Savage Love: Vulva Va Voom

Dear Dan,

A question on your favorite topic, Dan. Just kidding, it's a question about my vagina. I'm having a problem with the microbiome of my vulva and vagina. I've been going to my gyno for the last six months for recurrent bacterial vaginosis and yeast infections. She shrugs, gives me a script, the symptoms go away for a week or so, then they come back. I understand the infections are likely due to an imbalance in my vaginal pH, but I don't know what to do to fix this. I've used probiotic suppositories to boost the amount of lactobacillus and these help more than anything else, but the problem remains. I also wear cotton, loose-fitting undies and practice good hygiene and never douche or use anything scented. The problem started when I stopped using condoms with my partner, but it's not an STI. We've both been tested. There's tons of sites online talking about this problem, but no one has a solution that I've found. How the hell can women with this problem fix their pH?! Thanks a ton if you read this far, and thanks a million tons if you or one of your experts has any ideas to help.

—Vexed Und Lacking Vaginal Answers

"I love that she used the word 'vulva,'" said Dr. Debby Herbenick, a research scientist at Indiana University, a sexual health educator at the Kinsey Institute, and the author of Read My Lips: A Complete Guide to the Vagina and Vulva and numerous other books. "Most people have no idea what that even is!"

I know what that is! (Full disclosure: I know what that is now. I didn't know what that was when I started writing this column.) The vulva is (the vulva are?) the external genitalia of the female—the labia, the clit, the vaginal opening, some other bits and pieces. (Fun fact: Vulva is Latin for wrapper.) The vagina, aka "the muscular tube," runs from the vulva to the uterus. (Fun fact: Vagina is Latin for the sheath of a sword.) People tend to use "vagina" when referring to a woman's junk generally, and while meaning follows use and I'm inclined to give it a pass, saying "vagina" when you mean "vulva" makes scientists like Dr. Herbenick rather teste. (Sad fact: Teste is not the singular form of testes.) Now back to your vulva and vagina, VULVA ...

Dr. Herbenick recommends seeing a "true vulvovaginal health expert" (TVHE) about your problem, VULVA, and your gynecologist presumably qualifies as a TVHE ... right?

"Not necessarily," said Dr. Herbenick. "Gynecologists know far more about vaginal and vulvar health issues than most health care providers, but many gynecologists haven't received deep-dive (pun not intended) specialized training in difficult-to-treat vulvovaginal health conditions. And if they have, it was likely when they were in med school — so years ago. They might not be up to date in the latest research, since not all doctors go to vulvovaginal-specific conferences."

Is there a fix for that problem?

"Yes! If everyone lobbied for their doctors to go to events like the annual conference of the International Society for the Study of Vulvovaginal Disease (ISSVD)," said Dr. Herbenick, "we would live in a country with millions more happy, healthy, sex-interested women and others with vaginas and vulvas, too, like trans men."

As for your particular problem — a tough case of bacterial vaginosis — Dr. Herbenick, who isn't a medical doctor but qualifies as a TVHE, had some thoughts.

"There are many different forms of bacterial vaginosis (BV) and different kinds of yeast infections," said Dr. Herbenick. "These different kinds respond well to different kinds of treatment, which is one reason home yeast meds don't work well for many women. And all too often, health care providers don't have sufficient training to make fine-tuned diagnoses and end up treating the wrong thing. But if VULVA's recurrences are frequent, I think it's a wise idea for her to see a true specialist."

A TVHE is likelier to pinpoint the problem. Even so, Dr. Herbenick warns that it may take more than one visit with a TVHE to solve the problem.