Vaginal Discharge - Candida and Bacterial Vaginosis

Vaginal discharge can be many things, it can be completely normal or an indication of an infection or inflammation. The 2 most common infections are Bacterial vaginosis (I’m going to call it BV from now on) and candida. It is thought that 40-45% of women presenting with vaginal discharge have BV, and about 20-25% have candida. I find these numbers really interesting as most women think they have candida and many are guilty of using over-the-counter candida remedies and don’t see results as they are treating the wrong thing. The remaining 30-40% of women presenting with vaginal discharge may have a variety of other infections such as Trichomoniasis, chlamydia, gonorrhea, etc.  I’m going to focus on BV and candida as you they are by far the most common causes of vaginal discharge.

Let's start by considering a healthy vagina. Ideally, you would like low vaginal microbial variability, you want a Lactobacilli dominant microbiome. Lactobacilli can convert glycogen into lactic acid. Creating an acidic or low-pH environment that acts as a first line of defense, inhibiting the overgrowth of many nasty bugs. The ideal range is between 3.6-4.5.

Healthy vaginal fluid is clear to white, it is odorless, and has a high viscosity. The quantity and structure of this fluid changes over the month if you are still cycling to match the higher fluid demands of ovulation. Around this time your fluid can resemble that of egg whites with a wetter, whiter, stretchier mucus than at other times of the month.

On the other hand, a dysbiotic unhealthy vaginal microbiome has a pH of higher the 4.5,  can create a coloured discharge, causes vulvar irritation and itch, create an unpleasant odour, and may be linked to urinary tract infections and pain with intercourse. The physical discomfort can be matched with emotional discomfort and embarrassment.

Some of the factors that move a vagina towards an unhealthy state include

Hormonal status. With peri-menopause and its associated hormonal swings, you may experience a relative estrogen dominance, this increases your likelihood of issues with candida as candida thrives in an estrogen-rich environment. On the other hand menopause and its associated low estrogen state changes your vaginal pH away from an acidic environment and towards an alkaline environment reducing your risk of candida but increasing the likelihood of bv.

If you are still menstruating you may notice that menstruation also changes your risk profile. Menstruation itself increases your pH level and it also provides an iron-rich environment which many problematic microbes love especially Gardnerella vaginalis, the main bacteria implicated in BV.

Sexual activity can influence your pH with male ejaculate and saliva lowering it. In regards to lubricants, you really need to find a pH-friendly version, there are a few on the market these days but YES lubricant is a good one that is generally easy to find.

Some women are worried about their smell, and self-prescribe douches. There are very few scenarios in which douching actually helps. Please stop this unless you have spoken to a healthcare provider about your individual circumstances.

If you are a smoker, I’m going to give you yet another reason to quit. Smoking has an anti-estrogenic effect that has been linked to an increased risk of BV.

On to BV specifics.

Not only is BV common, but many women also get stuck in a vicious cycle of recurrent infections.

Whenever reoccurring infections happen think biofilms. I think of a biofilm as a dome that protects the infections. It is thought that biofilms can create a 10-1000-fold increase in protection against antibiotics. Gardnerella creates the scaffolding and structure of the biofilm and, then it likes to invite its friends to hide out together creating a polymicrobial biofilm that increases its strength and resistance. As Gardnerella increases your pH, it opens the door to other pathogenic bugs but its besties include privotella and Sneathia.

The vaginal discharge associated with BV is fishy in odour and whitish greyish in colour. It is common in all women but menopausal women and menstruation women at the time of their menses are most at risk.

On to candida specifics

Candida isn’t always a problem, it can be a commensal microbe but it does have pathogen potential. Candida thrives under certain circumstances. It loves an estrogen-rich environment, it loves a high glucose environment, it misbehaves after antibiotic use and in times of immunodeficiency. Pathogenic candida also loves to build itself a very sturdy highly structured biofilm house.

The vaginal discharge associated with candida can resemble cottage cheese and produces a most intense itch

The most common type of candida is candida albicans, the form that is most likely to reoccur and produce the sturdiest biofilm is candida glabrata. When glabrata is present a new approach is needed as the standard approach won’t tickle yet alone penetrate its biofilm. How do you know what form of candida is present - you test. Ask your local doctor or sexual health clinic to take a swab.

Creating a healthy vulvovaginal area (the vulva is the external genital and the vagina is the internal genital) starts with the environment - specifically its pH level and the health of the microbiome. Did you realise you can test your own pH levels at home? Find some litmus paper - remember this from high school science? It changes colour and measures pH. You need to find a paper that measures at least in 0.5 increments. Break off a piece of paper and insert it about 1/2 a finger into your vagina, wipe it on the internal surface, and remove and match the colour to the box. A result greater than 4.5 indicates an alkaline environment that is at greater risk of Bv and other pathogenic infections, as you have lost that acidic first line of defense. Treatment aim #1 is to assess and attempt to restore an ideal pH level.

When it comes to testing your vagina microbiome you have options, if you are experiencing an active issue you can get this fluid swabbed and identified by a medical professional. It's not a thorough microbiome test but it's looking at ruling in or out common causative factors, if you are after a more intense look at your microbiome several companies are offering self-swab kits. These are out-of-pocket expenses done in the comfort of your own home and provide a much more detailed look at your microbiome. Depending on your results, treatment aim #2 is to help restore a lactobacilli-dominant microbiome.

Next is assessing if you need to take a wrecking ball to the biofilm communities in your microbiome. If you are having reoccurring issues, you will have to do this to break the cycle.

Other factors to consider include hormonal status, cleaning up your diet and improving your blood sugar regulation, lifestyle factors, and personal hygiene factors such as using pH-friendly lubricants and avoiding self-douching. Your general immune health may need topping up and your nervous system may require some TLC to reduce the stress response.

If you need a hand achieving these aims, please reach out. I offer a complimentary discovery call so we can chat about what is happening for you and see if we are a fit to work together.