Although many women have never heard of it, Bacterial Vaginosis (“BV”) is one of the most common vaginal infections; and can lead to other problems.  Here are answers to basic questions about this condition.  Women today know more about their health than ever before.  As a result, they are able to avoid illness and seek professional care for problems at an early stage when medical treatment is most effective.  The growth of women’s health knowledge has been uneven.  For instance, yeast infections have been the subject of widespread educational and advertising efforts, but little attention has been paid to a more common form of infection: bacterial vaginosis, (BV).

What are the symptoms of “BV”?

Bacterial Vaginosis (“BV”) is associated with a foul-smelling (“fishy”) vaginal odor, a milky vaginal discharge and vaginal burning or itching.  One or more symptoms may be present, or there may be no symptoms.

Beyond the odor and discharge, does “BV” pose other problems for women?

Recent research has shown that BV increases the risk of some serious complications.  These include pelvic inflammatory disease (“P.I.D.”); infections following pelvic surgery, D & C, or abortion; and complications related to pregnancy, such as preterm labor, premature rupture of membranes, amniotic fluid infection, or post-partum infections.

What causes Bacterial Vaginosis?

BV is caused by an overgrowth of certain kinds of bacteria in the vagina.  Normally, the vagina contains protective bacteria called lactobacilli.  These “good” bacteria help maintain a normal pH level and hold down the growth of harmful microorganisms.  Anything that alters the normally acidic pH of the vagina can allow harmful organisms to take hold and flourish.

How many women get “BV”?

It is now thought that BV is even more common than yeast infections!  Studies show up to 1/3 of asymptomatic women will be found to be carriers of BV.

How do you get “BV”?

The cause of BV cannot always be traced.  It may be sexually transmitted—–but NOT always!  Having multiple partners will increase the probability of getting BV.  Many women diagnosed with BV are experiencing no symptoms.  This can make BV a serious hidden danger, especially because it could affect fertility and cause pregnancy complications.

What’s the difference between BV and a yeast infection?

A vaginal yeast infection is usually caused by Candida albicans, a fungus rather than bacteria.  Its symptoms include itching, burning and a “cottage cheese-like” discharge.  Yeast infections are usually odorless, and have not been associated with an increased risk of any serious medical complications.

Can I detect “BV” myself?

A fishy vaginal odor, burning, and a milky discharge are indicators of BV.  These are not always present.  If you suspect that you have BV, or some other type of vaginal infection, you should consult your gynecologist or nurse practitioner for proper diagnosis and treatment.

How will the doctor tell if I have “BV”?

The first thing that we may do is check the appearance of the vagina and cervix.  Women with BV typically have vaginal pH levels higher than 4.5, while normal levels are in the 4.0 range.  BV may cause the secretions to have a bad odor, but sometimes this is hard to detect.  A drop of potassium hydroxide (KOH) placed on a drop of secretions on a microscope slide will produce a positive “whiff test” if BV is present.  An additional test is the examination of the slides under a microscope to rule out the additional presence of yeast or trichomonas.

How does Bacterial Vaginosis affect my sex life?

There is no scientific evidence that BV affects sexual relations; but many women say they are bothered by the odor and vaginal burning during, and especially after intercourse.

Is “BV” a sexually transmitted disease?

Although BV is more common in women visiting clinics for sexually transmitted diseases, BV has also been reported in young girls and women who are not sexually active.

How is “BV” treated?

There are two topical and one oral method to treat BV.  Vaginal medicines include:  metranidazole gel (“MetroGel”) or clindamycin cream or ovules (“Cleocin”) used at bedtime for 1 to 7 nights, depending on the brand chosen.

The oral method is the use of metranidazole (“Flagyl”) tablets given orally for 5 to 7 days.

Once treated, could I get “BV” again?

As with most vaginal infections, recurrences of BV are common.  Some women have flare-ups of infection when they are on birth control pills or when pregnant

What about sex during the treatment?

It is recommended that your partner wear a condom while you are being treated.  The male is often not treated.

Most women feel physical or mood changes during the days before menstruation. When these changes affect a woman’s normal life, they are known as premenstrual syndrome (PMS).

