The Curbsiders' 'Hot Takes'

Vulvovaginitis: A Commonsense Approach

The Curbsiders


February 12, 2021

This transcript has been edited for clarity.

Matthew F. Watto, MD: Welcome back to The Curbsiders. I'm Dr Matthew Watto, and I'm joined by my two good friends and board-certified internal medicine physicians, Dr Stuart Brigham and Dr Paul Williams.

Paul N. Williams, MD: The episode that we are going to talk about today was with the great Dr Monica Christmas, who gave us tips for managing vulvovaginitis. Stuart, you had some takeaways from this podcast.

Stuart K. Brigham, MD: I have to point out that we are three guys talking about vulvovaginitis. My takeaway might seem like common sense, but it wasn't common sense to me. It's important to talk about the use of feminine hygiene products. Using either acidic or basic hygiene products will affect the pH balance and encourage overgrowth of bacteria or Candida species. This is especially important at menopause, when the vaginal secretions change.

Williams: Dr Christmas talked about genitourinary syndrome of menopause (GSM), which is the newer terminology for what was formerly known as atrophic vaginitis. The symptoms include vaginal dryness, reduced lubrication with sexual activity, and discomfort or pain with sex. I was astounded at the prevalence of GSM — it's around 40%-60%. It's not something that I typically ask my older patients about. Given the prevalence of GSM, I'll have to ask more often. I will be more proactive about eliciting the symptoms of GSM because there are things you can do to relieve them, such as moisturizers, lubricants during sex, and topical estrogen. My big takeaway? Make sure to ask.

Watto: Returning to Stuart's point, Dr Christmas said multiple times that the vagina is a self-cleaning organ, and all the products out there — soaps, fragrances, douches — are not helping. When you have someone who has recurrent candidiasis or bacterial vaginosis, with chronic vaginitis symptoms, make sure above all that they stop using these products. Hammer home the point that it is a self-cleaning organ, and they may be exacerbating symptoms instead of making them better.

Another thing she said is that it's pretty common to have recurrent symptoms of bacterial vaginosis or candidiasis. With bacterial vaginosis, the treatment is 16 weeks of metronidazole gel, and for candidiasis it's 16 weeks of weekly fluconazole. Boric acid suppositories (or pessaries) can be bought from a famous online retailer if patients can't find them at their local pharmacy.

Williams: If you enjoyed this conversation or want to hear more from our podcast with Dr Christmas, click on #244: Vulvovaginitis for All Ages or find The Curbsiders' podcasts on iTunes. You can read our show notes and join our mailing list.

Thank you for watching.

The Curbsiders are a national network of students, residents, and clinician educators from across the country representing 15 different institutions. They "curbside" experts to deconstruct various topics in the world of medicine to provide listeners with clinical pearls, practice-changing knowledge, and bad puns. Learn more about their contributors and follow them on Twitter.

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