Most female patients phrase this question in a sheepish and embarrassed tone. These patients also tend to look as if they’d rather be anywhere else than in our consult room asking about vaginal discharge.
First of all, vaginal discharge is perfectly normal in ladies of childbearing age. It is produced by glands in your cervix & vagina and this mucus carries away dead cells and bacteria, keeping your female reproductive tract healthy!.
The amount and consistency of your vaginal discharge can vary depending on the time of your cycle as this is influenced by hormones. The colour may vary from milky white to yellow after exposure to air. During ovulation, vaginal discharge takes on a clear stretchy egg white texture.
This is a yeast infection that tends to cause thick clumpy white vaginal discharge & intense itching. It is treated with anti-fungal oral pills or vaginal pessaries.
This is a common bacterial infection that creates a characteristic fishy odour with thin watery vaginal discharge & discomfort, easily treated with a course of antibiotics.
Gonorrhoea, Chlamydia, Trichomoniasis – These conditions also cause abnormal vaginal discharge together with other symptoms like vaginal burning, painful intercourse, painful urination & bleeding.
There might be abnormal bleeding noticed after sexual intercourse or foul-smelling vaginal discharge. Most cervical cancers are due to HPV infections ( Human papilloma virus) hence cervical cancer vaccines such as Gardasil 9 are recommended for females before they become sexually active. Regular pap smears aid in early detection of any early cancerous changes & presence of HPV infections in the cervix.
It is important to have a proper consultation, examination and tests so that you will receive appropriate treatment.
Medications like birth control pills alter the hormonal balance and pH of the vaginal environment. Antibiotics kill both good and bad bacteria sometimes allowing overgrowth of yeast resulting in vaginal thrush.
Sexually transmitted diseases like chlamydia, gonorrhoea, trichomoniasis are spread via sexual contact with infected partners. Bacterial vaginosis is also more common in women with multiple partners.
Diabetes causes raised blood glucose levels due to insulin resistance resulting in reduced immunity and increased susceptibility to infections such as yeast.
Douching, vaginal dryness, natural lack of lactobacilli in your vaginal flora all predispose to vaginal infections such as bacterial vaginosis.
The vaginal walls become thin and dry may cause increased number of vaginal & urinary tract infections.
Dora is the managing partner of Mint Medical Centre who possesses the sincere heart and warm pleasant demeanour of a caring family physician. She has always understood the holistic and varied nature of family medicine, so has clinical experience that encompasses children’s and adult’s emergencies, obstetrics & gynaecology, neurosurgery, respiratory medicine, anaesthesia, paediatric surgery, health promotion board (school health) and the government polyclinic.
Mint Medical Centre is the fulfilment of her bigger dream of providing ongoing care in a well-rounded, friendly family medicine clinic that serves all people; both locals and expatriates, young and old. She derives special satisfaction from helping those who are new to Singapore and enabling them to settle here well.
This is the question most of our urinary tract infection (UTI) patients in Singapore ask. in this article, i will be explaining what is a UTI, the types of UTI, the symptoms, the probable causes and how to reduce your risk of getting them in the future.
The urinary system consists of the kidneys, ureters, urinary bladder and the urethra. Urine is formed in the kidneys and is drained down this system (tract). Urinary tract infection is the infection that involves one or more components of this system. The presence of pathogens, such as yeast and bacteria, in the urine suggest the presence of an infection along the urinary tract.
Recurrent UTI is a condition where patients keep contracting the infection two or more times over a 6 months period or three or more times over a 1-year period. This for is more common among young and healthy women.
There are two types of acute uncomplicated UTI, which is based on the location of the infection:
|Lower UTI (Most common)||Upper UTI|
|Cystitis (Urinary bladder||Pyelonephritis (Kidney)|
|Urethritis (Urethra)||Ureteritis (Ureter|
Unfortunately, UTI’s are more common in women than in men. Almost 50% of women will experience an episode of UTI during their lifetime. Approximately, 1 in every 3 women will have had an episode of infection requiring antibiotics by the age of 24 years old.
UTI is uncommon in males with an incidence of approximately 5 to 8 per 10,000 per year in men aged below 50. The incidence of UTI in male increase only after the age of 50.