Premenstrual syndrome can affect menstruating women of all ages and backgrounds. The cause of PMS is unclear. However, the symptoms can be managed in many women.

Symptoms

Premenstrual symptoms are a common part of the monthly cycle. In fact, at least 85 percent of women who menstruate have at least one premenstrual symptom.

Women with PMS experience a pattern of symptoms month after month. They also find that the symptoms interfere with some aspect of their family, social or work lives.

Common symptoms of PMS are:

• Emotional and behavioral symptoms
• Physical Symptoms

Diagnosis

To diagnose PMS, a doctor must confirm a pattern of symptoms. A woman’s symptoms must:

• Be present in the five days before her period for at least three menstrual cycles in a row
• End within four days after her period starts
• Interfere with some of her normal activities

PMS or Something Else?

Symptoms of other conditions can mimic PMS. For instance, premenstrual dysphoric disorder (PMDD) is a severe type of PMS.  PMDD affects a small percentage of women with PMS.

Depressive and Anxiety Disorders

These disorders are the most common conditions confused with PMS. The symptoms of depression and anxiety are much like the emotional symptoms of PMS. The symptoms of these disorders may worsen before or during a woman’s period. This makes some women think they have PMS.

Menopause

Women entering menopause may have PMS-like symptoms. These symptoms include mood changes and fatigue.

Other Conditions

Your doctor will want to rule out other conditions that share symptoms with PMS. These conditions include chronic fatigue syndrome, irritable bowel syndrome, and endocrine problems.

What You Can Do

Lifestyle and dietary changes often can relieve some PMS symptoms.  Talk with your doctor about your symptoms and treatment options.

Aerobic Exercise

For many women, aerobic exercise lessens PMS symptoms.

Relaxation

Finding ways to relax and reduce stress can help women who have PMS.

Dietary Changes

Simple changes in your diet may help relieve the symptoms of PMS.

Dietary Supplements

Dietary supplements help lessen the symptoms of PMS in many women.

Medications

Women with severe PMS may not feel relief with lifestyle or dietary changes alone. If these changes don’t reduce symptoms, your doctor may suggest medications.

Talk With Others

Talking with others about what you are going through can help. Sharing your feelings may help your family to support you more.

Finally …

Many women with PMS find relief with exercise and lifestyle changes. Others may find dietary supplements or medicines to be helpful.

If you have PMS, talk with your doctor about ways to find relief. Simple changes may help improve your well-being, all month long.

The Pap test (Papanicolaou test or Pap smear) checks for changes in the cells of your cervix. The cervix is the lower part of the uterus (womb) that opens into the vagina (birth canal). The Pap test can tell if you have an infection, abnormal (unhealthy) cervical cells, or cervical cancer.

During a Pap test, a small sample of cells from the surface of the cervix is collected. The sample is then spread or smeared on a slide (Pap smear) or mixed in a liquid fixative and sent to a lab to be looked at under a microscope. The cells are examined for cell changes that may be or can lead to cervical cancer.

A Pap test is usually done as part of a woman’s regular pelvic exam.

Why do I need a Pap test?

A Pap test can save your life. It can find the earliest signs of cervical cancer – a common cancer in women. If caught early, the chance of curing cervical cancer is very high. Pap tests also can find infections and abnormal cervical cells that can turn into cancer cells. Treatment can prevent most cases of cervical cancer from developing.

Getting regular Pap tests is the best thing you can do to prevent cervical cancer. About 13,000 women in America will find out they have cervical cancer this year. And in 2004, 3,500 women died from cervical cancer in the United States.

Should I get a Pap test when I have my period?

No. Doctors suggest you schedule a Pap test when you do not have your period. The best time to be tested is 10 to 20 days after the first day of your last period.

How is a Pap test done?

Your doctor can do a Pap test during a pelvic exam. It is a simple and quick test. While you lie on an exam table, the doctor puts an instrument called a speculum into your vagina, opening it to see the cervix. She will then use a special stick or brush to take a few cells from inside and around the cervix. The cells are placed on a glass slide and sent to a lab for examination. While usually painless, a Pap test is uncomfortable for some women.

How do I prepare for a Pap test?

