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Burning and Itching Vagina - Why and What Can be Done?
Burning or pricking sensation or pins and needle sensation accompanied with itching is a very common complaint in females of all age group and a large fraction feel shy of it in reporting.Its better to consult your health care provider at earliest than piling up the problem.
Queries which come in minds of patients are-
- What could be reason of itching and Burning ?
- Has my periods anything to do with it ?
- Will it affect my fertility in future ?
- How it can be prevented ?
- How it can be treated ?
Here are the answers-
Itching or burning or irritation anywhere on the body causes discomfort and is a sign of infection.More than its pathology in extreme situations patient may be affected psychologically only.So its important to break Itch scratch cycle.More so when its infective in origin
To begin with we have to see for common things first.Certain changes in life style only may help.
There is concept of Menstrual hygiene,sexual hygiene and genital hygiene.Taking care of all these alone may help majority
Lets go into depth of factors.Cause can be organic or inorganic which may act as irritant or allergen or can be infective agent causing inflammation changes locally so releasing chemicals which triggers itch sensation. This happens more so in humid climates and in lack of air circulation
1. Candidal Infection- Yeast, bacterial vaginosis. Patient often gives history of smelly discharge per vaginum
2. Urinary infection- May present with burning and frequent micturition
3. Other infections like- Chlamydia,herpes,warts,STDs
5. Sexual encounters with multiple partners
6. Antibiotic resistance or drug interactions as by mixing different pathies
7. Menopause, breast feeding
8. Immune disorders
9. Diabetes mellitus
10. Chemical irritants. A number of chemical substances, including creams, condoms douches,contraceptive foams, laundry detergents, soaps, scented toilet paper, and fabric softeners can irritate the vagina and vulva.
- Skin disorders like Lichen sclerosis
- Sexual Abuse esp in young girls
- Premenstrual Syndrome(PMS)
How to prevent ?
Prevention is better than cure
Here are a few tips for preventing and treating vaginal irritation at home:
- Avoid scented pads or toilet paper, creams, bubble bath, feminine sprays, and douches.
- Use water and a plain, unscented soap to regularly clean your external genital area. But don't wash more than once a day. Doing so can increase dryness.
- Always wipe from front to back after having motion.
- Wear cotton panties (no synthetic fabrics), and change your underwear every day.
- Do not douche.
- Change the diapers of small girls regularly.
- Use condoms during sexual intercourse to prevent sexually transmitted diseases.
- For menopausal,Your dr may advise you certain hormonal remedies
- Don't scratch -- you can further irritate the area.
Affect on future fertility:
That depends on the cause.If its infection like STDs then it may impact your genital organs and fallopian tubes so impairing chances for natural pregnancy
Correlation To Menstrual Periods?
Some patients may have such symptoms as part of Premenstrual syndrome which needs different line of treatment
When you think of becoming a mother it becomes your responsibility to provide the best in terms of baby’s growth. For that to maintain and follow a healthy lifestyle is a prerequisite.
- Balanced diet: Take balanced diet rich in seasonal fruits and vegetables
- No smoking: Smoking is absolutely very dangerous for the baby as carbon monoxide, nicotine adversely affect the growth of baby’s organs. Smoking is also considered to cause premature delivery
- Stay away from alcohol: Say no to alcohol,If you are taking it under peer pressure then you are not doing anything good for your baby. Doctors always advise expecting mothers to stay away from wine, beer or any other kind of alcohol
- Take adequate sleep: Lack of sleep will make you feel tired and may increase the chances of developing high blood pressure in you, during pregnancy. Minimum 7-8 hours sleep should be there.Proper sleep also helps to get rid of stress
- Junk foods: Avoid Junk foods like burgers, pizzas, cold drinks, cake must go out of your life. A successful pregnancy demands lots of necessary nutrients and vitamins which you cannot get from the junk food. For better health of baby in future, get ready to switch to green leafy vegetables, fruits, dry fruits etc.
