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How To Treat Recurrent Bacterial Vaginosis, According To Ob-Gyns
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Imagine this: You're on a tropical getaway…but between the persistent vaginal itching and irritation you're feeling, you're in sweatpants instead of a bikini. Recurrent bacterial vaginosis doesn't care about your plans, whatever your life looks like at the moment. If you're dealing with symptoms like fishy odor, watery gray discharge and burning, pain, or irritation of the vulva, and this isn't the first time you've experienced these issues recently, it's likely you have a bacterial vaginosis (BV) infection that won't quit.
BV can commonly recur, especially if you never really treat the underlying cause, which is an overgrowth of the bacteria Gardnerella vaginalis. It's naturally found in the vagina and doesn't always cause problems—but sometimes, it can get too feisty.
Here, ob-gyns share everything you should know about recurrent BV and how to kick it to the curb for good.
What causes recurrent BV?If you tend to have three or more BV infections in a year, that's the threshold for recurrent bacterial vaginosis, Suzanne Bovone, MD, a board-certified ob-gyn at Pediatrix Medical Group in San Jose, California, tells SELF. For the infections to warrant an official diagnosis of recurrent BV, they all need to be confirmed by a lab or your doctor, Dr. Bovone says.
There are a few reasons BV infections can recur, but it's not unusual for BV to come back a few times. One study found that 58% of cases among the 121 participants recurred even after treatment. Stubborn cases along those lines are often not the person going through them's "fault," Kameelah Phillips, MD, a board-certified ob-gyn based in New York City, tells SELF: You can follow all the courses of treatment and take all the precautions, and BV can still come back. But why?
Whatever the cause, recurrent BV comes from a consistent imbalance of "good" and "bad" vaginal bacteria.It might make more sense to think of BV as a "state of affairs" rather than an infection, Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine, tells SELF. It's ideal to have a balance of "good bacteria," or lactobacilli (a common bacteria found naturally in the vagina and found in probiotics) and "bad bacteria," or Gardnerella vaginalis. (While it may seem counterintuitive, an overgrowth of lactobacilli can also lead to a yeast-infection-like condition called cytolytic vaginosis. It's a delicate dance down there!) "The good lactobacilli make acid, which tends to keep the bad bacteria away," explains Dr. Minkin. When there's not enough acidity, it can throw off your vaginal pH and cause an overgrowth of harmful bacteria, a.K.A. A BV infection. Here's what might be throwing things out of whack and contributing to your stubborn BV.
Washing your vaginaCertain products used around or inside the vagina, like douches or cleansers (and especially ones that contain fragrance), can alter your vaginal pH and contribute to BV. They tend to strip away the lactobacilli that help maintain a balanced, acidic pH in the vaginal microbiome and might allow infection-causing bacteria to flourish.
So put down the soap—you don't need anything fancy to wash with, given that your vagina is self-cleaning. One of the most important things to remember: "The vagina does have a natural odor, and many products try to make you think any odor is bad," says Dr. Bovone. Using products to mask that natural scent could give you the illusion of making the vagina "cleaner" or "healthier," but the opposite ends up being true. And if it leads to a BV infection, you might ultimately have to deal with a pungent scent that's way more pronounced—and unpleasant.
Sex (sorry!)While BV is not a sexually transmitted infection (STI), the bacteria that sometimes causes it can be passed between sexual partners. Sex can lead to BV when the natural chemistry or pH balance of a partner's genitals is different from what your vagina is used to, and so, contact between the two changes your vaginal microbiome. Annoyingly, you might encounter (and get BV from) the bacteria that causes issues every single time you have unprotected sex with even one partner whose pH isn't gelling with yours: "The BV-associated bacteria can be passed back and forth," Dr. Phillips says. "Having a consistent sexual partner can increase the risk for recurrent BV." Sex-related BV can also arise when you have a new sexual partner, or multiple partners, especially ones whom you're having unprotected sex with.
Other lifestyle factorsThere are some other less-expected habits that might have something to do with BV that won't leave you alone. For instance: Smoking cigarettes can also up your chances of getting BV more frequently, says Dr. Phillips. According to research published in Nature, smoking can alter the vaginal microbiome and contribute to deficiencies in lactobacilli bacteria. It could be that cigarettes cause a continuous bacterial imbalance that makes you vulnerable to infections, making it an even better idea to quit if you smoke.