Many things can cause wrong test results by washing away or hiding abnormal cells of the cervix. So, doctors suggest that for two days before the test you avoid:

• Douching
• Using tampons
• Using vaginal creams, suppositories, and medicines
• Using vaginal deodorant sprays or powders
• Having sex

What do abnormal Pap test results mean?

It is scary to hear that your Pap test results are “abnormal.” But abnormal Pap test results usually do NOT mean you have cancer. Most often there is a small problem with the cervix.

Some abnormal cells will turn into cancer. But most of the time, these unhealthy cells will go away on their own. By treating these unhealthy cells, almost all cases of cervical cancer can be prevented. If you have abnormal results, to talk with your doctor about what they mean.

Over one fourth of all women may be infected with a virus that may remain undetected by routine methods, such as the Pap smear.  This virus, called Human Papilloma Virus (“HPV”), has now reached almost epidemic proportions among sexually active women.  If left untreated for many years HPV has been linked to the potential development of cervical cancer.

Discover whether HPV is a Threat to You:

Experts estimate that over 85 % of all women with cervical cancer at one time were infected with HPV. Studies have shown that with proper detection and definitive treatment, the human papilloma virus should not progress to a cancerous stage.

One reason why HPV is not detected is the widespread reliance only on the Pap smear—often thought to be a fail-safe test for cervical disease.  If a woman’s Pap smear came back “negative,” she was told that she was free of cervical disorders. Recent studies have shown that pap smears often fail to diagnose HPV, a possible precursor to cancer.

Frequently, women report no symptoms of an abnormality that would indicate HPV. When there are symptoms, they may  include:

• Burning after intercourse
• Chronic vaginal discharge
• Warts on the vaginal opening, or anus

Often, it is up to the primary care physician or gynecologist to rule out the possibility of HPV. Here, warning signs include:

• Abnormal Pap smear
• Frequent vaginal infections

Who Gets the Virus?

Age is no barrier to HPV.  Women of all ages have been found to have HPV. All sexually active women are at risk, even those in a monogamous relationship:

Although HPV is primarily spread by sexual contact, this is not always the case.  There are reports of infection from gym equipment, tanning beds and shared towels.

Another cause is thought to be a depressed immune system—such as that caused by smoking. Finally, some women may have been born with the infection.

New Technology Detects HPV Before it reaches A More Critical Stage

Because of modern medical advances, procedures are available to help discover and treat diseases that were once responsible for disability and even death.  The Thin Prep is a specialized Pap smear designed to eliminate errors by human technologists. This test adds to the cost of a Pap smear, however insurance may not pay for it. An aggressive approach to chronic infections or a Pap smear showing only “Inflammatory Changes” often discovers unsuspected HPV.

With Proper Treatment, HPV Rarely Progresses to Cervical Cancer

To halt the progress of the HPV epidemic, it is believed that within a few years every sexually active woman will be told to have some sort of diagnostic test for human papilloma virus along with her Pap smear. If HPV is suspected, one or more of the following may be utilized:

COLPOSCOPY: This diagnostic inspection of the cervix with a microscope may include biopsies of suspicious areas.

“LEEP” SURGERY: This office surgical procedure involves the use of an electrically energized wire loop to remove the abnormal tissue.

LASER SURGERY: This technique uses a microscope to deliver energy in the form of a tiny beam of laser energy to destroy abnormal tissue.  It may be done in our office, or in a hospital setting.

CRYOSURGERY: Diseased tissue and warts can often be removed by freezing.

CREAMS: Prescription creams such as Efudex, or Aldara can sometimes be used on the cervix or individual warts on the perineum.

Effective Diagnosis and Treatment are NOW AVAILABLE in Our Area

The Center for Women’s Health is known in the metro Kansas City area for innovative treatment methods.  Because of clinical research affiliations with major pharmaceutical companies, Dr. Hodes and Dr. Nauser have access to new developments that are not yet widely available.  They have been involved in the study of Human Papilloma Virus, and are dedicated to alerting women in our area to its danger.

The office is equipped with the latest Colposcopy equipment, as well as in-office Laser and LEEP surgery.  The staff is especially sensitive to the needs of women with HPV and provides the compassionate care they need to fully recover.

