Free Book Excerpt from "The V Book: A Doctor's Guide to Complete Vulvovaginal Health"

by Elizabeth Gunther Stewart, MD,
Fellow of the American Congress of Obstetricians and Gynecologists

A renowned vulvovaginal expert and author of The V Book: A Doctor's Guide to Complete Vulvovaginal Health (Bantam Books, 2002), Dr. Stewart is working with the Vagisil Women's Health Center^SM (VWHC) as a member of the medical advisory board. Below are informative excerpts from Chapter 7 of The V Book, dealing with many of the most common vulvovaginal problems. For information on how to obtain the full book, visit www.randomhouse.com.

The Most Bothersome Symptoms

Possible Causes and Cures

An aggravating,can't-take-your-mind-off-it irritation begins. Or you notice that your vaginal discharge has a funny scent and is more profuse than normal. Or you feel uncomfortably, even painfully, dry, so that intercourse or even inserting a tampon hurts. One or more of these symptoms may represent a V problem, either on the vulva, in the vestibule, or up in the vagina. A variety of harmless scenarios also may be to blame. To help you evaluate the situation, here's a detailed tour of some of the most common—and annoying—vulvovaginal symptoms women experience: odor, itching, unusual discharge, and dryness.

Vaginal Odor

Almost every woman worries at one time or another that she has an unpleasant odor associated with vaginal secretions. Yet this is one symptom that my patients are especially reluctant to admit to because they believe that odor implies poor personal hygiene. Inadequate washing is almost never the cause of a V scent. Remember that some scent is to be expected from all activity in the Vs. As I mapped out in Chapter 2, the vulva has many sweat glands, and sweat produces odor. Normal secretions from the vagina may not be noticeable at all or may smell faintly like sour milk. Then there are the secretions, discharge, and menstrual flow that stay on a pad or underwear and are exposed to bacteria normally present, producing an odor. Not least, you should realize that every woman has her own unique scent. Most women are especially sensitive to this personal scent, which may not be detectable to others. If the same odor that you've had for as long as you can remember is suddenly bothering you or your partner, first consider whether anything simple discussed in this chapter—sweat, a new vitamin pill—might be responsible. If not, it should be checked out by your clinician…

Vaginitis is the number-one reason behind an unpleasant odor. More specifically, the leading culprits include the following types of vaginitis:

Vaginal Itching

…In the vulvovaginal area, everything itches! That's how most problems first show up. Correctly pinpointing the source of this annoying symptom is important, because misdiagnosis can prolong or even complicate it…

…What causes itching? The possibilities can range from the truly benign (and easily remedied) to more serious conditions that require a clinician's care.

Unusual Vaginal Discharge

Remember that all women have discharge. It's useful to be familiar with what's normal for you so that you can use a change from that baseline to help figure out what's wrong if you develop a problem. The appearance, texture, scent, and amount of discharge differ for different women; what's normal for you can also vary depending on where you are in the menstrual cycle and your stage of life… …Individual women tolerate widely different amounts of secretions—another reason to cue into what is normal for you…

Here's what normal discharge is not: It does not itch, irritate, or burn. It does not smell like fish. It does not smell like ammonia.

Abnormal discharge usually occurs when there is an infection. There's no single variation to look for. Abnormal can mean many things: The discharge may vary from scant, to more than usual, to quite profuse. Its color may be gray-white, yellow-white, or yellow-green. It might be bloodstained if the inflammation is severe. If you notice any of these things, or if there is suddenly a marked change in the amount of discharge and it bothers you, you'll want to have it checked out.

Among the possible causes of unusual discharge:

Unusual Vaginal Discharge

V lubrication is one of those things you don't think about until it's gone. Normal secretions from the vulva, vestibule, and vagina keep you comfortable. Their amounts vary from woman to woman, with a wide range of normal. During sexual arousal, a clear and relatively odorless fluid adds to the normal secretions as the perfect natural lubricant. When normal day-to-day V lubrication is present, you may not notice, but when it's absent, you may start to feel dry and uncomfortable. Sexual intercourse can be painful.

V dryness is a problem that plagues women of all ages from time to time. Fortunately, it can usually be remedied fairly simply.

What causes vulvovaginal dryness? A number of things can, many of them the same causes of V itching…

… Key causes of dryness include:

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