The reason for the low incidence in males is due to the urinary tracts more superior innate defense to infections. This means when a male gets a UTI, it is usually a more complicated condition and further investigations are needed. Things to look out for include an enlarged prostate gland blocking the outflow of urine from the bladder, diabetes, partial blockage of the urethra by a stricture and even a sexually transmitted disease.
One of the main reasons why it is more common in females is because of the shorter urethra when compared to males. Besides that, the opening of the urethra is close to the anus. This allows bacteria from your intestine to enter the urethra and due to the short urethra, it easily travels up to the bladder.
The rate of men and women getting it increases as they get older.
Some research studies have linked a family history of UTI to an increased likelihood of having recurrent UTI.
Sexual intercourse is known to trigger UTI in women and is the cause of up to 80% of cases in women. Research data has shown that the more frequent you have intercourse the higher your risk of getting it. This is where the term ‘honeymoon cystitis’ came about. This is where women develop a bladder infection due to the increased amount of sexual activity on their honeymoon.
Besides that, it is also known that the risk of recurrent UTI is higher when having a new sexual partner.
There are a lot of changes that happen to the structures in the pelvis after menopause. Due to weakening of the pelvic floor muscle, the bladder and uterus may shift downwards causing a prolapse of those structures. This in turn may cause changes in the flow pathway of urine and cause incomplete urination. Due, to the hold up of urine, bacteria may start growing and cause an infection.
There are also changes in the vagina, which may affect the bacterial lining (flora) around the urethra. This may also potentially lead to an infection.
Other risk factors associated with UTI and/or recurrent UTI are:
b) Use of diaphragm or spermicide
d) Presence of indwelling urinary catheter (draining urine from bladder using a tube)
e) Pre-existing urinary tract structural abnormalities or stones along the urinary tract.
Well after reading the section above on symptoms and you think you might have a UTI, it is advised to see a doctor. The doctor will need to take a full detailed history and examine you to make sure you don’t have any complications of the infection and to see if a cause can be identified. The doctor will then prescribed you antibiotics and advise you on methods to reduce your risk of developing UTI.
These tips are essential for patients who suffer from recurrent UTI:
As described above, sexual activity increases your risk of contracting the infection especially with the use of spermicide. Therefore, you should reduce the use of spermicide or spermicide containing products during sexual activity. Besides that, having a high number of active sexual partners also increase your risk of getting a UTI, so one should reduce the number of partners. For those that are using diaphragm for contraception should consider other options for birth control.
We all have been told by our parents, when young, that we should drink a lot of water. Besides keeping you well hydrated, that advice decreases your risk of getting a UTI because this leads to a higher urine production which makes you pass more frequently. Therefore, it reduces the stagnation of urine and doesn’t provide the bacteria a lot time to cause an infection.
During intercourse, there is a probability of introducing new pathogens in the urethral opening. Therefore, urination right after intercourse will help flush them away and reduce the changes of them causing an infection.
There are a lot of bacteria that tend to hang around the anus. Wiping from back to front, especially after a bowel movement, potentially transfers some of those bacteria to the urethral region. However, if you wipe from front to back, it is less likely that you would transfer them to the urethral region.
You tend to see a lot of people recommending the consumption of cranberry juice during or in preventing a UTI. However, there has not been any conclusive clinical studies demonstrating its benefit in reducing recurrent UTI rate. Despite that, there have been some lab-based research that showed cranberries have certain properties that may stop the adherence of bacteria to the cells found in the lining of the urinary tract. In conclusion, there is no direct harm in trying this prevention method except for the slight increase in calorie intake.
Antibiotic prophylaxis is a type of treatment prescribed by a doctor to prevent illnesses.
Taking antibiotics over a period has been shown to be very effective in patients with recurrent UTI. Usually the doctor will recommend the above behavioral changes initially, if not working they will then prescribe antibiotics. This is under the discretion of the doctor as it depends on each patient’s situation such as the frequency of recurrences and if there are any patterns in the recurrences. In other words, it can be used continuously or just after sex (post-coital) to prevent recurrences.
In some patients, the doctor may prescribe antibiotics for self-treatment when a patient starts developing early signs of recurrence.
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