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When we call out sick from work with a cold, we tell our friends and co-workers exactly what’s going on. But, stigma often keeps us from telling our close friends, and even partners, when we have a vaginal imbalance or infection.
I’ve had enough hushed conversations with friends to know that sometimes having an imbalance feels like you can’t catch a break. And once you’re on the roller coaster of experiencing everything from burning pee to itchiness, it can feel like things will never even out.
You probably won’t pass people on the street yelling, “Bacterial vaginosis, again!” but you can bet that you’re not alone.
We’re here to take a look at the three most common imbalances — urinary tract infections (UTIs), yeast infections, and bacterial vaginosis (BV) — and why it could be a good idea to pause your sex life when they occur.
Not the same as STIs
For the record, BV, yeast infections, and UTIs are not considered sexually transmitted infections (STIs). People who aren’t sexually active can get them. However, sexual contact might be the cause or the reason why they’re constantly reoccurring.
I sat down with Lily and Maeve*, friends who were willing to dish about their own experiences for the greater good. I also turned to Kara Earthman, a women’s health nurse practitioner based in Nashville, Tennessee, for all the clinical details.
Let’s start off with UTIs, which are often characterized by:
- pelvic pain
- a burning feeling when you pee
- cloudy urine
UTIs affect your urethra so they aren’t technically a vaginal imbalance. But, they often occur because bacteria around the vagina gets into the urethra since they’re very close in proximity, says Earthman.
For Maeve, UTIs tend to happen after having a lot of consecutive sex, waiting a little bit to pee after sex, not drinking enough water, or after drinking a lot of alcohol or caffeine.
“One thing I’ve realized,” she says, “is that if I feel symptoms coming on, I need to take care of it right away. I had an experience where [a UTI] escalated really fast and I had to go to the ER after having blood in my urine.”
Since these chronic UTIs put her on high alert, she knows exactly what to do for her body. “Now, I basically run to the bathroom to pee after sex. I actually take a UT biotic prophylactically each day to decrease my chances of getting a UTI.”
Maeve also sang the praises of the urinary pain relief medication that she takes to reduce pain until antibiotics kick in. (Don’t worry if you notice your pee has turned a quite vibrant orange…that’s normal when taking UTI pain relief meds.)
According to Earthman, recurring UTIs can also occur if you don’t practice proper hygiene. But what is “proper hygiene” anyway? Earthman describes it as:
- drinking a lot of water
- wiping from front to back
- urinating before and after intercourse
- showering after intercourse, if possible
Be sure to also clean sex toys before and after use as well, especially if they’re shared. And even in the spur of the moment, it’s a good idea to take a minute to wash your hands if it’s been a while.
So, when is it safe to try natural remedies and when should you head to the doctor?
Earthman says if you feel symptoms of a UTI coming on, you can start by drinking more water and cutting out caffeine and acidic foods.
If your symptoms persist through a full day or begin to worsen within the day, she recommends seeing a healthcare provider. UTIs, unlike BV or yeast infections, can quickly turn into kidney infections, which can sometimes be life-threatening.
If you also have a fever, chills, or flu-like symptoms with a UTI, Earthman says to head straight to your provider or your nearest urgent care (or even ER, if need be).
When is it an anatomy thing?
If Earthman’s patients are following proper hygiene protocols and still experience recurring UTIs, she tends to wonder if a structural abnormality is the root cause. Only a specialist can determine that, so Earthman often refers her patients to a urologist or a urology gynecologist.
Next up, yeast infections. Common symptoms include:
- cottage cheese-like discharge
- pain during sex
While yeast infections left untreated aren’t dangerous in the same way UTIs can be, they’re certainly uncomfortable.
Since it’s possible for bacteria to be passed back and forth during intercourse, using condoms or the withdrawal method, which decrease amount of sperm in the vagina, can help decrease your risk.