While this is what we know so far about common BV culprits, exactly why some people have recurring cases more so than others, in terms of the root causes, isn't an open-and-shut case just yet. "We need additional research to pinpoint exactly which other lifestyle factors are most likely to contribute to recurrent BV," Dr. Phillips explains.
How to take care of yourself in a recurrent BV cycle Don't self-diagnose.A lot of the time, people with BV might not be familiar with it, and so mistake it for a yeast infection or urinary tract infection (UTI), which have similar symptoms—think itchiness and irritation. But trying to self-diagnose sometimes leads people to start taking OTC yeast infection treatments while their BV bacteria is raging, which doesn't help—and sometimes leads to a more uncomfortable infection, for a longer time, or one that just keeps coming back. This means you have to be sure of what you're actually dealing with.
It is a possibility that you can have both infections at once, but it's best to see an ob-gyn or go to a sexual health clinic to confirm what's going on. "While BV is the most common cause of abnormal vaginal discharge, it's possible that people may have a co-infection with yeast or other bacteria that can complicate diagnosis," Dr. Phillips adds.
Get evaluated by a health care provider to get the most accurate diagnosis, says Dr. Phillips—and find a new one if you're not getting good answers or helpful treatment as things stand.
Give health care providers all the info they need to make a complete diagnosis.Bacterial STIs can also be strikingly similar to BV, symptom-wise. The condition can look a lot like trichomoniasis, which usually comes with funky-smelling discharge and itchiness, or Mgen, which causes unusual or smelly discharge, burning when you pee, and vulvar pain or discomfort. To avoid a misdiagnosis, Dr. Bovone recommends that providers test for all STIs, especially those with bacteria and parasites as vectors, or which come with symptoms of vaginal itching and discharge with an off odor (like gonorrhea and chlamydia). "We see it all, and can reassure you what is normal. And if anything is off, we can help," says Dr. Bovone.
Ask a doctor to test you for BV specifically, too. Dr. Phillips starts appointments with a verbal screening to clarify her patients' symptoms, then takes a vaginal swab sample to send out to a lab for analysis. Once she knows what's actually going on, she's able to devise a treatment plan.
When a doctor prescribes you treatment, follow their instructions and stick with it for the whole time you're supposed to—even if your symptoms get better.Depending on the infection and the clinic, you might be given the option of oral or vaginal antibiotics (often, clindamycin or metronidazole) to treat BV. To target recurrent BV, Dr. Bovone explains that doctors might prescribe a longer course of treatment than they would for a one-off case, such as using an antibiotic for seven to 10 days, plus a weekly dose of a vaginal antibiotic gel for four to six months afterward to prolong the treatment. There are also newer treatments, including a clindamycin vaginal gel called Xaciato that can be applied like a tampon to deliver a strong single dose of medication.
BV can come creeping back if you veer off course with a prescribed treatment, such as not taking all of the antibiotics every day or stopping before the intended date, even if it seems like your symptoms are clearing up. "Inadequate treatment is a setup for a recurrence: BV is a disruption of the normal vaginal flora, and that flora needs to be re-established," says Dr. Bovone. It can become unclear whether the recurrence is a reinfection, or if the infection never really cleared in the first place. So, even if you're feeling better, don't stop taking medication before the set end date, or else you might risk a BV infection creeping back.
Keep things moisturized.One way to keep your vaginal pH as close to acidic (and infection-free) as possible is to make sure there's enough lubrication on a day-to-day basis. Vaginal dryness, which can happen due to lower estrogen levels during menopause or during a period of breastfeeding, among other things, can lead to a less acidic pH, according to Dr. Minkin. She recommends a vaginal moisturizing gel like Replens to help with dryness.
Get a doctor's opinion before you use OTC suppositories, like those containing boric acid.You may have heard of boric acid suppositories and other over-the-counter treatments that purportedly balance the vaginal microbiome. No matter what, you should speak with your health care provider to confirm you have BV before trying these out, Dr. Phillips says. From there, you should know that boric acid supplements are not FDA-approved, and that the jury's still out about whether boric acid on its own can help with BV. (SELF has a full rundown of how boric acid affects your vagina, including if you have a bacterial or yeast infection.)
