Sexual Desire
Frederick R. Jelovsek MD
   
Why do I have a vaginal odor?
First you have to be sure the odor is vaginal rather than perineal. To distinguish, wear a tampon for awhile. If the odor mostly goes away then the odor is from vaginal secretions; if the odor persists, it is from oils or bacteria on the outside skin called the perineum.
Vaginal odor almost always comes from the interaction between bacteria and vaginal secretions or semen. If semen is not an issue, then a vaginal odor may be from bacterial vaginosis especially if the odor is "fishy" like. If so, it is best treated with antibiotic vaginal cream or oral antibiotics. See our disease profile on bacterial vaginosis. You will have to get these prescriptions from your doctor. Over-the counter treatments are not ideal but medicated douches may help at least temporarily. We don't recommend them long term but douches such as vinegar-based ones are ok to use for an active bacterial vaginosis. Also at the pharmacy you can get tablets with lactobacillus acidophillus to take by mouth. They help colonize the GI tract to decrease the recurrence of bacterial vaginosis.
Perineal odor is from the oils in the sweat glands and the skin bacteria. If your perineum (vulva) has any irritation, itching or burning then there is a secondary skin infection with opportunistic bacteria. Keeping the perineum clean, dry and non sweaty will help. The sweat oils come from food you eat with more pungent foods and increased fats causing more smell. Dietary change with less fat and meat and spices can help that as well as exercise that depletes the sweat gland oils.
I have absolutely NO skin irritation in that area. I didn't even know this until my sexual partner told me. So, is it best to make an appointment with my GYN? I'm totally stupid to this, I'm sorry! I have no one else to ask these questions to!
Then am I to understand that you yourself do not recognize an odor but only your partner? You may have to see your Gyn but if there is no discharge and you are not aware of an odor, then it may be your partner's perception. There are always "sexual" odors present. They aren't floral but they are not offensive. Could that be what we are talking about?
Vaginal dryness affecting sex
Vaginal lubrication is due to fluid "sweating" from the dilated blood vessels that occur during the arousal phase of sex. It would be hard to believe that your vaginal blood vessels are not dilating if you can get to orgasm but I suppose it is possible. Is there any chance you so not perspire at all with exercise? If so you may have a condition called anhidrosis. This may be treatable, but only under a doctor's care, using beta 2 adrenergic stimulants such as terbutaline used for asthma.
K-Y® regular lubricant will increase the dryness. For a vaginal lubricant, use the bioadhesive brands such as Replens or K-Y Long-lasting. Also if you are not using condoms for contraception you can use a mineral oil or an essential oil base such as grapeseed oil, jojoba oil or even a vegetable oil like canola. Many women have done well with the commercial products such as Intimate Moisture by Very Private®. I don't think the lubricant is the cause of the problem but it can worsen it.
I assume you are not taking any medications or supplements, and not using douches or any soaps inside the vagina - is that true? Has antything been tried other than the estrogens?
I think this problem will require working very closely with a physician who is interested in helping you solve this. If I were working with someone who had what you have so well described, I might include the following:
- serum hormones - testosterone, estradiol, TSH to make sure they are not abnormal even though I agree that it is unlikely that they are abnormal.
- trial of Viagra as used for arousal disorder. Not much evidence about this yet but would give a trial of about 3-4 uses to see if it makes a difference. Basically it causes more and longer engorgement of the pelvic vessels.
- if any suggestions of decreased estradiol or increased testosterone, might consider an Estring as delivery of a constant dose of estradiol to the vaginal epithelium.
- correct any thyroid hormone abnormality
- consider a trial of a beta 2 agonist such as an albuterol inhaler used for asthma. Note this would be quite experimental so needs to be done working closely with a physician.
Vaginal odor after withdrawal from sex
There are probably still some of the same bacteria in the vagina and when mixed with semen, odorous amine chemicals are released. Condom use would prevent that or a least make a diagnosis for you that that is the cause of the odor. In other words if you use a condom and the odor goes away, then it is the interaction between the semen and the bacteria or the semen itself that is causing the odor.
