Dr. Victoria J. Mondloch, M.D.

You ask a simple question that could have a variety of answers based on more background information. But the most common reason is a change in the balance of vaginal bacteria. There are approx. 30 bacteria that live in harmony in the vaginal vault; they all have a role to play in cleaning up menstrual blood, rebalancing the alkaline pH of semen back to the acid pH of the typical vaginal vault and to help show the rebalance of bodily fluids when we ingest antibiotics which will preferentially kill some bacteria while allowing other bacteria to flourish. So the most basic answer to your question is that your body is trying to rebalance the pH in your vaginal vault. This may need to happen from an increase in sexual encounter with an increase in exposure to an alkaline pH of semen. This may also need to happen with irregular bleeding or spotting that triggers ‘clean up’ and balancing to occur in the vaginal vault or if you were recently on antibiotics and need to rebalance. Another commonly overlooked reason is the increase in dietary sugar which can trigger overgrowth of yeast in the vaginal vault; this would likely result in an irritating and itchy vaginal discharge but not always in its early stages. And there is also the discharge of a strep carrier; many patients carry strep in their respiratory system which can trigger more frequent strep throat occurrences but they can also carry strep in their vaginal vault; this is problematic with pregnancy and delivery but it can also be problematic with hormone changes, including adolescence, polycystic ovary hormone swings, perimenopause, menopause and even post-menopause. Balance is a marvelous thing that we take for granted; but the body does a lot of hard work to do this and sometimes we need to recognize that the body is working a little harder than it should and we need to recognize the triggers for the imbalance and help.

If you are aware of having an infection and you know your partner who you suspect you got the infection from then most patients have already asked their partner those questions. If they haven’t, then they need to find out the answer to those questions or they need to call their partner to have them get seen by their own healthcare provider or by an Urgent Care. The best approach is to take precautions at the time of relations; and if you are unwilling to ask those questions, and are unwilling to ask your partner after the fact, then you may need to ask yourself why you’ve put yourself into that situation; unless you’ve been coerced which means protect yourself at all costs!!!

Actually, the first question I’m going to ask you is do you have swelling in your ankles and your lower legs? The biggest reason the women experience your symptoms is that they have varicose veins and spider veins that become leaky and you end up with increasing amounts of fluid in your feet/legs that should’ve ended up passing through your kidneys, ending up in your bladder as urine that you pass. When you keep increasing fluid in your legs, you see ‘sock marks’ from tighter socks pressing on the tissues; then when you go to bed at night, what will start happening is you will get up not just once, but some women get up every 2-3hours as they mobilize that fluid in their legs by raising their legs to heart level while sleeping; THEN they pass that fluid through their kidneys and to their bladder which wakes them up because otherwise they’ll pee in their bed! And you may say ‘I don’t have varicose veins!’; but most of us do! So press your finger against your shin on your leg; if you leave a dent, then you have fluid in your legs. My usual approach with patients is to wear a knee high compression stocking; it doesn’t have to be ugly and white like the kind hospitals give you with surgery. Some of the best compression stockings are quite stylish and look just like pant socks but they are tight enough to compress the fluid back into your veins; and then your urinary system will go back to ‘normal’. Check with your primary care or GYN; the most cost effective brand is from a company called L&R who also specialize in lymphedema garments for cancer patients and post-operative patients with limited mobility. A knee high stocking from L&R can cost as little as $30 retail; not the $150 that a Jobst stocking could cost. And see if your insurance company will pay for it; after all, it’s treating a medical diagnosis of ‘peripheral edema’ which has a diagnosis code; of you may have an HSA or Health Savings Account that pays for ‘medical expenditures’ not covered by your insurance. At any rate, this is usually the most common reason that I see in my patients and it will keep you out of specialists offices that will do expensive tests to tell you your bladder is fine and send you back to your primary doctor without an answer.

Shame on your doctor for not prescribing for your partner as well; that’s why Chlamydia continues to flourish is that one partner is treated and the other is also exposed (and likely infected) and also needs treatment. It is usual and customary to also prescribe antibiotics for your partner and I would contact your healthcare provider and ask why you were not given a script for him as well?

