
• A burning sensation, especially while urinating or having vaginal intercourse
• Vaginal rash
• Thick and white odorless vaginal discharge with the texture and appearance of cottage cheese
• Watery vaginal discharge 

When to See Your OB/GYN

Many times a simple yeast infection can be treated with over-the-counter medications like Monistat, which will kill the candida fungus and relieve symptoms like itchiness and pain. However, there are certain situations in which it is necessary to see a doctor.

Call your OB/GYN if:

• You have possible complications
  • Pregnancy
  • Uncontrolled diabetes
  • A weakened immune system
• You have more than four yeast infections in a year
• Your symptoms are severe
  • Swelling
  • Extreme redness
  • Intense itchiness that leads to tears from scratching
  • Cracks
  • Sores
• Your symptoms are not relieved by over-the-counter treatments
• You develop other symptoms or your symptoms worsen
• You have never had a yeast infection before
• You are unsure whether your symptoms are caused by a yeast infection

Treating Yeast Infections

Depending on the severity of the yeast infection, there are a few treatment options. The doctor will also take into account how frequently you get them while deciding on a treatment plan.

Infrequent with Mild to Moderate Symptoms

• Vaginal therapy: A topical antifungal can be used for between three and seven days to clear the infection. This is referred to as short-course therapy. These medications come in several forms including ointments, creams, suppositories, and tablets. Common antifungals used include terconazole and miconazole and can either be prescribed or purchased over the counter at a drugstore.
• Single-dose oral medication: Available only by prescription, an oral antifungal medication called fluconazole, known by the brand name Diflucan, is taken orally. For infrequent and mild to moderate yeast infections, one dose is sufficient. You should only take the oral antifungal if you are not pregnant.

Frequently Occurring or Severe Infections

• Long-course vaginal therapy: Antifungal medication is prescribed to be used every day for up to two weeks. For those who have frequent infections, the medication should also be used once a week for six months to prevent a recurrence.
• Multi-dose oral medication: The oral medication fluconazole is taken by mouth in two or three doses over a span of several days. 
• Therapy for antifungal resistant candida: If you develop an infection that is resistant to the standard antifungal medications, then your doctor may give you a capsule of boric acid to insert into the vagina. The boric acid is potentially fatal if taken orally, but can be effective in treating resistant fungus when used vaginally.

Make an Appointment

At Green Valley OB/GYN, we have decades of experience providing both obstetric and gynecological care to the women of the Greensboro, NC area. Our physicians have over 200 years of combined experience, so you can feel confident you are receiving the best care possible, whether you need a yearly well-woman checkup or are experiencing a high-risk pregnancy. If you have questions or concerns about any gynecological issues, including yeast infections, call us at (336) 378-1110 to make an appointment.

Some of us will try for children at some point, others will choose not to at all. But, if you are having vaginal intercourse, there is a risk of unwanted conception. Thankfully, there are birth control methods that can lower that risk. Some methods lower the risk to below 1%, which can be comforting if you are trying to avoid pregnancy.

Not every type of birth control is right for every person. You should talk to your doctor about what kind of birth control options you have based on your health and lifestyle. Some people are fine on hormonal methods while others cannot tolerate them. Some need or want long-term options and some people even want permanent solutions. 

With each type of birth control, there is a “typical use failure rate.” This is how often the birth control fails with typical use. Typical use refers to how strictly most people follow usage guidelines and differs from perfect use. Basically, typical use means there could be some slight user error. 

The CDC has plenty of information on contraception and avoiding pregnancy. Here is a rundown of the birth control options that may be available to you:

Long Acting Reversible Contraceptions

Intrauterine Devices

Intrauterine devices (IUD) are good options for women looking for long term birth control that they do not have to think about daily.  IUDs last between 3 and 10 years depending on the type. They are T-shaped devices inserted into the uterus to prevent pregnancy. There are two types of IUD:

• Copper: This type of IUD is hormone free and can last up to 10 years. Typical use failure rate: 0.8%
• Levonorgestrel (LNG): This type of IUD releases small amounts of progestin each day to prevent pregnancy.  Can last for up to 5 years. Typical use failure rate: 0.1-0.4%