There are not very good over-the-counter treatments for bacterial vaginosis. Temporarily you can use a vaginal douche before intercourse to reduce the number of bacteria and thus the amount of odor. In the long run, though, douching can continue to favor the growth of BV. You should call the doctor's office and see if you can get another prescription for the Metrogel Vaginal® or see if the doctor made the last prescription refillable. They may want you to come in to be seen but most offices will refill that if you have been seen recently. If it keeps recurring, you may need to take oral metronidazole on an acute and then a chronic basis. I would suggest trying the douching and condom use first until you have gone another month without the odor after sex. Then stop using the condoms if you have other protection. Then stop using the douching about 3-4 weeks later if you are still symptom free.
Can the herb feverfew affect orgasm?
I cannot say if this is an effect or not. As you are aware from looking at scientific articles, the work about smooth muscle has been done in rabbits mostly and we do not know of any effects like this in humans. The fact that you took the dried preparation goes against the permanent effect as indicated in the abstract reference below, because the effect has been shown to be with freshly extracted feverfew, not dried preparation (R).
I would not rule out however that this can be a cause. You will have to wait and see if the delayed time to orgasm reverts to normal within a week or two of stopping the feverfew. I still would doubt very much if it could ever be a long term effect beyond 6 months to a year. You may be the first person to describe this and I would be interested if any other women taking feverfew have noticed this.
Vaginal pain and bleeding after intercourse
There is no way to answer this without your having an exam to see if the bleeding is in the vagina or from the cervix versus uterine bleeding that was induced by intercourse.
If the bleeding is from a cut in the vaginal skin from the entrance of the vagina anywhere back to the cervix, you must hold off intercourse until that completely heals (2-3 weeks). Then resuming intercourse may require using vaginal dilators to gently increase the elasticity of the vaginal skin.
It is not common that intercourse can induce an early menses, but it certainly is heard of. It should straighten out over the next month or two.
Irritant vulvitis versus vulvodynia -- how can I tell?
With a recurrent or secondary yeast infection of the vagina, the yeast metabolizes glycogen (sugar) in the vaginal cells to alcohol. When alcohol gets on the vulvar skin, it burns and irritates it. If you wear tampons to prevent the discharge from getting on to the vulva and the pain lessens or goes away, then the main problem is a recurrent yeast infection. Also, vaginal yeast cultures will show heavy growth.
With an irritant vulvitis, vaginal yeast cultures are generally negative, and pain does not improve with tampon use. If the vulvitis is constant, it is by definition vulvodynia which merely means vulvar pain. Vulvodynia is a constant, chronic condition which has different etiologies such as chronic yeast infections, a contact dermatitis (irritant vulvitis) but a large category is unknown cause. Vulvar vestibulitis which is an inflammation or the glands of the vestibule skin is actually a very less common cause of vulvodynia but an important one because it is a persistant disease refractory to manytreatments.
Decreased libido and vaginal dryness on the birth control pill.
In general, a lower pregestin and higher estrogen pill is a good choice because progesterone contributes both to moodiness and vaginal dryness. Estrogen does the opposite. So a lower progestin potency pill with more estrogen is a good choice. Orthocyclen® should be good to decrease moodiness. It has a low progestin to estrogen potency ratio compared to other pills.
The dryness you are having is probably not a pill effect. While it could be, Orthocyclen® should be a good pill to not be dry. I would look for other causes of the dryness. Specifically, the normal vaginal bacteria may be disrupted from the episodes of vaginitis. Acidophilus supplements on a daily basis may help this. Another cause, especially if the dryness is most noticeable with sex, is the decreased desire or lack of arousal during sex. In other words, that can be the primary problem and the dryness just a secondary problem.
Temporarily use a vaginal lubricant both with and in between sex.
To increase libido, you have to look at the causes of decreased libido and then try to get rid of the cause. I do not know what is the cause in your case so you will have to be your own detective in figuring it out. The most common causes are (in descending order of frequency in my opinion):
- stress, fatigue
- fear of pain with intecourse (due to dryness or other conditions causing pain
- medications, especially antihypertensives and mood affecting drugs
- anger with partner (many times subconsciously)
- generalized depression
- adversion to partner's sexual technique or body habitus, odor, habits etc.
- decreased estrogens, especially after menopause
There are of course other causes and decreased libido can be made up of more than just one cause. Can you identify any of the above which might be playing a role in your case?
If you are really sure none of the above apply to you, you might try one of the herbal preparations such as the Arginmax® for Women which has a basis in scientific studies as effective.
Do vaginal lubricants affect trying to conceive?
I cannot speak to Astroglide® but Baby Oil® (mineral oil) and canola oil appear not to affect sperm motility whereas K-Y® jelly does (R).
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