- Use of mobile and laptops: Excess use can give you neck and back pain, unseen rays from these gadgets may not be good for your baby. Limit yourself with the use of mobile and computers and focus on book reading or walking or yoga
- Negativity: Stay away from negative things
- Avoid Stress: If you take too much of stress, it can affect your chances of conceiving easily. A stressful mother will not be able to offer good, health to her baby. Stay away from all negative feelings and think positive if you want a healthy and happy baby
- Caffeine: Avoid taking too much of coffee, soft drinks and other beverages containing caffeine. Excess of caffeine intake can give rise to infertility
- Prescription: Don’t take any medicines without consulting your doctor
Fluid Collection in IVF-Myths and Facts
IVF is a finer treatment option for childless couples but it needs a better understanding before opting for it.It has lots of Myths and Facts associated with it.Patients often have fear of side effects of medicines used to stimulate their ovaries to grow their eggs.
One such side effect is Accumulation of fluid in the body what we call medically as OHSS (Ovarian Hyper stimulation Syndrome) but its not a uniform feature in all IVF patients.OHSS has a tendency to happen in selective group of patients with high risk factors which can be predicted and prevented.So via this write up our focus is on to single out such predisposing factors so that appropriate measures can be taken on time.Its not only duty of a treating doctor but a patient also needs to be aware than landing up with sudden surprises and bitter experiences.
Why is it a concern?
• Marked increase in patient population in infertility clinics
• Changing lifestyle
• Advances in the field of ART – act as a Double edged sword with pros and cons
• ART technology – is more patient friendly, with less complication with cost still a limiting factor with no 100% guarantee
What is OHSS?
It is a Life Threatening medical (Iatrogenic, drug induced) Complication and unique to the treatment of infertility with an an acute onset but reversible in nature with enlarged ovaries with cysts and fluid accumulation in body cavities to variable extent depending on gravity and grade
What are types of OHSS ?
Mild, Moderate, Severe and Critical
Who all have risk to develop OHSS?
• Young age, Low body mass index
• Higher doses of exogenous gonadotropins
• HighEstradiol levels with rapid rise
• Previous episodes of OHSS
• Multiple developing follicles(20-25)
• Exogenous hCG for superovulation/ luteal support
• Multiple Pregnancy
• Serum factors increasing permeability of blood vessels
It’s a general concept even in layman that for pregnancy one needs to have regular and timely menstrual periods.But in certain patients periods may not come regularly ever since menarche.Besides they may have history of weight gain,acne, excessive hairs on skin of face, may need to go for threading more often than required and may have cousins, sisters or evn mother having same issues.Such symptoms and signs point towards –
- PCOS – as the first most diagnosis
- Hormonal imbalance- FSH,LH ratio change with high LH levels
- Insulin resistance
- May have add on Thryoid/prolactin derrangements
These patients generally have high body mass Index(BMI)but some fall into category of lean with periods regular.
What all these lead to is a situation called-Chronic anovulation- a common cause of infertility.
Most of such PCOS patients have normal FSH but high LH levels.Its a multifactorial condition with life long implications
What we can do about it ?
Yes we can do major part especially if weight is more then Lifestyle modifications alone will help to keep things on track but it needs constant action in a well planned manner.So tips to keep a check on PCOS-
- Weight loss- at rate of 5-10% over a period of 5-6 months.If you have 80 kg then you should loose between 4 to max 8 kg only slowly with crash courses/diets or short cuts
- Daily brisk walking at least for 30 minutes to burn extra calories
- Moderate exercise on regular basis
- Joining a structured programme like Gym
- Take healthy balanced food(if possible with help of dietitician)
- Cut down carbohydrates like banana,rice,rice products with a check on milk and milk products and less of fats
- Keep proper hydration(3-4 LITRES of water daily)
- Avoid junk foods with empty calories
Dear readers all these need to be followed as part of life and not till you have pregnancy as PCOS has more of chronic affects also later on due to tendency to gain weight due to hormonal disturbances
Polycystic ovary syndrome (PCOS) is diagnosed in
approximately 60–70%of women with such features.
How to plan pregnancy in PCOS?
