The vagina is a place where gross things sometimes happen, which creates a conversational catch-22: If these things were less gross, we'd talk about them more often; the less we talk about them, the grosser everything tends to get.
If you've never had bacterial vaginosis or a yeast infection, I bet your stance towards both things is: No. I don't wanna talk about it. I'll cross that gross bridge when my vagina makes me. But then, the gross things happening, and you don't have a damn clue how to deal.
So. We are doing this. I'll start.
A true story about me is that I have been battling near-constant yeast infections since I was about 15 years old. I have my theories about why—it may have something to do with the fact that I spent 90 percent of my waking hours as an adolescent hanging out in a chlorinated pool—but I rest easy (enough) knowing I am not an isolated case. Many, many women experience recurring yeast infections.
And suffice it to say that over the past 13 years, I have learned a thing or two about how to recognize yeast, and how to show it who's boss. (Me, sort of. More on that later.)
But about a year ago, something else truly awful started happening. It stumped doctors for almost a year and ruined my sex life for about as long, so I want to (over)share my experience, should any other woman out there be suffering in the same way.
At first I thought it was bacterial vaginosis—it felt sort of like BV—but I wasn't getting the usual signs and symptoms. Most of the time, going about my daily life, I was okay. I didn't feel itchy, and nothing burned or stung, but I had this constant, hard-to-pin-down sense of discomfort, and I had to pee way more than usual.
This led me to the doctor for the first time, where I was tested for BV, a yeast infection, a UTI, and every STD imaginable. At this point I was at the beginning of a committed relationship, so I didn't mind: the tests were a good idea, anyway.
Everything came back negative, so I tried to blame my weird symptoms on my imagination. That worked for a while until I started bleeding during sex. Profusely. And the blood wasn't a result of impact, if you get my drift—it was coming from the skin inside my vagina, which was so raw that I wanted to cry if my boyfriend so much as came near it with a finger.
I went back to the doctor, who shuddered at the angry inflamed redness, but didn't know what to do. More doctors, more STD tests, some ultrasounds to see if I had cysts or anything else weird going on with my cervix/uterus/ovaries: nothing. This went on and on for another six months or so, and I had more than a few teary conversations with my boyfriend about how he should just "go on without me."
Then, one night, we were out for drinks with a friend of mine who's a midwife, and we were telling her all about my problems. (Let me pause to say: my boyfriend is a trooper.) It turned out that she had a friend—another midwife—with the same issues, who'd done all the research herself and learned about these bizarre little bacteria called ureaplasma.
I have never met this woman, but as far as I'm concerned, she deserves a Nobel prize.
Ureaplasma/mycoplasma are small bacteria that live inside of other cells' walls and are believed to cause symptoms such as increased or painful urination, pelvic pain, fertility problems, and recurring yeast infections. They are unfazed by most of the usual means of attack and thus require special antibiotic treatment; they can be quite resistant to even powerful antibiotics, and may require several rounds to cure. There still seems to be a lot of confusion in the medical world regarding the potential impact of these bacteria, but some doctors believe there's a connection between ureaplasma infection and infertility or miscarriage, and/or that there's a connection between ureaplasma infection and ailments of the urinary tract or bladder.
A fair number of American doctors seem to think ureaplasma/mycoplasma is all a hoax, but European and Eastern doctors are more likely to take it seriously. And there's one American company that believes it to be enough of a problem that they are developing a vaccine for prevention and treatment of ureaplasma/mycoplasma, which they believe to be an underdiagnosed cause of a wide range of infections.
It's believed that, as with other vaginal infections, the presence of ureaplasma/mycoplasma isn't necessarily harmful, but that its overgrowth is what can cause symptoms; in fact, some doctors say that most people will have an excess of ureaplasma at some point but just won't experience symptoms. Men and women alike can become infected through sexual contact or a variety of other means of exposure (they say you can't pick things up from toilet seats, but unsettling rumors, at least, circulate about this nefarious organism online).
