Author: Hon Assoc Prof Amanda Oakley, Dermatologist, Hamilton, New Zealand, 2012.
Many women complain that they have a bad smell or malodour coming from the vagina, even after washing frequently. This can be very distressing, particularly if it is noticed and commented on by someone else.
Genital odour is due to the combination of vaginal secretions, eccrine and apocrine sweat and external sources (urine, faeces, topical applications).
A bad smell could be due to genital infection or disease. Clues include:
Sometimes the apparently bad vaginal smell is actually normal, as vaginal secretions in every adult woman have a rather musty odour. The smell can vary throughout the menstrual cycle. There is also a wide variation in what is considered acceptable.
Bad smell is however often associated with infectious or noninfectious causes of vaginitis or less often, vulval disease.
Malodorous vaginal infections include:
Although candidal vulvovaginitis (thrush) is very common, it causes a yeasty smell, which is not considered particularly unpleasant by most women.
Noninfectious causes of vaginal malodour include:
Women complaining of genital malodour should undergo careful external and internal examination after a careful history has been taken. Tests may include pH, vaginal and/or vulval swabs for microbiology and sometimes skin biopsy.
Treatment depends on the underlying cause. Antibiotics should be prescribed for confirmed infection.
General measures should include:
Excessive washing, antiseptics, deodorants and douching (rinsing out the vagina) may irritate the vagina and vulva, potentially resulting in increased irritation and discharge from vulvitis, chemically-induced vaginitis or secondary infection. Don't do it!
Vulvovaginal Disorders: an algorithm for basic adult diagnosis and treatment — ISSVD
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