Your ob-gyn probably won't prescribe boric acid alone to treat acute BV, since it's a homeopathic remedy and has not been proven to be more effective than prescription antibiotics. That said, there's a chance your gyno might recommend it as a maintenance treatment for acidifying the vagina and keeping recurrent BV away. Studies show it can lead to some irritation of the vagina, though, so it may not work well for everyone. And you shouldn't use boric acid supplements if you're pregnant or trying to conceive, because there's not enough research to show that it won't cause harm to a fetus.
If you decide to give boric acid a try with your ob-gyn's blessing, a typical cycle of treatment is 30 days (you shouldn't use it for longer than that, which can lead to even worse irritation). To avoid contact irritation to your partner's skin or damage to condoms or diaphragms—both of which can be caused by boric acid—it's best to hold off on having penetrative or receptive oral sex while you're using it, Dr. Bovone advises.
Err on the side of not using products in or near your vagina.Double-check with your gyno before trying any over-the-counter products that could alter your pH and send you into a BV spiral. "You don't need any vaginal wash. This will disrupt the normal bacteria and create more issues," says Dr. Bovone. The vagina is meant to be self-cleaning, thanks to vaginal discharge sweeping out any bacteria, and will regulate its own pH and natural odor, as SELF previously reported.
And, hate to say it, but…don't have sex until you get to the bottom of things, and use protection whenever possible when you do.This might seem like a given, but don't have penetrative sex or receive oral sex, even with barrier protection, during your antibiotic treatment. If you do, it can throw things off course as your pH is settling back into its normal groove. Once you finish the whole course of medication and your vagina seems calm again, you're good to go.
If your partner's pH is potentially the X factor here: Whether your partner has a penis or vagina, using condoms or dental dams might be able to decrease spread of the bacteria until you get the overall imbalance under control.
Take a breath—and don't beat yourself up about this.We know, BV is not a good time—especially when you have life events that involve bikinis! Wedding days! Beach vacations! Or simply getting laid! And it can be particularly difficult to get to the bottom of the recurrent cases. But don't be ashamed—this is SO common, and there are effective treatments available to you. It just takes a bit of trial and error—and patience. With the right help (and perhaps a thorough audit of the products you use near your vagina), you'll figure it out.
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Originally Appeared on SELF
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16-Year-Old Loses Left Testicle Into Body While Picking Up Golf Ball
When an otherwise healthy 16-year-old male leaned over trying to retrieve a golf ball, he suddenly ... [+] developed pain in his lower left abdomen and then soon noticed that something was missing in his left groin area. (Photo: Getty)
gettyWas this a case of losing one ball while trying to pick up another? A case report just published in the journal Urology Case Reports described what happen to an otherwise healthy 16-year-old male when he leaned over trying to retrieve a golf ball. He suddenly developed pain in his lower left abdomen and then soon noticed that something was missing in his left groin area. Was it his keys? His wallet? No, it was his left testicle. And that's the kind of thing that you can't simply go to the golf course "Lost and Found" to relocate.
Yes, something nuts had happened. The left portion of his scrotum was left with no left testicle. This was a total scrotal change. His left testicle was presumably present and accounted for earlier that day. Granted, not everyone with testicles may do a scrotum inventory each and every morning and say, "Whew, still got balls." But as is the case with either your significant other or cheese, you tend to notice fairly soon when one of your testicles goes missing.
Also, the guy didn't recall suffering any type of trauma to his balls at any point that day. Trauma to your balls is something that you tend to notice and remember. Rarely, will you say, "Hmm, did I just get kicked in the balls? I can't quite tell." He wasn't really exerting himself at the time his ball went a-missing, either. Golf is not exactly the most strenuous of sports, unless you happen to be mixing some mixed martial arts (MMA) with it.
Leaning over seemed to become an "lean in" situation, from a testicle standpoint. (Photo: Getty)
gettyRather than asking around, "Have you seen my testicle," or starting a "Go Find Me" page, the 16-year-old apparently recognized that such a situation called for immediate medical care. At the hospital, he underwent a CT that showed his left testicle to be in the wrong neighborhood. His left testicle had moved on up into his abdomen, higher than what's called the internal inguinal ring. The patient continued to suffer mild abdominal pain along with nausea, which he would use over-the-counter pain relievers to control.
It turned out that the patient's balls did in fact have an unusual travel history. That's both the right and the left. Soon after his birth, it was noticed that his right testicle didn't exactly come on down. Typically, when you are a fetus, your testicles first form in your abdomen. During your last couple months of squatting in your mother's uterus, your testicles gradually descend from your abdomen through your groin via a tube-like structure in your groin called the inguinal canal, making their way down into their final destination: your scrotum. When your testicles don't descend in this manner, they are called undescended testicles or cryptorchidism. This obviously has nothing to do with crypto currency, unless that's what you are using to pay for your health insurance.
