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What Every Dad and Husband Needs to Know About Vaginal Yeast Infections & Bacterial Vaginosis

HELP!!! I think my wife (or daughter) may have a vaginal yeast infection

Maybe, it's that her jeans are too tight, or clitoral/labial adhesions, or a change in menstrual hygiene or vaginal hygiene habits.... even maybe changing a bathsoap or laundry detergent may cause your wife's (or daughter's) vulvovaginal area to begin itching. Any of these may have something to do with vulvovaginal itch and/or irritation. But if the itch keeps getting itchier, even when her tight-fitting jeans have been off for awhile, then there's something else involved.

That something else could very well be a fungus whose technical name is Candida, and which causes what is often called a "yeast" infection. Such infections are most common in teenage girls and women aged 16 to 35, although they can occur in girls as young as 10 or 11 and in older women (and less often, in men and boys as well). You do not have to be sexually active to get a yeast infection.

The Food and Drug Administration now allows medicines that used to be prescription-only to be sold without a prescription to treat vaginal yeast infections that keep coming back. But before you run out and buy one, if you've never been treated for a yeast infection you should see a doctor. Your doctor may advise you to use one of the over-the-counter products or may prescribe a drug called Diflucan (fluconazole). FDA recently approved the drug, a tablet taken by mouth, for clearing up yeast infections with just one dose.

Though itchiness is a main symptom of yeast infections, if you've never had one before, it's hard to be sure just what's causing your discomfort. After a doctor makes a diagnosis of vaginal yeast infection, if you should have one again, you can more easily recognize the symptoms that make it different from similar problems. If you have any doubts, though, you should contact your doctor.

In addition to intense itching, another symptom of a vaginal yeast infection is a white curdy or thick discharge that is mostly odorless. Although some women have discharges midway between their menstrual periods, these are usually not yeast infections, especially if there's no itching.

Candida is a fungus often present in the human body. It only causes problems when there's too much of it. Then infections can occur not only in the vagina but in other parts of the body as well--and in both sexes. Though there are four different types of Candida that can cause these infections, nearly 80 percent are caused by a variety called Candida albicans.

The biggest cause of Candida infections is lowered immunity. This can happen when you get run down from doing too much and not getting enough rest. Or it can happen as a result of illness.

Though not usual, repeated yeast infections, especially if they don't clear up with proper treatment, may sometimes be the first sign that a woman is infected with HIV, the virus that causes AIDS.

FDA requires that over-the-counter (OTC) products to treat yeast infections carry the following warning:

"If you experience vaginal yeast infections frequently (they recur within a two-month period) or if you have vaginal yeast infections that do not clear up easily with proper treatment, you should see your doctor promptly to determine the cause and receive proper medical care."

Repeated yeast infections can also be caused by other, less serious, illnesses or physical and mental stress. Other causes include:

Sometimes hot, humid weather can make it easier for yeast infections to develop. And wearing layers of clothing in the winter that make you too warm indoors can also increase the likelihood of infection.

"Candida infections are not usually thought of as sexually transmitted diseases," says Renata Albrecht, M.D., of FDA's division of anti-infective drug products. But, she adds, they can be transmitted during sex.

The best way not to have to worry about getting yeast infections this way is not to have sex. But if you do have sex, using a condom will help prevent transmission of yeast infections, just as it helps prevent transmission of more commonly sexually transmitted diseases, including HIV infection, and helps prevent pregnancy. Teens should always use a latex condom if they have sex, even if they are also using other forms of birth control. (See "On the Teen Scene: Preventing STDs" in the June 1993 FDA Consumer.)

If one partner has a yeast infection, the other partner should also be treated for it. A man is less likely than a woman to be aware of having a yeast infection because he may not have any symptoms. When symptoms do occur, they may include a moist, white, scaling rash on the penis, and itchiness or redness under the foreskin. As with females, lowered immunity, rather than sexual transmission, is the most frequent cause of genital yeast infections in males.

The OTC products for vaginal yeast infections have one of four active ingredients: butoconazole nitrate (Femstat 3), clotrimazole (Gyne-Lotrimin and others), miconazole (Monistat 7 and others), and tioconazole (Vagistat). These drugs are in the same anti-fungal family and work in similar ways to break down the cell wall of the Candida organism until it dissolves. FDA approved the switch of Femstat 3 from prescription to OTC status December 1996 and a similar switch for Vagistat in February 1997. The others have been available OTC for a few years.

When you visit the doctor the first time you have a yeast infection, you can ask which product may be best for you and discuss the advantages of the different forms the products come in: vaginal suppositories (inserts) and creams with special applicators. Remember to read the warnings on the product's labeling carefully and follow the directions.