Contraceptive Implant

• Implant: A small thin rod containing progestin is inserted under the skin of a woman’s upper arm. The implant works for three years. Requires a prescription and insertion by a doctor. Typical use failure rate: 0.01%

Other Hormonal Methods

• Oral contraceptive pill: An oral dose of the hormones progestin and estrogen. Some varieties have a combination of both hormones and others just have progestin. The pill needs to be taken at the same time every day to be most effective. Typical use failure rate: 7%
• Injections: Progestin shots received every three months from a doctor. Typical use failure rate: 4%
• Patch: The patch is placed on the skin on the buttocks, lower abdomen, or upper body, excluding the breasts. A new patch is applied every week for three weeks. On the fourth week you do not use the patch and have a menstrual period. Prescribed by a doctor. Typical use failure rate: 7%
• Vaginal Contraceptive Ring: This ring is placed in the vagina where it releases hormones. The ring is worn for three weeks and then removed. After the fourth week when you have your period, you put a new ring in. Prescribed by a doctor. Typical use failure rate: 7%

Barrier Methods

Just as they sound, barrier methods of birth control create a physical barrier that prevents sperm from entering a woman’s uterus. There are several options within this category:

• Diaphragm or Cervical Cap: Both of these methods are placed inside the vagina before intercourse to cover the cervix, which blocks sperm. Should be used with spermicide. You should visit your doctor to obtain a diaphragm to get it fitted. Typical use failure rate: 17%
• Male Condom: Worn by the man to prevent sperm from entering the vagina. Traditionally made of latex but also available in synthetic materials. These varieties also help prevent STDs. Lambskin or those made with natural materials are effective contraceptives but do not protect against STDs. Condoms can only be used once and should only be used with water-based lubricants as oil-based lubricants weaken them causing tearing or breakage. Available at drug stores. Typical use failure rate: 13%
• Female Condom: The female condom is worn inside the woman’s vagina and can be inserted up to eight hours before intercourse. It works similarly to the male condom in that it keeps sperm from entering her body. Also like the male condom, it can help prevent STDs. Available at drug stores. Typical use failure rate: 21%
• Spermicides: These work by killing sperm. You can get them in multiple forms, including gel, foam, cream, tablet, or film and are available at drug stores. The spermicide should be placed in the vagina no more than one hour before intercourse. They are left in the vagina for at least six to eight hours after intercourse. Spermicides can be used in combination with other barrier methods. Typical use failure rate: 21%
• Contraceptive Sponge: A contraceptive sponge is placed in the vagina over the cervix. The sponge contains spermicide and works for up to 24 hours. It is removed and discarded when it has been in the vagina for at least six hours after intercourse. Typical use failure rate: 14% – 27% depending on if the woman has had a baby.

Permanent Birth Control

If you are positive that you do not want to get pregnant and want a permanent method of birth control, there are two options.

• Female Sterilization/Tubal Ligation: Commonly known as “getting your tubes tied.” The fallopian tubes are closed or tied so that sperm and eggs can never meet for fertilization. Surgery can be done as an outpatient procedure at a surgical center or in a hospital. Effective immediately. Typical use failure rate: 0.5%
• Male Sterilization/Vasectomy: This procedure prevents a man’s sperm from making it to the penis by sealing the vas deferens. That means his ejaculate will contain no sperm and therefore cannot fertilize eggs. It is an outpatient procedure. Takes about 12 weeks to become effective and tests should be done to make sure the sperm count has dropped to zero before having unprotected sex. Typical use failure rate: 0.15%

Fertility Awareness Methods

For some people, using any of the above methods are not possible or attractive. Fertility awareness-based methods (FAMs) rely on knowing the female partner’s fertility pattern. They are sometimes called natural birth control methods or the “rhythm method”.

Being familiar with and keeping track of your fertility pattern is easiest if you have a regular menstrual cycle. If you have an irregular cycle, these methods may be more difficult to use and less reliable.

Once you know the fertility pattern, you can determine which days you are able to get pregnant, unable to get pregnant, and the days when you probably wouldn’t get pregnant but it is still possible. If you do not want to get pregnant, you abstain from unprotected vaginal sex on the days conception is possible. This can mean not having vaginal sex at all or using a barrier method during that time. If you do want to get pregnant, then you have unprotected vaginal sex on those days.