Interstitial Cystitis (IC), also known as Painful Bladder Syndrome, is a condition that results in recurring discomfort or pain in the bladder and the surrounding pelvic region. The symptoms vary from case to case and even in the same individual. People may experience mild discomfort, pressure, tenderness, or intense pain in the bladder and pelvic area. Symptoms may include an urgent need to urinate (urgency), a frequent need to urinate (frequency), or a combination of these symptoms. Pain may change in intensity as the bladder fills with urine or as it empties. Women’s symptoms often get worse during menstruation. They may sometimes experience pain with vaginal intercourse.

Because IC varies so much in symptoms and severity, most researchers believe that it is not one, but several diseases. In recent years, scientists have started to use the term painful bladder syndrome (PBS) to describe cases with painful urinary symptoms that may not meet the strictest definition of IC.

IC can affect people of any age, race or sex. It is, however, most commonly found in women.

What are the Symptoms of Interstitial Cystitis?

Some or all of these symptoms may be present:

• FREQUENCY: Day and/or night frequency of urination (up to 60 times a day in severe cases). In early or very mild cases, frequency is sometimes the only symptom.
• URGENCY: The sensation of having to urinate immediately, which may also be accompanied by pain, pressure or spasms.
• PAIN: Can be in the lower abdominal, urethral or vaginal area. Pain is also frequently associated with sexual intercourse. Men with IC may experience testicular, scrotal and/or perineal pain, and painful ejaculation.
• OTHER DISORDERS: Some patients also report muscle and joint pain, migraines, allergic reactions and gastrointestinal problems, as well as the more common symptoms of IC described above. It appears that IC has an as yet unexplained association with certain other chronic diseases and pain syndromes such as vulvar vestibulitis, fibromyalgia and irritable bowel syndrome. Many IC patients, however, have only bladder symptoms.

How is Interstitial Cystitis Diagnosed?

Most IC patients have difficulty obtaining a diagnosis. To make a proper diagnosis of interstitial cystitis, a doctor must follow these steps:

Take urine cultures to determine if there is a bacterial infection present.

Rule out other diseases and/or conditions that have symptoms resembling IC. These diseases may include bladder cancer, kidney problems, tuberculosis, vaginal infections, sexually transmitted diseases, endometriosis, radiation cystitis and neurological disorders.

Perform a cystoscopy with hydrodistention under general anesthesia if no infection is present and no other disorder is discovered. If distention under anesthesia is not performed, the diagnosis of IC may be missed. Cystoscopy during a routine office visit may not reveal the characteristic abnormalities of IC and can be painful for those who have IC. It is necessary to distend the bladder under general or regional anesthesia in order to see the pinpoint hemorrhages on the bladder wall that are the hallmark of this disease. A biopsy of the bladder wall may be necessary at this time to rule out other diseases such as bladder cancer and to assist in the diagnosis of IC. IC is not associated with bladder cancer.

How is Interstitial Cystitis Treated?

At this time there is no cure for interstitial cystitis, nor is there an effective treatment which works for everyone. However, a vast majority of IC patients are helped by one or more of the following treatments:

Oral Medications – There are several drugs used to treat the causes and symptoms of IC.

Bladder Instillation – During a bladder instillation, also called a bladder wash or bath, the bladder is filled with a solution that is held for varying periods of time, averaging 10 to 15 minutes, before being emptied.

Bladder Distention - During this procedure, the bladder is distended or stretched by filling it with liquid. This not only helps diagnose interstitial cystitis (IC) but also, for reasons that aren’t completely clear, brings relief to a significant number of patients.

Other Treatments – These include changes in diet, stress reduction, visualization, bio-feedback, bladder retraining and exercise.  Additionally, surgery or electronic nerve stimulation might be required to treat IC.

Human papillomavirus (HPV) is one of the most common causes of sexually transmitted infection (STI) in the world. Health experts estimate there are more cases of genital HPV infection than any other STI in the United States. According to the Centers for Disease Control and Prevention (CDC), approximately 6.2 million new cases of sexually transmitted HPV infections are reported every year. At least 20 million people in this country are already infected.

Genital warts

Genital warts (sometimes called condylomata acuminata or venereal warts) are the most easily recognized sign of genital HPV infection. Many people, however, have a genital HPV infection without genital warts.