Symptoms usually improve within a few days, but it's important to continue using the medication for the number of days directed, even if you no longer have symptoms.

Candida infections in the mouth are often called "thrush." Symptoms include creamy white patches that cover painful areas in the mouth, throat, or on the tongue. Because other infections cause similar symptoms, it's important to go to a doctor for an accurate diagnosis.

Wearing artificial fingernails increases the chance of getting yeast infections under the natural fingernails. Fungal infections start in the space between the artificial and natural nails, which become discolored. Treatment for these types of infections--as well as those that occur in other skin folds, such as underarms or between toes--require different products, most of which are available only with a doctor's prescription.

Knowing the causes and symptoms of yeast infections can help you take steps--such as giving those tight jeans a rest--to greatly reduce the chances of getting an infection.

And, if sometimes prevention isn't enough, help is easily at hand from your doctor and pharmacy.

What is bacterial vaginosis (BV)?

Bacterial vaginosis, also called BV is the most common vaginal infection in women of childbearing age. It happens when the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria. The vagina normally contains mostly “good” bacteria, and fewer “harmful” bacteria. BV develops when there is an increase in “harmful” bacteria and fewer “good” bacteria.

What causes BV?

The cause of BV is not understood. It can develop when something, like sexual contact, disrupts the balance between the good bacteria that protect the vagina from infection and the harmful bacteria that don't. It is not clear what role sexual activity plays in the development of BV, but BV is more common among women who have had vaginal sex. But BV is not always from sexual contact. We do know that certain things can upset the normal balance of bacteria in the vagina and put you more at risk for BV:

We also know that you do not get BV from toilet seats, bedding, swimming pools, or from touching objects around you.

What are the signs of BV?

Women with BV may have an abnormal vaginal discharge with an unpleasant odor. Some women report a strong fish-like odor, especially after sexual intercourse. The discharge can be white (milky) or gray and thin. Other symptoms may include burning when urinating, itching around the outside of the vagina and irritation. However, these could be symptoms of another infection too. Some women with BV have no symptoms at all.

How can I find out if I have BV?

There is a test to find out if you have BV. Your doctor takes a sample of fluid from your vagina and has it tested. Your doctor may also be able to see signs of BV, like a grayish-white discharge, during an examination of the vagina.

How is BV treated?

BV is treated with antibiotics, which are medicines prescribed by your doctor. Your doctor may give you either metronidazole or clindamycin. Generally, male sex partners of women with BV do not need to be treated. You can get BV again even after being treated.

Is it safe to treat pregnant women who have BV?

All pregnant women with symptoms of BV or who have had a premature delivery or low birth weight baby in the past should be tested for BV and treated if they have it. The same antibiotics that are used to treat non-pregnant women can be used safely during pregnancy. However, the amount of antibiotic a woman takes during pregnancy may be different from the amount taken if not pregnant.

Can BV cause medical problems?

In most cases, BV doesn't cause any problems. But some problems can happen if BV is untreated.

How can I prevent BV?

BV is not well understood by scientists, and the best ways to prevent it are unknown. What is known is that BV is associated with having a new sex partner or having multiple sex partners. Follow these tips to lower your risk for getting BV:

How to Avoid Infection

Many people recognize the transition of a little girl into a young lady when she has her first period. "Menarche" is a young lady's first menstruation, or the date she has her first menstrual period, and when she begins menstruating.

A young lady's first period or menarche usually begins between the ages of 9 and 14, although sometimes as early as 8 and as late as 16. Her first period is also a sign that puberty has begun. For more information about your daughter's puberty, see our article; Puberty: When Your Daughter Becomes a Young Woman.

Special note to Dad's: Your daughter needs your love and support now more than ever. Be involved!! Menstruation and growing up is a normal part of YOUR daughter's life and not something to shy away from. Talk with your daughter about these topics, let her know that you know what she will be experiencing and to feel free to ask you any questions she may have, and that if you don't know the answer(s), that you will find out for her. Don't let your daughter get the answers to her questions from her girlfriends, or other unreliable sources. When she gets her first period, and sees blood coming from her vagina, she may be very frightened. Some girls, who were not prepared by the mother or father for their first period, absolutely thought they were dying. They were scared and afraid. Prepare your daughter, prepare yourself, and have the talk with her!

And when she has her first period, celebrate the day and make a big deal of it... take her out on a special daughter - daddy "date" to her favorite restaurant, buy her flowers, take her shopping.... let her know that you are thrilled about her becoming a young lady!!

Women normally menstruate until they are 45 to 55 years old, when menopause begins. Menopause is when a female stops menstruation. An operation called a hysterectomy, which removes some or all of the female reproductive organs, also stops menstruation.