Your assessment is quite good and historical; thank you for that. First, I don’t think this is HSV (herpes simplex virus) as there is usually a prodrome of tissue tingling before any lesions appear and they are quite painful, not just when urinating but HSV can masquerade with other viruses so you are right to be wary. Second, I think the yellow-tinge to the vaginal discharge means more and could actually be a Chlamydia or other bacterial overgrowth (did you use a condom EVERY time or were there a few ‘misses’?); likely not Bacterial vaginosis as that would have a rotten fish odor. Chlamydia can affect your future fertility and it can have anything from symptoms that you describe to absolutely no symptoms; so getting a culture is important as you don’t want internal scar tissue closing off your Fallopian tubes causing infertility down the road; simple antibiotics cure Chlamydia. Third, yeast does not always have a white chunky discharge; it can be early with no discharge or it can be white creamy as it starts to progress; only when it’s been there a little while or it’s a really strong yeast infection do you visibly see the white chunks. One of the easiest things to do over the weekend is use a topical cream such as Monistat or even A&D or Desitin (yes, the baby’s diaper rash creams because butt skin yeast is what A&D and Desitin were formulated for. And if it’s kind enough for a baby’s bottom, it will be kind enough for your bottom.) Fourth, when you start on OCP’s (oral contraceptive pills) or birth control, your normal hormone levels get suppressed and the artificial hormones of the pill take over. In many cases your vaginal tissues take longer to respond to their ‘loss of elasticity’ from going on OCP’s or Mirena or other hormone containing contraception and you will notice any ‘stretch’ of the vaginal tissues will become uncomfortable and stinging due to decreased elasticity (the same thing happens with perimenopause and menopause), something most healthcare providers just conveniently forget to tell patients. Add that to a sudden and daily increase in relations and it’s the perfect storm of vulvar and vaginal irritation that is hormone-deprivation based, and likely not even infection based. Think of the comparison of any other mucosal tissues getting a sudden increase in activity and decrease in natural ‘tissue protection’ like natural hormone; it’s not uncommon, therefore, to have the symptoms that you describe.

Irregular bleeding at the start of a menstrual career (from puberty to menopause) is quite common. The usual swings of female hormone can be significant and these swings reflect anything from daily bleeding to unpredictable bleeding/timing to missing months at a time. These hormone swings can happen for months to years before periods normalize to a monthly cycle and these swings are genetic. Know that these swings are able to be managed; you simply need to have your healthcare provider check blood levels of Estradiol, Progesterone, and Total/Free Testosterone. You can also check out my book for adolescents, Blossoming, Becoming a Woman available on Amazon. Please check out my website: victoriajmondlochmdsc.com

Severe abdom pain with or without fever or nausea or vomiting is rarely going to solve itself, even if it comes and goes. Many times this is recurrent and tied to your period; then it could actually be a chronic medical condition called endometriosis that can cause scar tissue, bleeding inside your abdomen and even infertility. It can also be an ovarian cyst that can tort or twist on its own blood supply and you may lose the ovary or the cyst may rupture, causing scar tissue and sometimes patients will lose consciousness. Severe abdom pain can sometimes be an ectopic pregnancy which is always a surgical emergency and needs urgent medical attention. Severe abdom pain with fever can sometimes mean a ruptured appendix or a chronic appendix that can form an abscess and then rupture leaving pus in your belly; this will cause significant inflammation and scar tissue and can result in sepsis and sudden death. In any of the above scenarios, severe abdom pain is not going to have a happy ending and will usually require medical attention; please contact your doctor or if you are in severe pain, call an urgent care to get an appointment or call 911.

Abnormal periods and bleeding that won’t quit, whether heavy or light is the hallmark of hormone imbalance which is the lead up to perimenopause and menopause. Ask your doctor to check your female and male hormone levels as it’s the best way to track where you are and how to best manage what you are going through. Many women approaching perimenopause and menopause are not ovulating and need to take regular nightly bio-identical Progesterone to prevent heavy and persistent bleeding. If your doctor is uncertain what your levels mean, then feel free to contact my office and I’ll be happy to help. I write books on these topics as there are many questions that patients have and it can be quite confusing; so, you need your healthcare provider there to help you through it. Please check out my book on Amazon: Full Bloom; Perimenopause, Menopause, PostMenopause and Beyond as it will answer many of your questions.