There are a few different methods of this kind:

• The Calendar Method means charting your menstrual cycle on a calendar.
• The Cervical Mucus Method involves checking your cervical mucus, or vaginal discharge) daily.
• The Temperature Method requires taking your temperature before you get out of bed each morning.

Combining all three methods is the most effective route. 

As you can see, this type of birth control takes a lot of planning and sticking to a schedule. FAMs are not recommended for people not in a committed relationship as they provide no protection against STDs. The failure rate of FAMs varies widely, with the CDC citing a range of between 2-23%.

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If you have questions about what kind of birth control is right for you, the experienced providers at Green Valley OB/GYN can help. Call (336) 378-1110 to schedule an appointment and discuss the best option for your current stage of life and future family planning goals.

July is Uterine Fibroid Awareness Month. Uterine fibroids are common, but not all women who have them know they’re there. However, some women experience pain or discomfort due to fibroids. Usually, fibroids are harmless, but if any of the signs of uterine fibroids are interfering with your daily life, you should talk to your OB/GYN.

About Uterine Fibroids

Uterine fibroids are benign (noncancerous) growths or tumors that develop on or within the walls of the uterus. Fibroids can range in size from less than an inch than to over six inches in diameter. According to the Office on Women’s Health, it’s estimated that fibroids will affect 20-80% of women by the time they reach age 50.

Signs of Uterine Fibroids

1. Painful Periods

One of the hallmark signs of uterine fibroids is having painful periods. Many women experience some cramping, pain, or discomfort during their periods. But if you find yourself unable to get daily tasks done due to period pain, consult your doctor.

2. Heavy Bleeding During Periods

Not only do fibroids sometimes cause painful periods, but they may also cause heavy menstrual bleeding.

3. Bleeding Between Periods

Some women with uterine fibroids experience bleeding between menstrual periods. This bleeding could be light (spotting), or it might be heavier.

4. Pain During Intercourse

If you are having pain during sex, you should always talk to your OB/GYN. Not only is it one of the signs of uterine fibroids, but it could be a symptom of another condition even if you don’t have fibroids.

5. Pressure or Fullness in the Pelvis

Fibroids may create a feeling of fullness or pressure in the lower abdomen or pelvis.

6. Lower Back Pain

The pain caused by fibroids may radiate into the lower back.

7. Anemia

If heavy bleeding is one of the signs of uterine fibroids you experience, then anemia might also become an issue.

8. Frequent Urination

Frequent urination on its own is not a sign of uterine fibroids. It can be caused by other conditions like urinary tract infections (UTIs) or overactive bladder. However, if it is present with some of the other symptoms on this list, it could be related to fibroids.

9. Infertility or Recurrent Pregnancy Loss

Fibroids don’t usually have an effect on fertility, but in rare cases, they can make it difficult to get pregnant or maintain a pregnancy. This is because some fibroids may block the fallopian tubes or make it difficult for an embryo to implant in the lining of the uterine wall.

Treatment Options

The best treatment for uterine fibroids depends on the size and location of the fibroids. Other factors that influence treatment include the severity of a woman’s symptoms and whether or not she wants to try to have children later.

• Drug therapy: Hormonal medications such as oral birth control or an IUD can help control the symptoms of uterine fibroids. A type of medication called a gonadotropin-releasing hormone agonist can also help with symptoms and shrink fibroids. However, after the medication is discontinued, the fibroids will return to their previous sizes and symptoms will return.
• Uterine fibroid embolization (UFE): This is a minimally invasive procedure in which the vessels supplying blood to the fibroids are blocked. This causes the fibroids to shrink and reduces symptoms.
• Surgery: In cases where the symptoms and signs of uterine fibroids are not well managed with drug therapy, surgery may be recommended. 
  • A procedure called a myomectomy in which the fibroids are removed while the uterus is left in place can be done in some cases. However, new fibroids may grow after the procedure and multiple surgeries may be required.
  • A hysterectomy in which the uterus is removed is the only way to completely remove fibroids and prevent new growth. However, this is only recommended in cases where the symptoms are severe or the woman does not want to maintain fertility.