Girls have thousands of tiny eggs in their ovaries. Each month, or approximately every 21 - 42 days, on average, one of the eggs leaves an ovary and travels through a fallopian tube. When the egg leaves the ovary, this is called ovulation. Normally, the ovaries alternate each month, releasing an egg from the left ovary one month and then releasing an egg from the right ovary the next month.

As the egg travels in the fallopian tube, a soft spongy lining forms in the uterus. This lining is mostly made of tiny blood vessels and is called the endometrium. The lining gives nourishment in case an egg and sperm meet to form an embryo, or baby, that begins to grow in the uterus.

If the egg is not joined by a sperm, the endometrium or lining of the uterus is not needed. It flows out of the vagina. This bleeding is called a period. This whole cycle is called menstruation.

Menstruation is just one part of the menstrual cycle, in which a woman's body prepares for pregnancy each month. A cycle is counted from the first day of one period to the first day of the next. An average cycle is 28 days, but anywhere from 23 to 35 days is normal.

Estrogen and progesterone levels are very low at the beginning of the cycle. During menstruation, levels of estrogen, made by the ovaries, start to rise and make the lining of the uterus grow and thicken. In the meantime, an egg (ovum) in one of the ovaries starts to mature. It is encased in a sac called the Graafian follicle, which continues to produce estrogen as the egg grows.

At about day 14 of a typical 28-day cycle, the sac bursts and the egg leaves the ovary, traveling through one of the fallopian tubes to the uterus. The release of the egg from the ovary is called ovulation. Some women know when they're ovulating, because at mid-cycle they have some pain--typically a dull ache on either side of the lower abdomen lasting a few hours. The medical word for this is mittelschmerz, from the German, meaning middle pain. Some women also have very light bleeding, or spotting, during ovulation.

After the egg is expelled, the sac--now called a corpus luteum--remains in the ovary, where it starts producing mainly progesterone. The rising levels of both estrogen and progesterone help build up the uterine lining to prepare for pregnancy.

The few days before, during and after ovulation are a woman's "fertile period"-the time when she can become pregnant. Because the length of menstrual cycles varies from one person to another, many woman ovulate earlier or later than day 14. It's even possible for a woman to ovulate while she still has her period if that month's cycle is very short. Oftentimes, stress can play a role in this occurring.

If a woman has sex with a man during this time and conception occurs (his sperm fertilizes the egg), she becomes pregnant.

The fertilized egg attaches to the uterus, and the corpus luteum makes all the progesterone needed to keep it implanted and growing until a placenta (an organ connecting the fetus to the mother) develops. The placenta then makes hormones and provides nourishment from the mother to the baby.

If an egg is not fertilized that month and the woman doesn't get pregnant, the corpus luteum stops making hormones and gets reabsorbed in the ovary. Hormone levels drop again, the lining of the uterus breaks down, menstruation begins, and the cycle repeats.

In the illustration below, an egg has left an ovary after ovulation and is on its way through a fallopian tube to the uterus.

Feminine Hygiene & Your Monthly Period
Menstrual Bleeding, What's Normal and What's Not?

Most menstrual periods last from three to five days, but anywhere from two to seven days is normal. The amount of blood flow varies, too, but for most women, bleeding starts out light at first, followed by heavier flow for a day or two and then another light day or two. Sanitary pads or tampons, which are made of cotton or another absorbent material, are worn to absorb the blood flow.

Sanitary pads are placed inside the panties; tampons are inserted into the vagina.

The amount of bleeding varies from woman to woman because everybody's body has a different way of building up the lining of the uterus. A lighter flow or heavier flow doesn't mean you can't get pregnant as easily or you're never going to get pregnant, or that your periods will always stay the same way. But if you're bleeding excessively-soaking one or more tampons or pads an hour-you should see a doctor to see if there's a problem."

Teenagers often are concerned if they expel blood clots during their periods. This is very normal and not dangerous. The menstrual clots are clumps of pooled blood in the vagina. Sometimes, instead of flowing freely, blood drains from the uterus and stays in the vagina until there's a change in position--say, from sitting to standing.

Young women experiencing their first periods often wonder, "will my periods ever become “regular?”

When a girl starts to menstruate, her period may not come on a regular schedule for several years. Her periods may come three weeks apart, or even months apart.

A girl should keep a record so she'll know if her period is late. A late period may be sign of pregnancy or one or medical problems that you should immediately inform/visit your doctor. Also, your doctor can provide you with better care if he/she knows about your periods.