Genital warts are soft, moist, or flesh colored and appear in the genital area within weeks or months after infection. They sometimes appear in clusters that resemble cauliflower-like bumps, and are either raised or flat, small or large. Genital warts can show up in women on the vulva and cervix, and inside and surrounding the vagina and anus. In men, genital warts can appear on the scrotum or penis. There are cases where genital warts have been found on the thigh and groin.

CAUSE

More than 100 different types of HPV exist, most of which are harmless. About 30 types are spread through sexual contact and are classified as either low risk or high risk. Some types of HPV cause genital warts-single or multiple bumps that appear in the genital areas of men and women including the vagina, cervix, vulva (area outside of the vagina), penis, and rectum. These are considered low risk types. High-risk types of HPV may cause abnormal Pap smear results and could lead to cancers of the cervix, vulva, vagina, anus, or penis. Many people infected with HPV have no symptoms.

Some types of HPV cause common skin warts, such as those found on the hands and soles of the feet. These types of HPV do not cause genital warts.

TRANSMISSION

Genital warts are very contagious. You can get them during oral, vaginal, or anal sex with an infected partner. You can also get them by skin-to-skin contact during vaginal, anal, or (rarely) oral sex with someone who is infected. About two-thirds of people who have sexual contact with a partner with genital warts will develop warts, usually within 3 months of contact.

In women, the warts occur on the outside and inside of the vagina, on the opening to the uterus (cervix), or around the anus.

In men, genital warts are less common. If present, they usually are seen on the tip of the penis. They also may be found on the shaft of the penis, on the scrotum, or around the anus.

Rarely, genital warts also can develop in your mouth or throat if you have oral sex with an infected person.

Like many STIs, genital HPV infections often do not have signs and symptoms that can be seen or felt. One study sponsored by the National Institute of Allergy and Infectious Diseases (NIAID) reported that almost half of women infected with HPV had no obvious symptoms. If you are infected but have no symptoms, you can still spread HPV to your sexual partner and/or develop complications from the virus.

DIAGNOSIS

HPV infection is usually diagnosed based on results from an abnormal Pap smear, a primary cancer-screening tool for cervical cancer or pre-cancerous changes of the cervix. Another test to diagnose HPV infection detects the HPV DNA, which may indicate possible infection.

Your health care provider usually diagnoses genital warts by seeing them. If you are a woman with genital warts, you also should be examined for possible HPV infection of the cervix.

Your provider may be able to identify some otherwise invisible warts in your genital tissue by applying vinegar (acetic acid) to areas of your body that might be infected. This solution causes infected areas to whiten, which makes them more visible. In some cases, a health care provider will take a small piece of tissue from the cervix and examine it under the microscope.

TREATMENT

There are treatments for genital warts, though they often disappear even without treatment. There is no way to predict whether the warts will grow or disappear. Therefore, if you suspect you have genital warts, you should be examined and treated, if necessary.

Depending on factors such as the size and location of your genital warts, your health care provider will offer you one of several ways to treat them.

Imiquimod cream
20 percent podophyllin antimitotic solution
0.5 percent podofilox solution
5 percent 5-fluorouracil cream
Trichloroacetic acid (TCA)
If you are pregnant, you should not use podophyllin or podofilox because they are absorbed by your skin and may cause birth defects in your baby. In addition, you should not use 5-fluorouracil cream if you are pregnant.

If you have small warts, your health care provider can remove them by one of three methods.

Freezing (cryosurgery)
Burning (electrocautery)
Laser treatment
If you have large warts that have not responded to other treatment, you may have to have surgery to remove them.

Some health care providers inject the antiviral drug alpha interferon directly into warts that have returned after removal by traditional means. The drug is expensive, however, and does not reduce the rate that the genital warts return.

Although treatments can get rid of the warts, none get rid of the virus. Because the virus is still present in your body, warts often come back after treatment.

PREVENTION

GARDASIL is the only vaccine that may help guard against diseases caused by human papillomavirus (HPV) Types 6, 11, 16, and 18:

Cervical cancer
Cervical abnormalities that can sometimes lead to cervical cancer
Genital warts
HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases.

