About two months ago I had a yeast infection, which I was apparently a little overzealous in trying to cure. Immediately after the yeast infection, I got my period, which was followed by a foul, fishy odor. I went to my gyno and was told I had a bacterial infection. I completed the treatment and I thought everything was fine.
My next period was two weeks later, and with it came an awful, putrid smell. The smell was different from the bacterial infection, in that it was not at all fish. I actually don't even know how to describe it. My periods have always had a slightly unpleasant odor, as is normal for me, but this was very unusual. Sometimes I could smell it only myself, through my clothes. After my period ended, this smell persisted. It seemed that there was a light, colorless discharge that contained the smell.
After about a week, the smell dissipated. But I seemed to have a persistent discharge, which was slightly abnormal for me. Now, I have my period again and the scent is back.
I'm really concerned there is something wrong with me. I've done a bunch of internet searches but it's been inconclusive. And if there's nothing wrong with me, how can I restore vaginal homeostasis!?
Dear An: The most common reason for a malodor around the time of menstruation is the poresence of anaerobic (non-oxygen needing) bacteria. Bacterial vaginosis (BV) is caused by a type of anaerbic bacteria,
The reason it smells like dead fish after intercourse or around menses is that putriscene and cadaverine are released in an alkaline environment (and seminal fluid and menstrual blood are more alkaline than acidic). Some women advocate an acidophilus douche treatment . Perhaps this creates a temporary acidic vaginal environment so the smell is not so marked. However, acidophilus does not have the kind of hydrogen peroxide producing lactobacilli needed to rid the vagina of the undesirable anerobic bacteria. The use of Flagyl/metronidazole or tinidazole, or clindamycin, will kill the anerobes, but they can return unless the hydrogen peroxide producing lactobacilli are there in adequate numbers.
In terms of how to restore vaginal ecology, there is one over the counter product which has done studies about how to improve vaginal pH (RePhresh). Here is another citation from the National Library of Medicine site about non-prescription treatments:
J Womens Health (Larchmt). 2006 Nov;15(9):1053-60. Links Women's satisfaction with an intravaginal Lactobacillus capsule for the treatment of bacterial vaginosis. Marrazzo JM, Cook RL, Wiesenfeld HC, Murray PJ, Busse B, Krohn M, Hillier SL. Department of Medicine, University of Washington, Seattle, Washington, USA. firstname.lastname@example.org OBJECTIVE: To assess women's satisfaction with a vaginal capsule containing human-derived, H(2)O(2)-producing Lactobacillus crispatus at completion of a randomized, placebo-controlled study for treatment of bacterial vaginosis (BV). METHODS: Women aged 14-35 years with BV were randomized to Lactobacillus or placebo intravaginal capsule twice daily for 3 days monthly for 3 months. Attitudes were assessed with a standardized scale at the final follow-up visit, and associations of satisfaction with clinical and gram stain cure of BV were determined. RESULTS: Four hundred twenty-four women were randomized at enrollment, and 232 (55%) provided data on satisfaction at the final visit. Overall, satisfaction with the capsule was high and was independent of subjects' race, age, and prior history of BV. Report of satisfaction with the capsule, belief that it contained healthy bacteria, and belief that its use improved vaginal health were directly related to clinical cure and to improved Nugent score. Except for women who had BV at the final follow-up visit, most subjects believed that the capsule contained healthy bacteria independent of any outcome reflecting cure. Willingness to use the capsule again was not significantly related to whether subjects experienced clinical cure or normalization of Nugent score at either visit. Adverse effects were rare and were largely related to a perceived difference in vaginal discharge. CONCLUSIONS: Satisfaction with an intravaginal capsule and positive beliefs about its use for BV treatment were prevalent, especially among women with a clinical and microbiological response to BV therapy. However, most women expressed willingness to use the product again regardless of clinical response. Acceptability of and interest in alternative BV treatments, such as L. crispatus intravaginal applications, are high.
Bottom line, you should see a GYN or clinic and get a "for sure" diagnosis. If it is BV you can ask about the treatment options mentioned above. If it is not BV, another vaginal bacteria (eg E. Coli) may have overgrown. There are 20-30 differnet types of bacteria that can be normally found in the vagina. Also, trichomoniasis will produce maldors after sex or menstruation.
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