Ovulation (when the egg is released) happens 12 to 16 days before your next period starts. Ovulation, and the days before and after, is the time when you are most likely to get pregnant.

If the female does not get pregnant, her period comes and the whole cycle begins again, with Day 1 starting over again when the next period starts. The whole cycle usually takes 21 to 36 days, but even 42 days is not unusual for a cycle.

Cramps are a common complaint. More than half of menstruating women have cramp-like pain during their periods. The medical term for menstrual pain is dysmenorrhea. Cramps are usually felt in the pelvic area and lower abdomen, but can radiate to the lower back or down the legs.

Many girls have cramps severe enough to keep them home from school. In fact, according to Danforth's Obstetrics and Gynecology, dysmenorrhea is the most frequent cause of absenteeism from school among younger women. Women seem to go through phases when cramps are severe, then get better for several years, and then maybe worsen again. Most women find they have less menstrual pain after having children.

Cramps are like labor pains. Just as the uterus contracts to open up the cervix (neck of the uterus) and push out a baby, it contracts to expel menstrual blood. Often, after several years of menstruating or after childbirth, the cervical opening enlarges. The uterus doesn't have to contract as much to discharge the menstrual flow, so there is less cramping.

Menstrual pain may also come from the bleeding process itself. When the uterine lining separates from the wall, it releases chemicals called prostaglandins. Prostaglandins cause blood vessels to narrow, impeding the supply of oxygen to the uterus. Just as the pain of a heart attack comes from insufficient blood to the muscles of the heart, too little blood to the uterine muscle might cause the pain of menstrual cramps.

Menstrual pain can have other causes, although these are rare among teenagers. They include tumors, fallopian tube infection, and endometriosis, a condition in which fragments of the lining of the uterus become embedded elsewhere in the body

Cramps are the actual uterus' contractions. The uterus, which is like a pear-shaped muscle, helps get rid of the endometrium, or lining of the uterus, since no baby will be growing inside. These contractions, that sometimes feel like cramps, are the body's way of shedding, or getting rid the lining of the uterus, through the vagina, and out of the body, as the lining is no longer needed that cycle.

Some girls have cramps during their periods. For most they are mild and can be helped by exercise, a heating pad or aspirin. If there is a lot of pain, very long a heavy periods. or very irregular periods or very irregular periods you should get a checkup.

Cramps are usually mild. They can be helped by exercise, warm bath, use of a heating pad or pain relievers such as aspirin.

If there is a lot of pain, long or "heavy" periods (heavy meaning more bleeding than normal), which means saturating a tampon or pad in less than 2-3 hours, or if you have irregular periods, you should inform your parents and ask them to take you to your doctor for a checkup.

Menstruation is a very normal part of every girl's life. During your period, you can do everything you normally do, including daily baths or showers, exercising, dancing and playing sports are all fine. In fact, you will feel better by continuing your normal routine, and find that warm baths are a great way to help with any cramping you may have.

Should I choose sanitary napkins or tampons for my feminine hygiene choice?

Feminine hygiene products come in all sorts of types, sizes, shapes, absorbencies, smells (vulva and vaginal “deodorant” protection – which we recommend NOT using) and materials.

Sanitary napkins or pads, absorb the blood from your period on the outside of your vagina. Most sanitary napkins are made with adhesive strips that you simply peel off the backing and then they will stick or adhere to your panties or pantyhose.

Can I still take a bath during my period, or should I take showers instead?

Menstruation is a very normal part of every girl's life. When you get your period, you can continue doing everything you normally do. This includes continuing to take baths or showers. However, some girls may prefer to take showers during the days of their period that bleeding is heavier.

Sanitary napkins come in different shapes, styles, absorbencies, deodorant, non-deodorant, as well as thin pantiliners for light days and pads, for heavy days of menstrual bleeding. All sanitary napkins, pads and pantiliners are made with removable strips of paper that reveal adhesive tape that is made to stick to your panties. Other pads and pantiliners have wrap-around "wings" that wrap under your panties to keep it from moving or "bunching."

Some young ladies don't like the feeling of sitting on a pad and may choose a tampon and pantiliner on their heavy days.

Like pads and pantiliners, tampons come in many different brands, sizes, styles, absorbencies and deodorant, perfumed and non-deodorant choices. Also like pads and pantiliners, tampons absorb the menstrual blood, except tampons absorb the menstrual blood inside of the vagina, instead of on the outside. Tampons absorb the blood from your period like a pad or sanitary napkin, but they do so by placing the tampon inside your vagina. Tampons can be used whether or not a girl has had intercourse and tampons cannot get lost inside your body.

