Learn more about Gynecological Infections and Sexually Transmitted Infections:
Abnormal Pap Smears
Genital Warts and HPV
Pelvic Inflammatory Disease ("PID")
Urinary Tract Infections ("UTIs")
What does an abnormal Pap smear mean?A Pap smear allows your doctor to look at the cells from your cervix (the lower part of your womb) and see if there are any problems.
- An abnormal Pap smear means that the cells of your cervix have shown some slightly abnormal changes.
- Some abnormal cells are more likely than others to be cancerous. Ask your doctor which of the following changes you have.
ASC stands for atypical squamous cells. Squamous cells form the surface of your cervix. ASC is divided into two categories:1. ASC-US means that although some of your cells are not normal, your doctor may not know why the cells changed or what impact it will have on you.
- These changes are usually not serious and may be caused by a vaginal infection or infection with a virus called HPV (human papillomavirus).
- Your doctor may want to do a follow-up examination such as a repeat Pap smear or HPV testing.
2. ASC-H means that some of your cells are not normal and there is a small possibility that they may be precancerous.
- Your doctor will probably want to perform a colposcopy, which will allow your doctor to more closely examine your cervix. (Click for more information on colposcopy.)
AGC stands for atypical glandular cells.
- Glandular cells are cells that produce mucus and are located in your cervix or uterus.
- These results mean that some of your glandular cells are not normal, but your doctor does not know why.
- These changes are usually more serious. People with AGC usually have a higher risk for cervical cancer.
- Your doctor will probably want to perform a colposcopy to examine any irregular tissue.
LSIL stands for low-grade squamous intraepithelial lesion.
- Low-grade means there are early changes in the size and shape of the cells.
- LSILs are often associated with the presence of HPV, which may cause genital warts.
- You can be infected with HPV even if you or your partner have never had visible warts. (Click here for more information on HPV.)
- Your doctor will probably perform a colposcopy, HPV testing or recommend a repeat Pap smear.
HSIL stands for high-grade squamous intraepithelial lesion.
- High-grade means the cells are very different from normal cells. These cells are usually precancerous and are more likely to lead to cervical cancer.
- Your doctor will probably perform a colposcopy to determine how at risk you are for cancer.
Inflammation – if present in the cells on the Pap smear, it means that some white blood cells were seen on your Pap smear.
- Inflammation of the cervix is very common and usually does not mean there is a problem.
- If the Pap smear showed the inflammation is severe, your doctor may want to find the cause, such as an infection.
- Your doctor may also recommend a repeat Pap smear to see if the inflammation has gone.
Hyperkeratosis is a finding of dried skin cells on your Pap smear.
- This change in the cells of the cervix often occurs from using a cervical cap or diaphragm or from having a cervical infection.
- Hyperkeratosis rarely needs any more evaluation than a repeat Pap smear in 6 months to 1 year.
- If the hyperkeratosis is still present on the repeat Pap smear, your doctor may want to perform another Pap smear or perform a colposcopy.
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What is human papillomavirus?Human papillomavirus (also called HPV) causes a common infection that one person can give to another person during sex. There are many types of HPV:
- Some types of HPV cause genital warts
- Other types of HPV are connected with cancer of the cervix
Who should have a test for HPV?An abnormal Pap test does not mean that you have a disease of the cervix. When your Pap test is not normal, your doctor may want you to get a test for HPV.
The doctor may use the HPV test results to help decide if you should have a colposcopy exam. (A colposcope is a special magnifying lens that is used to look at your cervix.) Or your doctor may want you to have Pap tests every few months, or even some other tests.
How does the doctor test for HPV?The doctor rubs a small swab against your cervix and puts the swab in a tube of special liquid. This tube goes to a lab. If the lab finds HPV in the liquid, your doctor will know what HPV type you have.
What do the test results mean?
- If the test shows that you do not have HPV infection, you probably do not have a precancerous change on your cervix.
- A precancerous change is a cell change that might lead to cancer (but it might not). Your doctor may want you to get another Pap test in 4 to 6 months, just to keep watching for a problem.
Positive HPV Result:
- If the HPV test shows that you do have HPV on your cervix, your doctor may want you to have a colposcopic exam. Many women with HPV infection have an abnormal colposcopic exam.