Singleton live birth rates of up to 71% in 2 years can be
achieved in such patients with –
1) Induction of ovulation- it can be by clomiphene citrate as first line of treatment and Injectables gonadotropins as second-line
treatment with success rate varies from 2 to 3%
2)IUI- combined induction with IUI increases success rate from 8 -13% to 15-20%
3) IVF- not used as first-line therapy in these
patients, except for subgroups with a poor prognosis like-
- Advanced age group
- Longer duration of infertility
- Higher insulin:glucose ratio
- Failed ovulation induction
- Other indications of IVF-tubal factor,male factor,unexplained/idiopathic infertility
Outcome of IVF In PCOS-
The outcome of IVF in women with PCOS shows variable outcome as-
Response to Medicines is the main issue- erratic(resistant to hyper) which is generally unpredictable
- More oocytes obtained-with more of immature
- Less fertilization rate- both mature and immature oocytes
PCOS patients show reduced fertilization rates, presumably due to endogenous hormonal imbalance
- More chances to have poor quality eggs
- Chances of abnormal(aneuploidy)embryos is high
- Inc chances to form endometrial polyp with recurrence
- Inc chances of cancellation of cycle/use of high dose of medicines
- High chances of first trimester miscarriage
- But good part is despite reduced overall fertilization, IVF pregnancy rates in PCOS patients appeared to be comparable to normo-ovulatory women
- Also live birth rates are comparable
Female reproductive organs comprise of – Uterus,Fallopian tubes and ovaries.Altered function in any of these can land up into Assisted Reproduction with IVF as the last option with maximum success rates.
Any discussion of the potential risks and benefits should also highlight the potential effect of delaying IVF treatment, especially in older patients where other factors may play the determining role.
Whenever we as patients are told about the status of fallopian tubes which normally need to be functional and dynamic for natural pregnancy to happen but when affected then it can vary from-
- Complete blockage of both tubes
- Unilateral blockage
- Patent but non functional
- Blockage can be due to spasm,debris or pathology
- Damage can be by Infection like Tuberculosis,scarring,post surgical impact,adhesions
- Fluid accumulation intubes-Hydrosalpinx
Depending on the status next step will be either-As whether its damage or dysfunction
- Try to open them by laparoscopy
- Or Directly go for IVF
But the dilemma is as whether to carry out IVF directly or undertake tubal surgery – answer to this is based on –
- Clinical assessment of the severity of tubal damage
- Age of the patient
- Availability of specialized surgical services and IVF
Similarly second doubt which comes in mind is the impact of tubal dysfunction on IVF outcome .Although tubal disease in general is not associated with poor outcome from IVF, there is increasing evidence that distal tubal disease associated with hydrosalpinx may affect the chances of success from IVF treatment. Many studies have shown that it can negatively influence the chance of success with IVF by decreasing implantation rates such that as per a combined study it was observed that there were differences in pregnancy rates after IVF in tubal infertility with and without hydrosalpinx, pregnancy rates of 31.2% were observed in the absence of hydrosalpinx and 19.7% in the presence of hydrosalpinx
Conclusion- Each patient is different so cannot apply blanket treatment to all.Need a basic work up and scrutiny before planning treatment protocol.If beginning is correct then we can have best outcome at end.Needs a systematic and Individualised approach.
When Should We Opt for Ivf
IVF is the most refined treatment but not the first of treatment.
It has to be done as per the indication only.Sometimes delay in taking decisions may end up in opting for third party measures so what one need is correct and guided approach.
As patient we have many queries as why IVF only so here are the reasons as to when your clinician will advise you for same-
1)Fallopian tube damage or pathology-
Tubal block on X RAY(HSG) doesn’t always mean opt for IVF directly.In that case decision is taken as per level and grade of block ,age of female and married years besides cofactors
•If tubal surgery is not possible then,IVF is method of choice.
•In case of problem in tubal function even after tubal surgery, IVF is method of choice after an infertility duration of 2 years or longer.
Depending on the female age IVF can be done after a shorter duration of infertility.
Actually Tubal factor was the first indication when IVF was started in world to help childless couples
2) Unexplained infertility (idiopathic)-
When exact obvious cause cannot be diagnosed after all basic work up of couple.This is considered as most frustrating condition for both the doctor and the couples and adds to stress.It contributes to 10-15% of all infertility cases
IVF is indicated if the duration of infertility is 3 years or longer. But If the woman is older than 36 years, IVF maybe considered earlier.
Here couple has two options- Either go for donor sperm or Go for IVF/ICSI as per the Sperm count.