Tampons come in different sizes and thicknesses. They come in applicator and non-applicator styles. There are "slim" or "slender" tampons for young ladies who have never had intercourse, or given birth via vaginal delivery. Tampons can be used whether or not a girl has had intercourse. Tampons cannot get lost inside a girl's body. Tampons are shaped so that they can be easily inserted into your vagina and absorb the menstrual blood before the blood comes out onto the pad the monthly period.

Many women prefer to use a tampon to avoid any possible smells that are associated with menstruation, as the menstrual blood that is absorbed by pads and pantiliners, are exposed to the air, and not changing a pad or pantiliner frequently enough, may produce a menstrual smell that some find objectionable.

Inserting a tampon the first time takes a little practice. It gets easier with each new period. You may want to go to the bathroom or close your bedroom door as you will want some privacy. To insert a tampon, remove your panties, remove the wrapper of the tampon, and get into a comfortable position. Using a mirror may help you find your vagina, and insert the tampon the first few times. The best positions are those that help expand the vaginal walls inside your vagina, to help ease the tampon into place. Some women like a squatting position, others are comfortable sitting on the toilet. In any case, you will want to spread your legs apart, and then using one hand, spread the labia minora, so that you can see or feel the entrance to your vagina. Keeping your legs apart, while keeping your labia minora separated, slowly insert the tampon toward the small of your back. You may need to use a little vaginal lubricant spread on the outside of the tampon for easier insertion. Insert the tampon until the ridges of the tampon applicator come in contact with the entrance to your vagina. Then, slowly insert or press down on the plunger, that pushes the tampon into the correct position inside your vagina. Once a tampon is properly inserted, you shouldn't be able to feel it. If you can feel the tampon, you are using the wrong size tampon, or may not have inserted the tampon far enough into your vagina. After pushing down on the plunger, and inserting the tampon, remove and discard the applicator, BUT NOT IN THE TOILET!

Using the restroom with a tampon in your vagina is easy, simply move the tampon string to one side before urinating, so that you don't get urine on the tampon removal string. Going to the restroom may also be a great time to see if your tampon needs to be changed. One way of determining whether your tampon needs to be changed is by tugging slightly on the string. If your tampon seems to not want to come out, it's probably not time to change your tampon. If, however, your tampon seems to slide easily, this is an indicator that your tampon is saturated, or has absorbed as much blood as it can hold. Another indicator that it's time to change your tampon is that your vagina is leaking menstrual blood onto your panties.

Removing your tampon is also very easy. When you believe your tampon has absorbed as much menstrual blood as it can hold, it's time to change your tampon. Simply pull on the string of the tampon in your vagina. This will remove the saturated tampon. Then discard the used tampon in the trash - NOT IN THE TOILET! And insert a new tampon.

NEVER SLEEP OVERNIGHT WITH A TAMPON IN YOUR VAGINA AS THIS MAY CAUSE TOXIC SHOCK SYNDROME.

Most tampons come with a plastic or cardboard applicator to make it easier to put them in. Only the tampon remains inside the body.

For women who have had a vaginal birth, they wouldn't use the slender tampons because their vaginas have been enlarged due to vaginal childbirth. If they did use a slender tampon during their period, the slender tampon would not absorb all of the menstrual blood, and she would have leakage of menstrual blood from her vagina.

Adult women who have delivered vaginally, will choose the wider, thicker tampons that are larger than the slender tampons, due to the enlargement of their vaginas.

How often should tampons, pantiliners, pads or alternative feminine hygiene product be changed?

Pads, pantiliners, tampons or other alternative feminine hygiene product should be changed often enough so that there is no unpleasant odor or your clothes do not get stained as the feminine hygiene product cannot hold any additional menstrual blood. Changing tampons, pads, pantiliners, often can help prevent infections. During the heaviest days of your period, you may need to change them every 3-4 hours.

Depending on how heavy or light your menstrual flow is - which varies during each day of your period, from light bleeding, to heavy, almost “gushing” bleeding, back to light bleeding again, heavy – will determine the type(s) of feminine hygiene product you may use. Some women start out by using a pantyliner only. While the menstrual flow increases, they may switch to a pad, and many women find they need to use a pad and a tampon simultaneously for the best feminine hygiene results.

It is very common for women to use a pad as "back-up" to a tampon, as a tampon will leak if it is not changed when it is saturated.

Healthcare Marketing Services believes that it is very important that you choose a tampon that is made from organic cotton or use another form of feminine hygiene protection such as a menstrual cup or natural sea sponge tampons.

Most tampons come with a plastic or cardboard applicator to make it easier to put them inside your vagina. Only the tampon remains inside the body, the applicator, if you use this type, is dis-carded in the trash can after you insert it.