- If you do have HPV infection, your doctor may want you to have a biopsy. The doctor will cut a small bit of tissue from your cervix and check it for signs of cancer.
- HPV is an infection that may last for a long time. If you have it, you will always need to have regular and frequent Pap tests, to keep watching for signs of cancer. Your doctor may want you to have Pap tests every 4 to 6 months to check the status of the HPV infection.
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What is bacterial vaginosis?Bacterial vaginosis is a mild infection in the vagina caused by a type of bacteria (germ). The vagina normally contains a lot of "good" bacteria, called lactobacilli (say: "lack-toe bah-sil-li"), and a few other types of bacteria, called anaerobes. Too many anaerobes (say: "ann-air-robes") can cause bacterial vaginosis. We don't know why the anaerobe bacteria overgrow and cause this infection.
How do I know I have bacterial vaginosis?You may notice a discharge from your vagina. The discharge may be clear or colored. It may be very light or heavy. It may have a fishy smell, especially after you have intercourse. Some women have bacterial vaginosis without any symptoms.
How can my doctor tell if I have bacterial vaginosis?Your doctor will examine your vagina and use a cotton swab to get a sample of the discharge. This sample will be tested.
If this is an infection, did I catch it from someone?No. Bacterial vaginosis is an overgrowth of bacteria that are normally in the vagina. While it is more common in women who are sexually active, it also occurs in women who are not sexually active. It's not usually necessary for your sex partner to be treated.
Does it have to be treated?Yes. If the infection isn't treated, the bacteria may get up into the uterus or the fallopian tubes and cause more serious infections. Treating bacterial vaginosis lowers this risk. Treatment is especially important in pregnant women.
How is bacterial vaginosis treated?It can be treated in one of several ways. Your doctor may prescribe pills for you to take by mouth, or a cream or gel to put in your vagina. It's important to use your medicine exactly as your doctor tells you.
If your doctor prescribes metronidazole (brand name: Flagyl) or other medicines, don't drink any alcohol while taking the medicine or for 24 hours afterward. Combining alcohol with these medicines can cause nausea and vomiting. Even the small amount of alcohol in many cough syrups can cause nausea and vomiting if you are taking metronidazole. Also, be sure to tell your doctor about any other medicines you are currently taking.
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What is a chlamydial infection?Chlamydia is a bacteria (germ) that men and women catch by having sex with someone who is infected. It can also be given to newborn babies by mothers who have a chlamydial infection during the last part of their pregnancy.
How do I know I have a chlamydial infection?A chlamydial infection can cause many different health problems, including vaginal discharge, spotting, pain with sex, lower stomach ache, irregular periods, a burning feeling when urinating, a discharge from the penis and trouble getting pregnant. Sometimes, however, a chlamydial infection causes no symptoms at all.
How could I get this infection?You could get a chlamydial infection by having sex with a person who has a chlamydial infection. If you have had sex with a new partner, or many sex partners or a partner who has had many sex partners, and especially if you do not always use condoms, you are at higher risk of a chlamydial infection. Your doctor may check you for a chlamydial infection when you are pregnant, even if you have no signs of the infection, because the infection is so harmful to newborns.
How is a chlamydial infection treated?A chlamydial infection is treated with antibiotics. Your doctor may want to obtain a lab test to see if you have the infection. Your doctor may decide to give you antibiotics while waiting for the test results. If the results show you have a chlamydial infection, it is important to tell anyone you have had sex with that you have this infection, so they can be treated too.
Tell your doctor if you have any allergies to antibiotics and if there is any chance you might be pregnant. Be sure to finish all your antibiotics and do not have sex until both you and your sex partner(s) have finished taking the antibiotics. If you get a fever or bad stomach pain while taking the antibiotics, let your doctor know right away.
How can I prevent another chlamydial infection?Know the people you have sex with, and limit the number of people you have sex with. Always use a condom. You may also use nonoxynol-9 with the condom; it may help kill some of the bacteria that cause some sexually transmitted diseases.
Women aged 25 and younger who are having or have had any kind of sex (oral, vaginal, anal) should see their doctor on a routine basis to be screened for chlamydia.