Based on your timing and the dates that you recall, it’s quite possible that you were pregnant as condoms can be outdated and leak, even without having a tear or pulling off so always check the expiration date. Your extreme pain, esp feeling it in your rectum can mean a few things: it could mean an ovarian cyst that would sit like a water balloon in your pelvis and could sit on your rectum. Ovarian cysts can go away or can rupture; but are painful while they are larger than they should be. Rectal pain can also represent an ectopic pregnancy that can start to bleed with pressure in your rectum or you can miscarry an ectopic and it will land its products in your pelvis and can end up around your rectum. Then once you ‘miscarry’ the ectopic, your cycles will resume.; but the bleeding can cause scar tissue in the abdomen so it can be a troublemaker. Severe pain in your pelvis or abdomen is rarely going to have a happy ending; it usually means you need to have medical attention so don’t be afraid to contact your doctor; scar tissue in your abdomen or pelvis can cause trouble down the road so get checked out.

There are many reasons why abnormal periods occur; we want to make certain that pregnancy is or not the reason because it has huge implications about next steps. However, negative pregnancy tests usually mean hormone imbalance with very low Progesterone which is responsible for the bloating. Ask your doctor to help with natural Progesterone, NOT PROVERA which is synthetic and comes with a lot of very unpleasant side effects. But remember, having low Progesterone may mean other hormone imbalances so checking in with your doctor for full hormone testing on a regular basis is really helpful. Check out my book, Blossoming, Becoming a Woman on Amazon; it has a chapter on how to talk to your doctor and which blood tests to order.

As a diabetic you are completely correct; what you have to know are a few more facts: 1) What is your short term and long term sugar control? If you had a spike in blood glucose, that alone can trigger a yeast infection so know your glucose numbers. 2) Are you taking hormone replacements? If you are not, then you should explore taking either a vaginal cream which is perfectly safe in diabetics and is even prescribed safely for patients who have been diagnosed with breast cancer. If you are medically able to take topical or oral bio-identical hormones, then I highly encourage you to get your hormone bloodwork done and ask your doctor to prescribe hormones for you; this will give you better blood supply per square inch to your entire vaginal vault which helps rebalance your vaginal fluid pH or acid base balance and you will have a DECREASE in yeast infections! If your doctor is not comfortable doing your hormone labs, then get my book on Amazon: Full Bloom; Perimenopause, Menopause, Post Menopause and Beyond which may answer many more questions that you may have.

Masturbation is a natural action that we do to fulfill a natural desire; it causes contractions to the uterine muscle in general and those muscles extend to the cervix. You did not cause yourself any injury by stimulation uterine contractios; it’s similar to what the uterus does when it’s having a menstrual period or when they are stronger contractions, it can mimic labor pains. Both of these contractions are stimulated by Prostaglandin; so taking an anti-prostaglandin like Ibuprofen can help. Takin 400mg Ibuprofen is usually enough; but occasionally a repeat dose or an increase up to 600mg is necessary; but you did not cause any injury to yourself so know that you are healthy.

Abnormal bleeding with a negative pregnancy test can mean a few things: 1) Possible ECTOPIC pregnancy which may take longer to show on a home pregnancy test but can still be quite deadly, especially if the pregnancy is in the tube, it can slowly grow until the tube ruptures; so get a blood pregnancy test to be certain. 2) Missed ovulation from the prior menstrual cycle would result in an inability to trigger a normal period. Anovulation or missed ovulation by definition is an Estradiol dominant situation, building a thicker lining in the uterus which then gets too thick and starts to bleed a little before the remainder of the lining becomes unstable and then it will trigger heavier bleeding that may go on for days or weeks until ovulation and hormone balance ‘resets’ regular menstrual cycles. If this type of abnormal bleeding happens more often, then ask your doctor to check your blood values for Estradiol and Progesterone on d21 of your cycle with d1 being the first day of your ‘regular bleed’. When bleeding is abnormal, then have your doctor help you determine when is the best time to actually get your bloodwork done. Remember, knowledge of your hormone levels is one of the only ways to really know what is going on.

I lay out in my book, Full Bloom how the menstrual cycle works and what abnormal bleeding can mean; Full Bloom is available on Amazon.

That’s an easy question but a complicated answer. Rrect answer is : 1) adequate daily hydration is key: 128oz total oral fluids/day with 64oz wate, 16oz electrolyte and remainder in ‘other’. 2) Only additional calories/day that is needed in pregnancy is 300 calories extra/day; that’s an apple and orange. 3) Adequate exercise is key, even if it’s 4-6pair of stairs/day and/or 10,000steps/day. 4) Cutting unnecessary man-made carbs and knowing not only your fasting blood glucose AND your fasting insulin level is key to knowing if you are prone to gestational diabetes. 5) Most patients are told to gain 25-35# total for pregnancy based on many factors; know what your doctor has in mind for your and your baby’s best health. 6) Aerobic exercise IS reasonable and healthy for patients to do while pregnant, esp if they are already used to doing aerobic exercise.