After researching all of this, I called my doctor's office and asked if they could test me for it. They said yes. But once I went to my appointment, my doctor tried to brush me off, saying that, instead, she'd like to test for STDs again. I resisted the urge to strangle her and demanded the test. After a year, all it took was a simple test, a round of antibiotics for me and my boyfriend, and I was cured.
Now: just because you test positive for ureaplasma/mycoplasma doesn't mean that that's what's causing your symptoms. My experience is only one of many. Abundant anecdotal evidence suggests that for many women, antibiotics of any kind are ineffective, and there's a whole movement touting Chinese herbal supplements as the cure for ureaplasma/mycoplasma and a variety of other women's health issues.
But even though I don't have all the answers, I want more women to know about ureaplasma as a possibility, should you happen to be cursed, like me, with a vaginal infection that lasts for a year. I went to at least four doctors over the course of last year, and either none of them knew about it or none of them cared enough to investigate past the standard STD screening. And you can't consider all your options if you don't know what they are. Vaginas are mysterious, and having one often means aggressively advocating for your health, and you must educate yourself in order to do so.
So with that in mind, I'd like to offer some more (too much) information from my deep well of experience.
There is a very clear protocol that doctors follow when you show up complaining that your vagina itches, stings, and burns. First, they suggest that you probably have an STD. If you grew up in the South like I did, there's a lot of shame in this suggestion, as well as generally infused throughout the whole experience. Actually, allow me to rephrase: there's a lot of shaming infused throughout the whole experience, and let's take a moment to say every bit of this is undeserved.
Second, the doctors examine you and probably discover that you are oozing with some sort of bacterial or yeast overgrowth. Third, they insist that you still get tested for STDs, even if you were last tested a month ago or you are a virgin or whatever, because you are a modern woman, after all, and modern women are prone to these sorts of things. Fourth, they write you a prescription for Diflucan (or antibiotics) or tell you to buy some Monistat and send you on your way.
Unless you are very lucky, this approach will quickly fail. A normal, healthy vagina contains multitudes of organisms. It's an ecosystem; it's a system of checks and balances, and once you throw off that system, chaos is likely to ensue.
Think about the last time you took antibiotics. If your vaginal pH is anything like mine, you definitely got a yeast infection afterwards. Why? Because you killed off all the bacteria, and when the cat's away the yeast go fucking apeshit, as they say. Likewise, when you treat yeast with a fungicide resembling a nuclear bomb, you're likely to experience a bacterial overgrowth in the aftermath.
This is how I lived for many years. I treated a yeast infection, I got BV. I treated BV, I got a yeast infection. It became easy to tell the difference—yeast is chunky and white, while BV causes a watery discharge that sort of leaks out of you all day long. It was harder to spend much of my twenties not having sex.
Eventually you find your way to online forums, where desperate women implore other desperate women to share their remedies. This is where you learn to put things like apple cider vinegar, tea tree oil, whole garlic cloves, and boric acid in your vagina. These home remedies are much gentler than Diflucan or Monistat, which is important: if you have a minor imbalance, you want to gently urge the ecosystem back to normalcy, rather than eliminating the offending party in a full-on massacre that will only leave you vulnerable to another overgrowth in the future.
I have tried all of these natural remedies with varying degrees of success. After much trial and error, I've learned that, for me, the best solutions for both yeast and BV are boric acid suppositories or tampons soaked in tea tree oil (but dear sweet Jesus, diluted with jojoba or coconut oil: that was a lesson I only had to learn once). This product is also very nice, though I recommend refrigerating it so it doesn't get all melty.
But here's my favorite natural remedy. Afterwards, once you've attacked the yeast or offending bacteria, it's a really good idea to replenish with good bacteria. My preferred method for introduction of probiotics? Little yogurt ice cubes (unflavored, of course). Or, as they have now come to be known in my circle of friends, "vagina popsicles."
Yes. Vagina popsicles.
That concludes today's lesson. If you have something mysterious happening on the inside of your vagina, please: ask your doctor about ureaplasma. Make them give you the test even if they don't want to. Ask about natural remedies. And feel free to report back here.
Illustration by Jim Cooke.