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What is a colposcopy?A colposcopy is a way your doctor can examine your genitals, vagina and cervix closely. A colposcope is an instrument that shines a light on the cervix and magnifies the view for your doctor.
- A colposcopy is usually performed to help your doctor find the reason for an abnormal Pap smear.
- Is important because it can detect cancer of the cervix at an early stage.
- At the beginning of the exam, you lie back and place your feet in the stirrups as you would for a Pap smear.
- Your doctor inserts a speculum into your vagina and opens it slightly so he or she can see your cervix.
- A vinegar solution is applied to the cervix and vagina with a cotton ball or swab.
- The vinegar makes abnormal tissue turn white so your doctor can identify areas that may need further evaluation.
Is the procedure painful?
- If your doctor takes a biopsy sample, you may feel mild cramps and pinching when he or she removes the abnormal tissue.
- Relaxing your muscles as much as possible and taking slow, deep breaths during the procedure may help.
- You may feel less discomfort if you take an over-the-counter pain reliever before the procedure.
- Ask your doctor what kind of medicine you should take, how much to take, and when to take it. (When you ask, be sure to let your doctor know if you are pregnant or if you are allergic to any medication.)
How should I prepare to have a colposcopy?
- You may be more comfortable if you empty your bladder and bowels before the procedure.
- Do not douche or have sexual intercourse during the 24 hours before your appointment.
Does this procedure affect my ability to have children?No. If your doctor takes a biopsy sample, the amount of tissue taken from your cervix is very small and removing it will not affect any future pregnancies. However, it is important to let your doctor know if you are pregnant now or even if you might be pregnant. This information will change the way your doctor does the procedure.
Will I have bleeding after a colposcopy?You may have a dark-colored vaginal discharge after the colposcopy. If your doctor takes a biopsy sample, he or she will put a thick, brownish-yellow paste on that area to stop any bleeding. When this paste mixes with blood, it forms a thick black discharge. It is normal to have this discharge for a couple of days after the procedure. It is also normal to have a little spotting for at least two days after a colposcopy.
Can I use tampons after the procedure?No. Do not use tampons or put anything in your vagina for at least 1 week after the procedure, or until your doctor tells you it’s safe. Do not have sexual intercourse for at least 1 week.
When should I call my doctor?Call your doctor right away if you have any of the following problems after your colposcopy:
- Heavy vaginal bleeding (using more than one sanitary pad per hour).
- Lower abdominal pain.
- Fever, chills or a bad-smelling vaginal odor.
When will I get the results of my colposcopy?It usually takes 1 to 2 weeks for your doctor to get a report from the pathologist who looks at your biopsy samples. Your doctor’s office will contact you when these results are available. You will need to make a follow-up appointment with your doctor to talk about the results and any additional treatment you may need. Try to schedule an appointment no later than 1 month after your colposcopy.
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Genital Warts and HPV
What Is HPV?HPV stands for human papilloma virus. There are more than 100 types of HPV. Some produce warts — plantar warts on the feet, common hand warts, juvenile warts, butcher's warts, and genital warts.
About 30 types of HPV can infect the genital area — the vulva, vagina, cervix, rectum, anus, penis, or scrotum. Some types may cause genital warts. Some types may cause changes in cells. These types increase the risk of cervical and certain other cancers.
Most types seem to have no harmful effect at all.
How Many People Have Genital Warts?Between 500,000 and one million new cases of genital warts occur every year.
How Are Genital Warts Spread?Vaginal, anal, and oral sex spread genital warts. Genital warts often grow more rapidly during pregnancy or when a person's immune system is weakened by things such as diabetes, HIV/AIDS, chemotherapy, Hodgkin's disease or taking anti-rejection drugs after an organ transplant.
How Long Does It Take For Genital Warts To Appear After A Person Gets Infected?Warts usually develop three weeks to six months after infection. But it may take longer.
How Can I Avoid Getting Genital Warts?
- Abstinence is the only 100 percent-effective way to avoid infection.
- Use condoms every time. They can reduce the risk of genital warts but they are not as effective against HPV as they are against more serious infections, such as HIV.
- Protect your immune system with a healthy lifestyle.
- Stop smoking. Smokers may be more likely to develop genital warts than nonsmokers. They are also more likely to have warts recur.