Other option is SSR(Surgical sperm retreival) Provided doctor has expertise to do the same
What we focus in the semen is TMC-Total Motile Sperm count-This is the basis to take decision like mentioned below-
Total motile sperm count < 1 million: first treatment of choice isICSI•
TMC > 1 and < 10 million: IVF can be performed if infertility duration is 2 years or longer•
TMC > 10 million: treat as unexplained infertility
In case of mild or moderate endometriosis treat as unexplained infertility.•In case of severe endometriosis policy treat as tubal pathology
5)Cervical factor / immunological infertility- After an infertility duration of 2 years, IVF is indicated. This may be considered sooner if the woman is over 36 years of age.
Like in PCOS if after multiple ovulation induction cycles patient fails to get pregnant then one has to plan IVF.No of cycles of Ovulation induction vary asper female age partner but shouldn’t exceed 4 cycles as after that there is no benefit of doing so.
Stress, anxiety, and depression have been linked to lower IVF outcomes, and psychological intervention improves the chance of success. Paying attention to these factors will also improve interactions ofpatients and staff, and will help adjustment to the stresses of child rearing.Multiple pregnancies have been shown to cause considerable personal and marital stress. Early intervention may enhance the long-term well-being of these families.
Cancer is increasing in prevalence with improved detection and diagnostic techniques so prolonging the life and improving the quality of life.It has been observed to be affecting more of younger age groups so can have a lethal effect of the future fertility by destruction of their gametes (sperm or eggs). As doctor we feel need of spreading awareness at multidisciplinary level regarding preservation of future fertility which needs counseling and guidance at preliminary stages only before the damage happens.
- Oocyte/Egg cryopreservation
- Sperm Cryopreservation
- Embryo freezing
Method will vary as per the clinical status
Egg freezing means removing mature eggs and freezing them for later. This process may also be called egg banking . Its done in cancer patients preferably before exposure to chemo and radiotherapy.Its same like an IVF cycle except that embryos are not formed.Here medications are given to stimulate the development of multiple follicles in the ovaries.
Type of cancer can also decide the protocols.
Besides there are now more patient friendly mild stimulation protocol especially in estrogen sensitive cancers
The eggs are retrieved from the patient using a transvaginal technique under anesthesia and are kept frozen for future use by a method called vitrification.
Frozen eggs can be kept frozen for years(5 years as per ICMR but not specified for cancer cases) till the woman decides to use them for conception and once the patient is ready to get pregnant, the eggs are thawed and then fertilized using ICSI, an assisted reproductive technology that injects one sperm directly into the egg. The embryos (fertilized eggs) will then be transferred into the woman’s uterus (womb) in order to achieve a pregnancy.
It has the highest success rate compared to any other treatment. Its like normal IVF when eggs are retrieved and mixed with sperms. Once fertilized, the embryos (fertilized eggs) grow in the laboratory for 3-5 days until they are suitable for freezing.
Sperm Freezing is an effective and simplest way for men who have gone through puberty to store sperm for future use. Many men can store sperm (either from natural ejaculate or from a TESA sample
This is the success story of adopting an embryo which was frozen for 24 years.
Its no Less than a miracle but it also proves that THERE IS ALWAYS A HOPE
What we consider end may be a begining
Here via this platform we are sharing success story with our readers
The baby that was conceived just 18 months after its mother: Woman, 26, gives birth to baby girl from a donated embryo that was frozen for 24 YEARS - the longest ever Emma Wren, born on November 25 this year, was conceived in 1992 Her adoptive mother Tina Gibson, 26, was conceived in 1991 Tina married her husband Benjamin when she was 19 and he was 26 because he has cystic fibrosis (CF), a fatal disease with a life expectancy in the 30s Fertility is often an issue with CF so they decided they would adopt, and they fostered several children to prepare for itThen they heard they could adopt an embryo and have a pregnancy experience
The embryo was cryopreserved until March this year, making it 24 years frozen It is the longest time an embryo has been frozen, after one in Virginia which was frozen for 19 years and a few months Experts say this successful birth 'suggests the shelf life of an embryo could be infinite'
HOW DOES EMBRYO DONATION WORK?
- Couples who go through IVF tend to have extra embryos leftover, which are frozen and stored for later use. Eventually, when families decide they don't want any more children, they have to decide what to do with the leftover frozen embryos.
- IVF couples have a few options for their left over embryos:-
- donate the embryos to research
- thaw them and let them die
- keep them frozen donate them to a couple who can't conceive