The only way you can prevent getting an HPV infection is to avoid direct contact with the virus, which is transmitted by skin-to-skin contact. If you or your sexual partner has warts that are visible in the genital area, you should avoid any skin-to skin and sexual contact until the warts are treated.

Historically, research studies have not confirmed that male latex condoms prevent transmission of HPV. Recent studies, however, demonstrate that consistent condom use by male partners suggests strong protection against low and high risk types of HPV infection in women. Unfortunately, many people who don’t have symptoms don’t know that they can spread the virus to an uninfected partner.

COMPLICATIONS

Cancer

Some types of HPV can cause cervical cancer. Other types are associated with vulvar cancer, anal cancer, and cancer of the penis (a rare cancer).

Most HPV infections do not progress to cervical cancer. If you are a woman with abnormal cervical cells, a Pap smear will detect them. If you have abnormal cervical cells, it is particularly important for you to have regular pelvic exams and Pap smears so you can be treated early, if necessary.

Pregnancy and Childbirth

Genital warts may cause a number of problems during pregnancy. Because genital warts can multiply and become brittle, your health care provider will discuss options for their removal, if necessary. Genital warts also may be removed to ensure a safe and healthy delivery of the newborn. Sometimes they get larger during pregnancy, making it difficult to urinate if the warts are in the urinary tract. If the warts are in the vagina, they can make the vagina less elastic and cause obstruction during delivery.

Rarely, infants born to women with genital warts develop warts in their throats (respiratory papillomatosis). Although uncommon, it is a potentially life-threatening condition for the child, requiring frequent laser surgery to prevent obstruction of the breathing passages. Research on the use of interferon therapy with laser surgery indicates that this drug may show promise in slowing the course of the disease.

GARDASIL is the only vaccine that may help guard against diseases caused by human papillomavirus (HPV) Types 6, 11, 16, and 18:

Cervical cancer
Cervical abnormalities that can sometimes lead to cervical cancer
Genital warts
HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases.

Help Protect Yourself Today

Gardasil is for girls and young women ages 9 to 26. GARDASIL works when given before you have any contact with HPV Types 6, 11, 16, and 18. If you’ve already been infected with HPV, you may still benefit from GARDASIL, because it is unlikely that you have been infected with all 4 types of the virus covered by the vaccine. That’s why we feel it’s important for you to know about this vaccine now.

Important Information For Young Women Ages 18 To 26

Vaccination with GARDASIL does not take the place of Pap tests (cervical cancer screenings). You should keep following your doctor’s or healthcare professional’s advice on getting Pap tests.

Pap tests have been proven to help save lives. A Pap test looks for abnormal cells in the lining of the cervix before they have the chance to become precancerous or cervical cancer. The more severe the abnormality, the more likely it is that cervical cancer could develop in the future.

Having an abnormal Pap test isn’t any reason to panic—it doesn’t always mean that you are at risk for cancer or even have HPV. Your doctor or healthcare professional may repeat the Pap test or do other tests as needed.

Pap tests will still be an important part of taking control of your health—and taking care of yourself.

Important Information For Mothers Of Girls Ages 9 To 17

Pap tests (cervical cancer screenings) have been proven to save lives. A Pap test looks for abnormal cells in the lining of the cervix before they have the chance to become precancerous or cervical cancer.

Your daughter’s doctor or healthcare professional can tell you when her first Pap test should be.

In the meantime, you can start her good healthcare habits now. Take her for regular wellness visits. Understanding the importance of wellness visits now may help her maintain regular checkups as she gets older.

Important Information About GARDASIL

HPV Types 16 and 18 cause 70% of cervical cancer cases, and HPV Types 6 and 11 cause 90% of genital warts cases. GARDASIL may not fully protect everyone and does not prevent all types of cervical cancer, so it is important to continue regular cervical cancer screenings.

Anyone who is allergic to the ingredients of GARDASIL should not receive the vaccine. GARDASIL is not for women who are pregnant.

GARDASIL will not treat these diseases and will not protect against diseases caused by other types of HPV.

GARDASIL is given as 3 injections over 6 months and can cause pain, swelling, itching, and redness at the injection site, fever, nausea, and dizziness. Only a doctor or healthcare professional can decide if GARDASIL is right for you or your daughter.