How Can People With Genital Warts Avoid Spreading Them?People should stop having intimate contact as soon as they think they have genital warts. They should seek treatment immediately.
What Do Genital Warts Look Like?They often are flesh-colored, soft to the touch, and look like miniature cauliflower florets. Usually they grow in more than one place and may cluster in large masses. Genital warts usually are painless but may itch. You might see or feel genital warts in your vagina, vulva, cervix, penis, anus, or urethra. Although less likely, it is possible to have them in your mouth, on the lips, tongue and palate, or in the throat. Not all bumps are warts. Checking yourself is not the best way to find out if you have warts. Other infections that look like genital warts are treated differently. Secondary syphilis, hemorrhoids, skin tags, and, rarely, certain skin cancers, can look like genital warts. Conditions on the penis that resemble warts include Tyson's glands, lymphoceles, Fordyce's spots, and pearly penile papules, which appear in one out of three men.
How Are Genital Warts Diagnosed?Only clinicians can correctly diagnose genital warts. In women, genital warts are often seen during a pelvic exam. Unfortunately, men are seldom examined for sexually transmitted infection, unless they complain of symptoms. Women and men with more than one sex partner — or whose partners have more than one sex partner — should have regular exams for sexually transmitted infections, including genital warts.
Diagnosing Other HPV InfectionsHPV infections that cannot be seen with the naked eye may be seen with a variety of clinical instruments:
- A colposcope may be used to magnify cervical and vaginal tissue.
- A Pap test may reveal precancerous conditions of the cervix that are caused by HPV. Early treatment can prevent cancer of the cervix.
- Microscopic examination of tissue samples, called Hybrid Capture II®, can find very small amounts of HPV in fluid or tissue samples. Only a clinician can give the test, and some health insurance policies will pay for it. This test is not needed routinely for most people.
How Are Genital Warts Treated?Very often, genital warts fade away by themselves. But sometimes they need to be removed. Warts can be removed with various treatments, can cause discomfort. Some treatments cannot be used during pregnancy. <
- Podofilox and imiquimod can be applied directly to genital warts and are prescribed for use at home.
- A clinician applies other treatments, such as podophyllin, trichloroacetic acid (TCA), and bichloroacetic acid (BCA).
- They may be removed with cryotherapy (frozen off) or electrocauterized (burned off). Or they may be removed with surgery or with lasers.
- Less commonly, they are treated with injections of interferon or 5-fluorouracil/epinephrine.
Is There A Cure For Genital Warts?Most people are cleared of warts by the first series of treatments. Warts recur for some people, however, during several months after treatment - especially if they smoke cigarettes. Some people continue to have recurrences after long periods of time.
What Happens If Genital Warts Are Not Treated?They can disappear, stay the same, or grow in size and in number. Genital warts can cause sores and bleeding — which can increase the risk of HIV infection, if you are exposed.
Do Genital Warts Cause Cervical Cancer?No. The types of HPV that cause genital warts do not cause cancer. But people sometimes have more than one HPV infection at a time. Warts may be a sign of infection with more serious types of HPV. Pap tests are essential for women whether or not they have warts.
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GonorrheaGonorrhea (gone-o-RHEE-a) is a bacterium that can cause sterility, arthritis, and heart problems. In women, gonorrhea can cause pelvic inflammatory disease (PID), which can result in ectopic pregnancy or sterility. During pregnancy, gonorrhea infections can cause premature labor and stillbirth. To prevent serious eye infections that can be caused by gonorrhea, drops of antibiotics are routinely put into the eyes of newborn babies immediately after delivery. About 650,000 new cases of gonorrhea are reported every year in the U.S.
- For women: frequent, often burning, urination; menstrual irregularities, pelvic or lower abdominal pain; pain during sex or pelvic examination; a yellowish or yellow-green discharge from the vagina; swelling or tenderness of the vulva; and even arthritic pain.
- For men: a pus-like discharge from the urethra or pain during urination
How gonorrhea is spread: vaginal, anal, and oral intercourseDiagnosis: microscopic examination of urethral or vaginal discharges; cultures taken from the cervix, throat, urethra, or rectum. Urine tests are also available.