NEVER FLUSH A TAMPON DOWN THE TOILET AS THIS MAY CAUSE SERIOUS PLUMBING PROBLEMS!

Tampons have a string at one end that stays outside the body. To remove the tampon, gently pull on the string, removing the tampon, and throw it in the trash can. NEVER FLUSH A TAMPON DOWN THE TOILET AS THIS MAY CAUSE SERIOUS PLUMBING PROBLEMS!

IMPORTANT! NEVER LEAVE A TAMPON IN YOUR VAGINA FOR MORE THAN 4-6 HOURS (read the tampon manufacturers instructions). ALWAYS REMOVE THE LAST TAMPON AT THE END OF YOUR PERIOD. WHEN USING A TAMPON, ONLY USE THE MINIMUM ABSORBENCY FOR YOUR PERIOD AT THAT TIME. Example: Do not use a super absorbent tampon for a light day flow.

IMPORTANT! NEVER USE OR APPLY TALCUM POWDER ON OR NEAR YOUR VAGINA OR VULVA OR THAT OF BABY GIRL’S. This also includes not using talcum powder on your pad or tampon. Talcum powder use has been linked to cervical, vaginal, ovarian and vulva cancer.

Toxic shock syndrome is a rare infection that can happen during a woman's period. The symptoms include a sudden fever of over 101 degrees or more, diarrhea (the runs), vomiting (throwing up), muscle aches and a sunburn-like rash. If you have these symptoms during you period, see a doctor right away.

3. Change your tampon at least every 4-6 hours (read the tampon manufacturers information inside the box).

5. Do not use a birth control sponge or diaphragm during your period. During your period it is preferable to use other methods such as condoms and/or foam.

Premenstrual syndrome (PMS) is a group of symptoms related to the menstrual cycle. PMS symptoms occur in the week or two weeks before your period (menstruation or monthly bleeding). The symptoms usually go away after your period starts. PMS may interfere with your normal activities at home, school, or work. Menopause, when monthly periods stop, brings an end to PMS.

The causes of PMS are not yet clear. Some women may be more sensitive than others to changing hormone levels during the menstrual cycle. Stress does not seem to cause PMS, but may make it worse. PMS can affect menstruating women of any age.

PMS often includes both physical and emotional symptoms. Diagnosis of PMS is usually based on your symptoms, when they occur, and how much they affect your life.

Baby girls are born with special glands that are located on the inner surfaces of the clitoral hood. These glands produce an oily substance called sebum that lubricates the glans of the clitoris. The glans of the clitoris is the end or the tip of the clitoris that is sometimes exposed or can be exposed when you retract the clitoral "hood." The clitoral hood is that portion of the vulva where the labia minora come together above the vagina and urethra and looks like an inverted "v" ^ . The clitoral hood protects the clitoris and in particular, the glans of the clitoris which is very sensitive.

The sebum that comes from the glands that surround the clitoris produces a shiny appearance on the glans of the clitoris. When the sebum or oily substances are not regulary cleaned or bathed away, it accumulates, and then it is called smegma. Smegma has a white cheesy appearance, that becomes sticky and begins to adhere to the skin surrounding the vulva with greater, the longer it is not cleaned or washed away.

Without proper care and hygiene, the smegma will collect under the hood that covers the clitoris and the glans of the clitoris, which can result in pain, irritation and/or inability to experience orgasm. When the smegma is not properly cleansed from the vulva, and in particular, the areas surrounding and under the clitoral hood, the clitoral hood will adhere to the glans of the clitoris, which is referred to as a "clitoral adhesion." When the clitoral hood adheres to the clitoris, either partially or entirely, this prevents the hood from properly protecting and caressing the glans, making orgasm difficult or impossible.

It is very important for the glans of the clitoris to have adequate lubrication. This permits the the clitoral hood to slide over the glans of the clitoris easily and without undue sensitivity or discomfort. The clitoris, and especially the glans of the clitoris, is usually most sensitive to frictional stimulation, versus direct pressure. Womens masturbation methods almost always involve sliding the clitoral hood in various back and forth or circular motions across and over the glans of the clitoris. Without proper lubrication from the glands next to the clitoris, pain will result in the stimulation of the clitoris and when there is movement of the clitoral hood.

The smegma accumulations of the vulva, specifically in the area of the clitoris, needs to be cleaned on a regular basis. Otherwise, the smegma can accumulate and dry out, causing the smegma to harden beneath the clitoral hood, which causes resulting irritation leading to significant pain. This can result in pain during masturbation, vaginal intercourse, and perhaps when walking, or wearing tight pants. In addition, using sanitary napkins may be painful.