Knowing what your body works best with also helps: some patients do best with more carbs while other patients do best with more protein or more fats; knowing your metabolic body type is important but that is best done BEFORE you are pregnant.

Your question is timeless, and used to be Russian roulette until women realized that they could ask their doctor to check their female and male hormone levels. Many docs will only do an FSH (follicle stimulating hormone) test and tell you it’s the menopause test, but IT’S NOT!!!! In fact, our female hormone levels swing up and down and we can have 12 months of ‘no periods,’ then our body can actually kick back in for anywhere from 2-6 months with return of ovarian function. I call this the ‘Last Hurrah’ as it’s almost the last gasp of the ovaries before they stop functioning, but the timing is tricky and it’s different for every woman. Average age of menopause in the US is 50.5yo, but some women will stop and start and have ovarian function until as late as 58yo so nothing is for certain. I highly encourage you to get ahold of my book, Full Bloom; Perimenopause, Menopause, Post-menopause and Beyond. There is a section at the end of the book about how to talk to your doctor and how to ask for the appropriate blood tests that you want them to draw for you. But for now, I’d recommend that you still use some form of contraception until you know for sure; there are a lot of oops babies out there.

Irregular periods, late periods, spotting with or without cramping can all be related to pregnancy; the only way to know quickly is a urine pregnancy stick that you can get at the Dollar Store; if that is positive, then you need to see a healthcare provider to make certain the pregnancy is viable and in the uterus. Sometimes, abnormal bleeding can actually be a sign of pending miscarriage or it can also be a sign of ectopic pregnancy which can be a surgical emergency. But abnormal periods can also mean that you didn’t ovulate and your hormones are out of balance; if your urine pregnancy stick shows negative or if your healthcare provider does a blood test that shows negative, then I recommend getting your hormone levels checked; that means Estradiol, Progesterone, Total Testosterone, Free Testosterone, thyroid panel + thyroid autoantibodies to make certain there are no thyroid issues. I highly recommend that you check out my book Blossoming, Becoming a Woman as I help women understand how hormone balance can impact our daily lives. Blossoming can be found on Amazon; or feel free to contact my office. My website is victoriajmondlochmdsc.com.

Raw sushi or fresh caught fish is a staple in many areas of the world. What is truly important is how that fresh fish/seafood is handled, the temperature that it is kept at and how the cleanliness of the food preparation areas is maintained. Fish are a great source of omega 3 oils and an excellent protein source; there should be no reason to fear any suchi that is properly prepared.

Milk is a source of calcium and is many times fortified with Vit D. Many patients with dairy sensitivities simply take a calcium supplement so they don’t have to worry about drinking milk. Also, there are many countries in the world that do not have access to cow’s milk or even pasteurized dairy products; again access to calcium is what is important.

Yes, this needs to be investigated. This could actually be a vaginal/cervical infection that needs to be treated; it could also mean a serious bladder issue or infection that needs to be checked, cultured and then treated. In either case, you likely need to see you primary MD or your OB-GYN; I feel strongly that every woman needs to have a GYN MD who can help them with the female issues that could happen to them, esp if your GYN is a female herself.

I can’t answer why a doctor would tell you she prescribed something when she didn’t; except she may be overworked and mixed your note with another pt’s note who was similar but I’m speculating. Whenever a tampon is ‘lost’, it will continue to hold blood and vaginal bacterial and fungus that continue to grow on that bloody tampon and it can cause a very odiferous (smelly) discharge which can be very irritating to both the vaginal vault and to the urethral opening/bladder. Many times, an oversized metal speculum placement is needed to properly visualize that lost tampon and then retrieve it. And many times this entire affair causes so much irritation that bathing the vaginal vault in an iodine wash is needed to finish cutting down the risk of any infection. So many docs will list vaginitis because of its high rate of occurrence because the insurance company will certainly pay for your visit when the insurance company may not pay for your visit if only a ‘lost tampon’ is listed; then the cost of that visit is totally on you.