Treatment: Both partners can be successfully treated with oral antibiotics. Often people with gonorrhea also have chlamydia. They must be treated for both infections at the same time.
Protection: Condoms reduce the risk of infection with gonorrhea.
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What is herpes?Herpes is the name of a group of viruses that cause painful blisters and sores. One kind of herpes, herpes simplex causes both cold sores around the mouth and genital herpes (herpes around the sexual organs). Herpes zoster, another kind of herpes, causes chickenpox and shingles.
How is genital herpes spread?Genital herpes is spread easily.
- The virus from contact with an infected person can enter your body through a break in your skin or through the skin of your mouth, penis or vagina, urinary tract opening, cervix or anus.
- most easily spreads when blisters or sores can be seen on the infected person. But it can be spread at any time, even when there aren't any symptoms.
- Usually spread from one person to another by having sex, including oral sex.
- From one place on your body to another, such as from your genitals to your fingers, then to your eyes or to other parts of your body.
- Herpes can also be spread from a mother to her baby when she gives birth
What should I do if I think I have herpes?See your doctor as soon as you think you may have herpes. Herpes is easier to diagnose when there are sores. You can start treatment sooner and perhaps have less pain with the infection.
What happens once someone is infected?Once you have the virus, you'll go through different stages of infection. Each stage is explained in the following sections.
Primary stageThis stage usually starts 2 to 8 days after you're infected, but it can take much longer to begin. Usually, the infection causes groups of small, painful blisters. The fluid in the blisters may be clear or cloudy. The area under the blisters will be red. The blisters break open so easily that they quickly become open sores. You may not ever notice the blisters.
Besides having tender blisters or sores in your genital area, it may hurt to urinate. You may run a fever and have other flu-like symptoms.
While most people have a painful primary stage of infection, some don't have any symptoms at all, and may not even know they're infected.
Latent stageDuring this stage, there are no blisters, sores or other symptoms. At this time, the virus is traveling from your skin into the nerves near your spine.
Shedding stageThe virus starts multiplying in the nerves. It can then get into body fluids, such as saliva, semen or vaginal fluids. This is called shedding. There are no symptoms during this stage, but the virus can be spread during this time.
RecurrencesMany people have blisters and sores that come back after the first herpes attack goes away. This is called a recurrence. Usually, the symptoms aren't as bad as they were during the first attack.
Stress, being sick or being tired may start a recurrence. Being in the sun or having your menstrual period may also cause a recurrence. You may know when a recurrence is about to happen because you may feel itching, tingling or pain in the places where you were first infected.
Is there a cure for herpes?No. But medicines can help. The medicine acyclovir (brand name: Zovirax) can speed up healing and can lessen the pain of herpes for many people.
Acyclovir pills can treat primary or recurrent herpes and can stop or lessen the number of recurrences. Acyclovir also comes in a cream to put on sores during the primary stage or during recurrences.
Famciclovir (brand name: Famvir) and valacyclovir (brand name: Valtrex) are other medicines used to treat recurrent genital herpes and for prevention of recurrences.
Tips to soothe the pain
- Take aspirin, acetaminophen (brand name: Tylenol) or ibuprofen (brand names: Advil, Motrin, Nuprin).
- Place lukewarm or cool cloths on the sore place.
- Take lukewarm baths. (A woman may urinate in the tub at the end of the bath if she is having pain urinating -- this helps dilute the urine so it doesn't burn the sores so badly.)
- Keep the area dry and clean.
- Wear cotton underwear.
- Wear loose-fitting clothes.
What about how I feel about having herpes?It's common to feel guilty or ashamed when you hear you have herpes. You may feel that your sex life is ruined or that someone you thought you could trust has hurt you. You may feel sad or upset.
Keep in mind that you are one of millions of people with herpes. Herpes may get less severe as time goes by, and you can help protect your sex partner by not having sex during outbreaks and by using condoms at other times.
Talk to your family doctor about how you're feeling.
Is there a safe time to have sex and not spread herpes?No time is completely safe because it's hard to know for sure when you can spread herpes. You must tell your sex partner that you have herpes.
- You should avoid having sex if you have any sores. Herpes can spread from one person to another very easily when sores are present. Another reason to avoid sex when sores are present is that sores make it easier to catch the AIDS virus.