This accumulation of smegma also occurs in infants and preadolescent girls. Parents should check their daughter's vulva for these accumulations of smegma at every diaper change and bath by gently separating the vulva and looking for the cheesy-white accumulations and gently wiping/cleaning away. Always be sure to wipe her from the top of the vulva toward the bottom or rectum to prevent germs and bacteria from entering her vagina. In mild cases the dried smegma may only slightly irritate the clitoris, resulting in your daughter's need to rub or scratch it. This can result in infants and young girls masturbating frequently. The resulting redness, irritation, caused by the frequent masturbation may conceal the primary problem. Adult women may also be distracted by this mild irritation, feeling a need to masturbate or engage in sex frequently. This sensation should not be confused with that of having an erect clitoris. When the irritation is severe though, while the desire to touch the area is there, the inflammation makes any contact extremely painful. So accumulated smegma can either increase the desire for sexual contact, or make it impossible.

Proper bathing and care of the vulva prevents clitoral adhesions

Preventing clitoral hood adhesions means that you need to retract the clitoral hood each time you bathe or shower, and wash out the secretions from this area. Most women need to be aware that simply wiping their vulva with a washcloth or their hand may not be enough to keep it clean. The spaces between the labia minora, labia majora and the area under the clitoral hood can retain the sebum from the glands around the clitoris, as well as other accumulations such as sweat, vaginal lubrication, toilet paper, menstrual fluid, urine, bacteria and feminine hygiene products. The normal body fluids don't expose a woman to any harm as long as they are removed before bacteria that are normally present are able to reproduce, resulting in infection and odor.

Special "feminine" soaps and washes are not necessary to clean your vulva. All one needs to use to clean the vulva is plain water. In fact, the use of soap and feminine hygiene products can irritate the delicate genital tissues. And douching is rarely, if ever needed, to cleanse your vagina.

Douches, vaginal deodorants or vulva deodorants, and chemical additives pose unnecessary risks when applied to the vulva and vagina. These products have been linked to increased cases of vulvovaginitis and yeast infections.

Clitoral adhesions

Clitoral adhesions or labial adhesions limits or prevents the clitoral hood to slide across the glans of the clitoris. If you have adhesions, when you pull on your clitoral hood, the glans of the clitoris moves with it instead of the hood retracting by itself, i.e., the glans of the clitoris moves with your pulling the clitoral hood. This can be very painful.

You may not be able to pull the hood back far enough to expose the entire glans if you have clitoral adhesions. This could make cleaning the clitoral area difficult if not impossible.

Minor clitoral adhesions may be remedied by without the need for a doctor's intervention. The clitoral adhesions may be released through pressure on the clitoral hood. Things like bathing, masturbation, bicycle riding, and horseback riding. If you do not properly wash your vulva in a manner that places traction on her hood, or masturbate in a manner that causes you to pull back the clitoral hood, you may not separate any clitoral adhesions that form, or prevent the formation of adhesions in the future.

If you believe you have clitoral or labial adhesions, you may be able to eliminate them by repeatedly pulling on your clitoral hood, in 360 degree directions (up, down, left, right, rotating in circles as well), or by taking a hot bath.

Clitoral adhesions will not disappear immediately as it took some time for the clitoral adhesions to form.

Women who experience pain can ask their partner or doctor to examine their vulva, and separating the labia, attempt to locate the source of the pain or by using a mirror and seeking the source of the pain themselves. If you experience a clitoral adhesion, either you or your partner can moisten a q-tip with baby oil or vitamin E to clean and loosen the secretions. Remember, the clitoral hood needs to "glide" easily over the clitoris. To lubricate the clitoral hood and loosen the secretions underneath, you or your partner may want to massage the area with a topical cream or baby oil. This may require you and/or your partner to do this for several days or for several weeks. Due to the sensitive nature of the clitoris and clitoral glans, it may be painful during the cleaning or massage due to the adhesions.

In the event you are unable to treat the symptoms of clitoral adhesions, and you or your partner cannot determine the reason for the pain, a doctor may need to be consulted. If your clitoral hood extends well past the glans, or if your clitoral hood is thick or closed, the adhesions may be totally concealed, with no visible indications. You should be very explicit in your office visit with the physician regarding your pain and show him the exact location of the any pain, even retracting your clitoral hood, if necessary for his viewing.

The clitoral adhesions caused by the accumulated smegma is caused by the two tissues surfaces growing together, due to failure to wash away these accumulations. As a result, the body tries to heal and eliminate the source of the irritation, thus causing the tissues to fuse as adhesions. These clitoral adhesions, or labial adhesions in the event the labia minora fuse together, may also form as a result of the hood laying in constant contact with the glans of the clitoris.