It's important to mention something about the vaginal process here. In this situation, the vaginal process, otherwise known as the processus vaginalis, is not a fancy, non-romantic way of describing sexual intercourse as in, "It's time for us to begin the vaginal process." Instead, it is an outpouching of the abdominal wall that develops early on when you are fetus. In males, this outpouching normally gets obliterated. In females, the processus vaginalis, also known as the canal of Nuck, eventually becomes the round ligament of the uterus. When the processus vaginalis remains and you're a male, it can make it more likely for one or more of your testicles to get trapped in your abdomen.
Having your balls remain in your abdomen may seem like a great way of protecting them from being kicked. But the insides of your abdomen are very warm, which can keep your balls way too toasty. As a result, this may damage your testicles and sperm, adversely affecting your fertility and making it more likely for tumors to grow. For example, the following graphic lists cryptorchidism as one of the risk factors for testicular cancer:
(Illustration: Getty)
gettyAn undescended testicle can twist around in your body as well, resulting in testicular torsion, which is not a fun condition to have. Plus, you don't want to keep explaining to any partners that you may have that you do, in fact, have balls.
Therefore, at 18 months of age, the patient had undergone a right orchiopexy, which was a surgical procedure to bring that ball right on down. He also already had a history of a retractile left testicle. This is when the testicle seems to be outside of the scrotum, which was confirmed during a pediatric urology examination when he was 11 years of age. In this case, outside the scrotum didn't mean that the testicle was floating in the air or riding a bicycle. The testicle appeared to temporarily move back up into his groin. A retractile testicle is different from an undescended testicle, is considered to be normal, and normally doesn't require treatment.
However, what the 16-year-old had noticed on the golf course was different from simply a retractile testicle. This was a tougher nut to crack, so to speak. His left testicle was way higher up in the body than it should have been. The docs at the first hospital apparently realized that they weren't quite as on the ball about what to do about this situation and thus referred the patient to a pediatric urology clinic for further evaluation and management. This is presumably where the University of Utah authors of the case report (Jennison N. Cull, Deborah L. Jacobson, and Anthony J. Schaeffer) got involved. The pediatric urologists found the patient's left groin to be tender and no left testicle to be found. Eventually, they took the teen to the operating room where they used a scope to look inside his abdomen. There they found the traveling left testicle in the patient's abdomen. They also found a patent processus vaginalis, which meant that the vaginal process was still there.
The surgeons then tried to bring the left testicle back down through the inguinal canal into the scrotum. Now, you may consider having big balls to be a good thing. But, in this case, it was a bit of a problem. His left testicle was too large to go through his inguinal canal. Therefore, the surgeons had to do a fair amount of pushing and pulling before the ball dropped in place. The surgeons then repaired the patent processus vaginalis and used some stitches to anchor the left testicle to the scrotum, hoping that a stitch in time would save one, one testicle, from moving back up into the abdomen. The surgery ended up successfully resolving the issue without complications.
This was an unusual case of one losing oneself. Of course, you shouldn't have to worry about your testicles moving back into your abdomen every time you lean over on the golf course or anywhere else for that matter. Such a "lean in" situation just ain't that common. So, don't use your testicles as an excuse to get others to pick up things for you by saying something like, "Can you help get that for me? I'd do it myself but, you know, my testicles." In general, it's not a great idea to lean on your testicles as an excuse. Otherwise, things could get a little nuts.
The 19 Best T-shirt Dresses For Dressing Up Or Down In 2024
New York Post may be compensated and/or receive an affiliate commission if you buy through our links.What do you get when you combine the best basic top and the comfort and style of spring and summer dresses? The T-shirt dress, of course.
Not only are these easy and breezy styles to wear, but they are becoming more and more trendy as the cold of winter fades into the sunshine and warmer days ahead.
We realize this may be niche, but we found that this style actually yields a whole lot of choices, from short to maxis from Amazon, plain to patterned and options for petite, tall, extended sizing and more to fit every body and every budget.
Read on for our top picks for this comfy style that you can dress up for a special occasion or down for the beach, preparing your closet for spring and summer 2024.