- You should use condoms every time you have sex. Condoms can only help reduce the risk of spreading herpes if they cover all the infected skin.
Can I give herpes to my baby if I'm pregnant?Tell your doctor if you have genital herpes or if you have ever had sex with someone who did. The main concern is that the baby may be born while you have sores or are shedding the herpes virus, which could spread the infection to the baby. If a baby catches herpes, it could be serious.
The baby is usually safe in the uterus. When the baby passes through the birth canal, it may catch herpes. Your doctor may do a cesarean section ("C section") if you have an outbreak at the time you go into labor, so the baby won't have to go through your birth canal.
Tips on dealing with herpes
- Talk to your doctor if you think you may have herpes.
- Remember that you're not alone. Millions of people have herpes.
- Keep yourself healthy and limit your stress.
- Don't touch your sores.
- Tell your sex partner and use condoms.
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Pelvic Inflammatory Disease ("PID")
What is pelvic inflammatory disease (PID)?Pelvic inflammatory disease (PID) is an infection in the female reproductive organs. Normally, the cervix prevents bacteria in the vagina from spreading up into the internal organs. If the cervix is exposed to a sexually transmitted disease (STD) such as gonorrhea or chlamydia, the cervix becomes infected. If the disease travels up through the internal organs, they can also become inflamed and infected. It can damage the fallopian tubes and make it difficult to become pregnant.
How does a woman get PID?
- The most common way is to have sex with a person who has gonorrhea or chlamydia.
o These diseases are carried in the semen and other body fluids of infected people. During sexual contact, the germs spread to the woman's cervix.
o The germs can also infect the glands at the opening of the vagina, the urethra (passageway for urine) or the anus.
o When the cervix is infected with gonorrhea or chlamydia, normal vaginal bacteria can spread through the cervix and into the uterus, fallopian tubes, ovaries and abdomen.
o Sometimes women get PID without being exposed to gonorrhea or chlamydia. Doctors aren't sure why this happens, but sometimes normal bacteria in the vagina spread into the uterus, fallopian tubes and abdomen, causing PID.
- PID can also occur after certain surgical procedures on the female organs.
- It can occur after the insertion of an intrauterine device (IUD), but this isn't common.
- After an abortion or after procedures that take a sample from the inside of the womb, such as a dilatation and curettage (D & C).
- After the cervix is treated because of an abnormal Pap smear.
How do I know if I have PID?PID causes different symptoms in different women. Most women have a "stomachache," or dull pain and tenderness in the stomach. During a pelvic examination, it's common to feel pain or abdominal tenderness when your doctor touches or moves the cervix.
PID may also cause a vaginal discharge. The discharge usually has a yellow or green color to it and may have an unusual odor. Some women have irregular periods, such as extra long periods, spotting or cramps throughout the month. Other women become very sick, with chills, high fever, nausea and vomiting. Some women have pain during sex. Unfortunately, some women have PID without these symptoms and don't know they have it. If you have PID, follow all your doctor's instructions and finish all the medicine you are given, even if you feel better after a few doses. If you have any questions, talk with your doctor.
What should I do if I have symptoms of PID?Women who have these symptoms or who think they have been exposed to an STD should see their doctor right away. There is no over-the-counter treatment for PID. Your doctor can only diagnose PID with a pelvic exam and cultures (swabbing the area and having the sample tested). The sooner you see your family doctor, the better! Waiting even 1 or 2 days can allow the infection to spread farther into your body and cause more pain and damage.
What are the risk factors for PID?The same things that put you at risk for STDs put you at risk for PID. Risk factors for PID include sexual contact with multiple partners and unsafe sexual habits. Both men and women can carry STDs and not have any symptoms. They can expose their sex partners to a disease without knowing it.
How do I practice safe sex?Avoid sexual contact with people who are at risk of infection. If you decide to have sex, ask your partner first if he or she has any risks for infection. A male partner should always wear a condom. Even though the condom will not prevent 100% of STDs or PID, it will greatly reduce your chances of getting infected.
Remember, birth control pills, the birth control shot and birth control implants (brand name: Norplant) can't prevent you from getting PID or an STD. Only a condom can provide some protection against infections.