Additionally, either you or your partner may want to massage baby oil, vitamin E, or a petroleum based lubricant or antibacterial ointment up under your clitoral hood and on the glans of the clitoris.

Naturally, one of the best ways to keep from having clitoral adhesions is through proper washing of the vulva and to wash away the secretions before they turn into smegma. Proper care of your vulva or your daughter’s vulva means to wash away these secretions at every bath or shower. When you wash your vulva, it is important for you to retract the clitoral hood and wash this area. Also, be sure to wash the inner and outer portions and folds of the labia minora.

Parents can teach their daughters how to properly wash their vulva and help prevent them from experiencing the pain of clitoral or labial adhesions. Parents need to educate their young daughters about the various parts of their vulva so that they know they have more than "just a vagina," which they can't see, but a clitoris, clitoral hood, labia minora and labia majora, that they can see.

Proper cleaning of your daughter's vulva includes the following;

1. Gently spread the inner and outer labia and wash between them.

2. Place upward traction on the clitoral hood (in the direction of her bellybutton) while washing the exposed surfaces.

3. The glans of the clitoris may not be exposed when you do this. If there are adhesions, don't forcibly try to remove them.

4. Do not use any soap or other harsh ointments while cleaning away the, sebum, secretions or smegma.

5. You may need to use a q-tip or cotton ball moistened with baby oil or vitamin E to help loosen any stubborn smegma collections. If doing this, use another q-tip or cotton ball that is moistened with water to remove the baby oil or vitamin E.

6. Make sure that you are very gentle and use only light pressure when cleaning your daughter's vulva due to the sensitivity.

7. When your daughter is old enough to understand how to wash her vulva, may also be the right time to teach her the correct parts of her vulva, as well as explaining that her vulva is "private," and that she should be the one that cares for it. Also, when she is old enough, ask her permission to wash her vulva at bath-time, or ask her if she wants to wash her own vulva, following your directions to make sure that she removes the accumulated secretions or smegma.

SPECIAL NOTE:

Talcum powder has been linked to numerous cancers, including vulva, vaginal, cervical, uterine and ovarian. NEVER USE TALCUM POWDER NEAR YOUR DAUGHTER'S VULVA.

Instead of using talcum powder, you may want to consider the use of corn starch in this area, making sure that the corn starch is used externally and never placed in or near her vagina.

The doctor says that our daughter has labial adhesions. What are labial adhesions?

Young girls, and even adult women may get “labial adhesions.” Labial adhesions occur when the labia minora (sometimes the labia majora) or the “lips” of the vulva surrounding the vagina — have become stuck together. This happens to about 5% to 10% percent of all young girls. Young girls and women with labia that are stuck or fused together should immediately be seen by a pediatrician or gynecologist as the urine flow (and menstrual flow in adult women) can become blocked and a serious infection or infections are very likely to occur if she is not seen by a doctor.

What causes labial adhesions?

This probably happened because your daughter has little to no estrogen. Baby girls get a large dose of estrogen while they're still in the uterus. About one to two months after her birth, the maternal estrogen level drops off, and this hormonal change can affect many parts of a baby's body, including the lining of a girl's labia. Her labia may even stick together. This "adhesion" of her labia can continue or come and go throughout childhood, according to many pediatricians.

What can be done to treat labial adhesions?

First of all, parents should NOT try to pull or separate your daughter's labia apart, since that might hurt. Unless the adhesion is causing any problems, it's best to leave it alone. The idea of your daughter having labial adhesion probably worries you more than it bothers her. However, if the adhesion extends to cover the opening of the urethra and is trapping urine in the genital area, then you'll definitely want to see your child's doctor about treatment. Trapped urine can cause irritation and possibly infection. You'll know if your daughter's labial adhesions are covering the urethral opening if you find less urine in her diaper (for a young child) or she's having trouble peeing, or if her genital area looks irritated, she's irritable and crying, and she has a fever (due to infection).

Normally doctors prescribe a topical estrogen cream to treat the problem. Your doctor will tell you to apply this cream directly to the affected tissue, and in about two weeks it should unseal the labia. You'll probably start by applying the cream two or three times a day, then two times a day, then just once a day. It's important to reduce the amount of estrogen cream you use gradually. If you just stop the treatment suddenly, the labia will close up again.

Will our daughter always have labial adhesions?

Your daughter may continue to have adhesion off and on throughout childhood, but the labia tend to unstick when a girl approaches puberty and her body starts producing higher levels of estrogen. Until then, though, there's no reason to worry about the adhesion if it's not causing any problems. Many little girls never even know they have it.

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