Contact Green Valley OB/GYN

If you have any of the above symptoms or signs of uterine fibroids, the physicians and staff at Green Valley OB/GYN are here to help. Call us at (336) 378-1110 to schedule an appointment today.

Many women have experienced some kind of pelvic pain. Some pelvic pain is due to an acute condition such as an infection, but sometimes it is chronic and affects a woman’s daily life. The causes of chronic pelvic pain range from common conditions like menstruation to disorders that can damage the entire reproductive system.

1. Menstrual Cramps

Most women have experienced menstrual cramps, or dysmenorrhea, at some point. The throbbing and cramping pelvic pain happens just before and during the menstrual period. Cramps range from a mild annoyance to pain severe enough to interfere with daily activities. Because many women get cramps during each menstrual cycle, it can be considered chronic. 

Depending on the severity of the cramps, there are a few treatment options. If the pain is mild, over-the-counter pain relievers can be used. Prescription pain relievers may be given if necessary. Hormonal birth control is often given to reduce the severity of cramps.

2. Ovulation Pain

Some women experience pelvic pain in the middle of their menstrual cycle. This pain, referred to as mittelschmerz (German for “middle pain”), is caused by ovulation. It can cause chronic pelvic pain with each cycle, but it’s usually mild and can be treated with over-the-counter pain relievers. More severe pain can be treated with hormonal birth control to stop ovulation.

3. Recurrent Urinary Tract Infections

A urinary tract infection occurs when part of the urinary tract is infected, but when the bladder is infected, it is called cystitis. Cystitis can cause pelvic pressure and lower abdomen discomfort. Pain is accompanied by frequent, painful urination and there may be blood in the urine. Some women experience frequent, recurring UTIs that cause pelvic pain.

Urinary tract infections are usually treated with a short course of antibiotics, but if you have frequent UTIs you may be prescribed a different antibiotic treatment. You may be put on a low dose of antibiotics for six months or more or take a single dose of antibiotics after sexual intercourse. 

4. Ovarian Cysts

Many women have ovarian cysts at some point. They usually don’t cause any noticeable symptoms and disappear without treatment after a few months. However, some ovarian cysts can grow large or rupture and cause serious symptoms including pelvic pain. The pain associated with ovarian cysts is described as a dull or sharp ache in the lower abdomen on the side the cyst is on. Pelvic pain due to ovarian cysts is not always chronic, but if they are caused by endometriosis or a hormonal condition, the pain can become recurrent.

If you are experiencing pelvic pain, you may be given hormonal birth control to prevent cysts from developing. Surgery is also an option if the cyst is large or causes severe pain.

5. Endometriosis

Endometriosis, sometimes referred to as “endo,” is a condition in which tissue similar to the uterine lining grows outside of the uterus. According to the US Office on Women’s Health, it is estimated that more than 6.5 million women in the US have endometriosis. The tissue often grows on the ovaries, fallopian tubes, and tissues lining the pelvic cavity.

Like the uterine lining, endometrial tissue thickens, breaks down, and bleeds during the menstrual cycle. Scar tissue and bands of tissue called adhesions can develop. Chronic pelvic pain is the main symptom of endometriosis. Pelvic pain may worsen during menstruation.

Treatment options for endometriosis vary depending on the severity of symptoms and whether or not the woman wants to maintain her fertility. Pain medication and hormone therapy are often the first treatments prescribed. If symptoms are severe, surgery may be recommended. 

6. Uterine Fibroids

Fibroids are muscular tumors that grow in the wall of the uterus. Uterine fibroids are almost always benign or non-cancerous. Fibroids can cause pelvic pain, lower back pain, pain during intercourse, and heavy menstruation. Uterine fibroids may also increase the risk of pregnancy complications.

Women who experience mild symptoms may be treated with medications like pain relievers and iron supplements. Hormonal birth control can help with heavy bleeding and drugs called gonadotropin releasing hormone agonists can shrink fibroids. In severe cases, surgery may be recommended.

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Green Valley OB/GYN has been caring for the women of the Triad for over 70 years. Our physicians are dedicated to providing comprehensive care while continuing to learn about the newest minimally invasive procedures to treat a number of gynecologic problems that cause chronic pelvic pain.  If you have concerns about your gynecologic health, call us at (336) 378-1110 to make an appointment.