How is PID treated?Treatment begins with an exam. Depending on how sick you are, the treatment can be done either in the hospital or on an outpatient basis. If you are very sick with PID, or if you are pregnant, are under the age of 18 or have the HIV virus, hospitalization is usually recommended.
If you are treated as an outpatient, you must take your medicine just the way your doctor tells you. If you don't take all the pills, your symptoms will get worse and you may have to go to the hospital. A few days after you start taking the medicine, you'll have to see your doctor again.
What can happen to my body if I get PID?Early and complete treatment can help prevent complications of PID. Unfortunately, if PID isn't treated it can cause permanent damage to your internal organs. Scar tissue can form in the fallopian tubes and around the abdomen. These scars can prevent pregnancy or cause the pregnancy to form in the fallopian tube (called a tubal or ectopic pregnancy). Scarring can cause pain that lasts for months or even years. Occasionally, the effects of PID can be so severe that surgery is required to remove pus, get rid of scar tissue or remove damaged organs. Finally, PID is more likely to come back if you are exposed to STDs again. Each episode of PID causes more damage and a greater possibility of complications.
Should my partner be treated if I have PID?If you are treated for PID, especially if an STD is found, your partner must also be treated. Unless your partner is treated, you may be infected again. Making good choices about sexual contact is important. If you think you might have PID, check with your family doctor.
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TrichomoniasisTrichomoniasis (trick-oh-mo-NEYE-ah-sis) or "Trich" is a condition caused by a protozoan — a microscopic, one-cell animal. It is a common cause of vaginal infection. Up to five million Americans develop trichomoniasis every year.
- frothy, often unpleasant-smelling discharge
- itching in and around the vagina
- blood spotting in the discharge
- swelling in the groin
- urinating more often than usual — often with pain and burning.
How trichomoniasis is spread: vaginal intercourse; mutual masturbation; if fluids from one partner are passed to the genitals of the other.Diagnosis: microscopic examination of vaginal discharge
Treatment: Drugs called 5-nitroimidazoles are successful for both partners.
Protection: Condoms reduce the risk of infection with trich. Spermicide offers some protection.
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Urinary Tract Infections ("UTIs")UTIs are caused by bacteria that have spread from the rectum to the vagina or penis and then to the urethra and bladder. They may be sexually transmitted. UTIs include infections of the bladder — also called cystitis; the ureters — the tubes that lead from the kidneys to the bladder; and the urethra — the tube that carries urine from the bladder to outside of the body.
Severe cases, left untreated, may cause kidney infection.
- burning pain during urination
- the urge to urinate when the bladder is nearly empty
- a frequent urge to urinate, especially at night
- involuntary loss of urine
- lower abdominal pain or back pain
- blood and pus in urine
How UTIs are spreadAnything — including sex play — that brings particles of fecal material into contact with the vagina and urethra can cause UTIs. Unprotected anal intercourse is a very high-risk behavior for urinary tract infection. Some women who use the diaphragm or shield are susceptible to frequent UTIs.
Diagnosis: Consult your clinician to confirm diagnosis and treatment.
- Pyridium may relieve symptoms but will not cure the infection.
- Drink eight or more glasses of water a day. Avoid soft drinks, which can promote the growth of bacteria.
- Drink unsweetened cranberry juice.
- Urinate immediately before and after intercourse.
- Avoid using any sexual position that seems to trigger UTIs.
- Keep the pubic area clean and dry.
- Use latex or female condoms during vaginal or anal intercourse.
- Wipe from front to back after bowel movements to avoid the spread of bacteria to the urethra.
- Use lubricants during vaginal intercourse — especially if the vagina is dry.
- Some women who are susceptible to frequent UTIs take antibiotics to prevent infections when they have sexual intercourse.
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Is vaginal discharge normal?Yes. Glands inside your vagina and cervix make small amounts of fluid. This fluid flows out of the vagina each day, carrying out old cells that have lined the vagina. This is your body's way of keeping your vagina healthy and clean. The discharge is usually clear or milky and doesn't smell bad.
The color and thickness of the discharge change with your monthly cycle. The discharge is thicker when you ovulate (when one of your ovaries releases an egg), when you breastfeed or when you're sexually excited.