But, as our friend Lily learned the hard way, be sure to use plain condoms. She shares, “[Once] there was one condom left, so my partner at the time and I used it. I was trying to be better about using condoms with him, because his semen seemed to make the yeast infections worse. But I realized after sex that we had used a grape flavored condom. I was basically just sitting there waiting to get a yeast infection. A day or two later, there it was…”
According to Earthman, recurrent yeast infections are often linked to a weakened immune system. For example, people with diabetes often battle chronic yeast infections. Frequent antibiotic use can also hinder your body’s ability to keep vaginal flora in check, allowing for yeast overgrowth.
How can you prevent them?
There’s a laundry list of things to avoid but they’re all pretty easy. Earthman advises:
- avoiding scented soaps and laundry detergents (that includes bubble baths and bath bombs!)
- changing out of sweaty underwear or wet bathing suits as quickly as possible
- only cleaning your vagina once a day with a mild soap or warm water
- wearing cotton underwear
- taking a daily probiotic
Blood and semen can also alter the pH of the vagina, so Earthman recommends making sure that when you have your period, you’re changing pads and tampons out fairly regularly.
If you’re experiencing recurring yeast infections, you’ve got options
You can take an over-the-counter antifungal like Monistat. Earthman recommends using the three- or seven-day regimens instead of the one day. It’s more of a hassle, but it tends to work better.
For more complex and long-term yeast infections, your provider might prescribe fluconazole (Diflucan).
If you’d like to keep things natural, there are vaginal suppositories like boric acid that can sometimes provide relief.
Lily swears by Yeast Arrest. “I’ll put in a suppository like Yeast Arrest at the first sign of itching, and I’ll use a three-day over-the-counter antifungal if it gets worse. I take that with me on vacation, just in case. And if I really can’t kick it, that’s when I’ll call my doctor for Diflucan. Diflucan always seems to work, but I like to try other things first.”
As Earthman puts it, “Recurring BV is the bane of my existence! It probably keeps our office in business [because] it’s all too common.”
Symptoms of BV are fairly obvious. Discharge is thin white, grey, or greenish, and often comes with a fishy smell.
Could your partner have anything to do with it? Earthman says that, yes, occasionally there are bacterial strains that you and your partner can pass back and forth.
The only way to really know if you have these specific strains is to have a culture taken of vaginal flora, so that both partners can be treated. She doesn’t advise taking cultures immediately for BV since they can be pretty costly and most strains will respond to one or two antibiotic types.
Otherwise, because BV is another type of vaginal imbalance, there are standard prevention measures you can take. Earthman recommends a lot of the same prevention measures as she does for yeast infections, such as:
- avoiding scented products
- wearing cotton underwear
- daily probiotic
- using condoms or withdrawal method
When it comes to treating BV, there are a few natural options
First off, it’s possible that BV will resolve on its own. Earthman shares that the less you do, the better — the vagina is self-cleaning and really doesn’t need much.
She recommends taking probiotics, noting that although they can be expensive, they’ll eventually pay for themselves if they keep you out of the doctor’s office. Earthman also highly recommends cleaning sex toys before next use.
Vaginal imbalances are normal and nothing to be ashamed of. And while it’s true that they can put sex on pause, nobody should feel inclined to have painful, uncomfortable, or lackluster sex. It’s so important to be able to talk to your partner about either abstaining from sex or having nonpenetrative sex until you’re feeling better.
It’s always OK to take a break and focus on getting back to feeling like your freshest, healthiest self.
Track your vagina
Changes throughout the month are normal, so keeping track of things like changes in discharge and smell can help you know when something’s gone awry. We like tools and apps such as Clue, Labella, and Monthly Info.
Perhaps these lifestyle and hygiene tweaks will be enough to send you on your way. Or, maybe your provider can recommend a more rigorous course of treatment to knock out a stubborn infection. In any case, getting to know your body better can help you advocate for what you need.
Let’s face it: The vagina has a super delicate balance of flora and pH. It’s totally normal for something like a panty liner or sperm to throw your whole system off. But the more we talk about it, the more we’ll realize how normal it actually is.
*Names have been changed at the request of the interviewees.
Ryann Summers is an Oakland-based writer and yoga teacher whose writing has been featured in Modern Fertility, LOLA, and Our Bodies Ourselves. You can follow her work on Medium.