Amazon is a one-stop-shop when it comes to easy and breezy dresses. This one is part of Amazon Essentials line of basics, as you can wear this little black T-shirt dress anywhere. It also comes in an array of other colors and ranges in size from an XS to an XXL.
You'll want this dress to be yours after reading our article. This T-shirt dress from lululemon is a great way to transition from spring to summer or for all-year wear with tights and a coat. The dress ranges in size from a 0 to a 14, while supplies last.
Don't drop the ball when it comes to buying this dress. The Drop is Amazon's hub for all things trendy, and of course has a maxi-version of the classic T-shirt dress. This one comes in either olive green or black and comes in a range of sizes from an XXS to a 3XL.
We treasure the time spent in the warm weather, wearing a flowing dress as long as the season allows. This dress from Nordstrom is perfect for just that, coming in a sunshine yellow color or black, each with a high slit on either side to add some shape. The dresses range in size from an XXS to an XXL while supplies last.
Another favorite from Amazon Essentials, this T-Shirt dress is designed with puffed sleeves, which we love. A great choice for those self conscious about their arms (listen up, you're beautiful, ladies), the cut is fitted enough to look polished for the office, and relaxed enough for your comfort. Available in sizes XS-XXL.
Does this dress make your heart flutter? Sold at Spanx, the cut comes in right above the ankle for a classy maxi-length with a flattering slit up the side. It's available in a petite size as well as standard, ranging from an XS to an 3X.
Go west, or really anywhere in this dress. The UpWest brand dress really is as perfect as the title, with a cute pocket on the front and soft flowing cotton fabric. It comes in either maroon or dark gray and ranges in size from an XS to an XL.
Head to the cafe or the club in this versatile striped dress. This T-shirt dress is sold at Lulu's and comes in a few different color combinations with horizontal stripes on each for the café look. The dress currently comes in sizes between an XS and a XL in select colors while supplies last.
Add this slouchy but slinky t-shirt dress to your cart. An affordable find at Amazon, it comes in a range of gorgeous colors, is lightweight, and can even be worn with a pair of leggings. Available in XS-24. T
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Best spring dresses for occasions)Silk you can wash? Count us in. This T-shirt dress from Quince is unbelievably soft and made of washable silk so you can wear it every day without having to worry about your dry cleaning bill. The dress also comes in blue and black and in sizes ranging from an XS to XL.
Take a T-shirt silhouette and turn it up a notch. This is what this dress from Amazon does with its ruching and fitted cut. It comes in more than a dozen colors, can be dressed up with heels, and also looks sweet with a pair of sneakers.
(Best: Best midi dresses to add to your wardrobe)
We love this dress from Venus, which makes sense as the goddess of love. The Knotted Casual Dress is a great way to be chill all spring and summer long, wearing this blue patterned version or the gray, black or orange shade, each ranging from an XS to a 3XL.
For date night, special occasions or even work, slip on this pretty frock. It's A-line shape is flattering for most body types, plus how could you say no to all those ruffles? Available in sizes XS to XL and under $40, we're adding at least two into our cart.
(Related: Best maxi dresses for spring and summer)
You'll be wearing this dress for ever and ever. The Everlane The Linen Shirt dress is a classic, complete with the slouchy look and button-down front. Made of 100% European Flax Linen, it's available in three solid colors, as well as two prints.
Think of this as a girly take on a boyfriend shirt. Ideal for casual days, we love it. Pair with sneakers, sandals or heels. Regardless of what you choose, you'll look amazing. When the weather gets colder, add a pair of tights or leggings, and you'll be set.
For vacay or weekends, why not slip this easy number on? It's air and features a lovely scoop neck, plus comes in a variety of bright colors and fun prints. Available in sizes S to 5X, thousands of Amazon customers love it.
(Related: Best linen dresses in every style)
For a great budget option, get a T-shirt dress in every color for just under $11 at Shein. Choose from popular colors like mint green or black, or opt for pink, blue, gray or brown, available in sizes XS through XL.
Oh baby! This dress is perfect for spring, adding a pop of color to any look. The midi length hits right in the middle of the calf, and the dress comes in hot pink as well as in yellow, brown, and black.
For something cute and sporty, this T-Shirt Dress with an attached hood will do nicely. Its kangaroo pouch is perfect for slipping your phone or keys into, plus the dress is made of mainly cotton. Although on the lighter side, we think you'll like it, especially as the weather heats up.
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