What changes may be a sign of a problem?Changes that may signal a problem include an increase in the amount of discharge, a change in the color or smell of the discharge, and irritation, itchiness or burning in or around your vagina. This is called vaginitis. A discharge that's stained with blood when you're not having your period could also be a sign of a problem. If you have any of these signs, you should talk to your doctor.
What can cause these changes?These changes can occur if the normal balance of healthy germs in your vagina is upset. Many things can disturb the balance of a healthy vagina, including douching, feminine hygiene sprays, certain soaps or bubble baths, antibiotics, diabetes, pregnancy or infections.
How can douching be harmful?The chemicals in douches may irritate your vagina and change the normal balance of germs in your vagina. Douching can also spread an infection into the uterus, increasing your risk of getting pelvic inflammatory disease (PID). PID is an infection of the fallopian tubes that can cause you to be unable to have children.
Douching isn't necessary to keep your body clean. Smells you may notice usually come from outside the vagina (vulva). Keeping this area clean with gentle soap and water can prevent smells.
Tips on preventing vaginitis
- After using the toilet, always wipe from front to back. This may help prevent getting bacteria from your rectal area into your vagina.
- Wear cotton underpants during the day. Cotton allows your genital area to "breathe." Don't wear underpants at night.
- Avoid wearing tight pants, pantyhose, swimming suits, biking shorts or leotards for long periods.
- Change your laundry detergent or fabric softener if you think it may be irritating your genital area.
- The latex in condoms and diaphragms and the sperm-killing gels that are used for birth control can be irritating for some women. If you think one of these things is a problem for you, talk to your doctor about other types of birth control.
- Avoid hot tubs.
- Bathe or shower daily and pat your genital area dry.
- Don't douche
- Avoid feminine hygiene sprays, colored or perfumed toilet paper, deodorant pads or tampons, and bubble bath.
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What is a vaginal yeast infection?Vaginal yeast infections are caused by a fungus called Candida albicans. Yeast are tiny organisms that normally live in small numbers on the skin and inside the vagina. The acidic environment of the vagina helps keep yeast from growing. If the vagina becomes less acidic, too many yeast can grow and cause a vaginal infection.
The acidic balance of the vagina can be changed by your period (menstruation), pregnancy, diabetes, some antibiotics, birth control pills and steroids. Moisture and irritation of the vagina also seem to encourage yeast to grow.
How do I know if I have a yeast infection?Yeast infections can be very uncomfortable, but are usually not serious.
Symptoms include the following:
- Itching and burning in the vagina and around the vulva (the skin that surrounds your vagina)
- A white vaginal discharge that may look like cottage cheese
- Pain during sexual intercourse
- Swelling of the vulva
How are these infections treated?Yeast infections are usually treated with medicine that you put into your vagina. This medicine may be a cream that you insert in your vagina with a special applicator, or it may be a suppository that you put into your vagina and allow to dissolve on its own. Medicine in a cream form can also be put on your vulva to help relieve itching. Medicine in a pill form that you take by mouth is also available.
Should I see my doctor every time I have a yeast infection?Be sure to see your doctor the first time you have symptoms of a yeast infection. It is very important to make sure you have a yeast infection before you start taking medicine. The symptoms of a yeast infection are also the symptoms of other infections, such as some STDs. Treating yourself for a yeast infection when you actually have another type of infection may make the problem much worse.
If you have often been diagnosed with yeast infections, talk to your doctor about using a medicine you can buy without a prescription.
Here are some things you can do to help prevent another yeast infection:
- Do not wear tight-fitting or synthetic-fiber clothes.
- Wear cotton panties.
- Do not wear pantyhose or leotards every day.
- Use your blow dryer on a low, cool setting to help dry your genital area after you bathe or shower and before getting dressed.
- Wipe from front to back after using the toilet. This may help prevent the bacteria that normally live in your rectum from getting into your vagina.
- Change out of wet swimsuits or other damp clothes as soon as you can.
- Do not douche or use feminine hygiene sprays, deodorant sanitary pads or tampons, or bubble bath, and avoid using colored or perfumed toilet paper. These items seem to affect the balance of acidity of the vagina and can lead to symptoms of a yeast infection.