TOILET INFECTION: WHY SO TROUBLESOME?

"TOILET INFECTION"

The term TOILET INFECTION is known and used by all Nigerians, educated and uneducated alike to refer to infections of a woman's v-part by whatever organism. My Patients will come in and say,
"Dr., I have an infection," and I would say, "I don't understand," just to ensure they actually spill the beans. Some will timidly clarify further while others will boldly tell you "toilet infection now".
"Toilet infection" is a socially acceptable term to obscure the implication that the sufferer has a sexually transmitted infection and is by extension promiscuous (we are all "saints"in Nigeria). Let me, however, quickly point out that, of the commonest causes of "toilet" infections, only trichomoniasis is sexually transmitted. It is also important to note that you do not get these infections from toilets, not even from public toilets. The chances are very slim, so no doctor will even believe you got it from the toilet.

Toilet infections are actually vaginal infections, which is a broad diagnosis encompassing infection caused by different organisms. The commonest vaginal infections are vulvovaginal candidiasis, bacterial vaginosis, and trichomoniasis. The organisms implicated in these diseases are actually normal flora of the v-part, but because of our habits, or changes in our system, they proliferate beyond what the body can naturally curtail and result in diseases.

How do I know I have a vaginal infection?

This is one of the commonest self diagnoses made in Nigeria. Most females from the age of puberty will come in and tell you they have toilet infection. On further questioning, they will tell you they have:

Vaginal discharge

Vaginal odour

Vaginal itches

Painful intercourse

Painful urination.

These are all correct symptoms of vaginal infection. Remember though, that not all vaginal discharge is due to infection. When you have an abnormally copious discharge which smells offensively, is greenish, brownish or like spoilt milk, it is time to see your doctor.

Why is it difficult to treat?

Vaginal infections constitute the commonest complaint in the gynaecology clinic. They are very easy to treat, but our practices either lead to treatment failure or recurrence. Factors that make them seem difficult to treat are:

1. Douching

This is the act of washing the inside of the v-part with plain or soapy water. Some women use over-the-counter douching preparations. The majority of women douche because they want to reduce the smell of the area, prevent infections, prevent pregnancy, wash out menstrual blood etc. Now, as I said earlier, the organisms that cause vaginal infections are normal residents of that area. The body has its natural system of keeping the area clean and safe. Everything there is important; the mucus lining, the pH and the organisms there. So, when you wash out the area, you allow for free proliferation of the troublesome organisms.
Ironically, researches have shown that douching at least once a month SIGNIFICANTLY increases the risks of bacterial infections, preterm labour and delivery, pelvic inflammatory disease, ectopic pregnancy, infertility and cancer of the cervix. Consequently, The American College of Obstetricians and Gynaecologists have strongly discouraged the practice.
Simply washing the outside of your area with mild soap and warm water is enough.

2. Washing the private part

When washing the private part with water, especially after "number 2" (passing stool), the movement of the hand should be from front to back, then out. Front to back, then out. Not back to front, or front to back to front again. This is to prevent introduction of bacteria from the a-part behind to the v-part in front.

3. Sexual habits

Anything that will cause introduction of a large bacterial load to the v-part should be avoided. Common sexual practices that may predispose to bacterial infections include:
"Fingering" with a dirty hand,
Unprotected sexual intercourse,
Multiple sexual partnering,
Poor technique in handling condom: only wear it when you are about to go in,
Poor hygiene of sex toys (yes they are becoming very common in Nigeria now), and
                                                                Inappropriate lubricants.

4. Wrong therapy

Because of the patient:doctor ratio, and the amount of patients a doctor has to see per day in a typical government hospital in Nigeria, the infection may not be adequately treated.
Other factors in this category are:

Treating only one partner: The couple has to be treated at the same time. If it is a polygamous setting, all the wives have to be treated with the husband. If there are concubines, they should be treated too. Some experts advise abstinence during the period of therapy or using a condom.

Not completing therapy: I am very guilty of this even as a doctor. Once I start feeling better or feel that I am well already, I just discard the remaining drugs. This is not good as it can lead to resistance in the organisms when the infection recurs. Candidiasis, for instance, may need application of cream for at least two weeks, even when you do not feel the itches again.

Over-use of antibiotics: This is the other extreme. Just yesterday, I saw a lady that had been using Augmentin for 3 months! Yes, 3 months to treat "toilet infection". When you use antibiotics excessively, you kill the normal bacterial flora and create a fertile environment for candida to grow.

Treating yourself: DON'T. Seriously, stop it. It is wrong, uneconomical and complicates your therapy. Do not call doctor friends on phone. See a doctor.

5. Medical conditions

Conditions like diabetes mellitus, pregnancy, reduced immunity from systemic diseases like cancer or HIV or drugs, and oestrogen-containing contraception may increase the risk for vaginal infections.

6. Personal hygiene

Biko, wear well aerated and dry underwear and change them regularly. Do not use padded undies to give you the shape you do not have. There is a man for every shape. Do not overprotect the place. Only you: menstrual pad, then panties, then leggings, then bum short, then skirt, haba! Na Central bank? Seriously, even when you feel like being well assured going out, when you come back, wear lighter clothings to prevent too much moisture in the area.

Conclusion

In conclusion, take note of the factors pointed out and help your doctor to help you. Feel free to ask your questions. Aliases are accepted on my blog if you want to protect your identity. Let me know for how long you have been battling with this problem. Your experience will help us become better doctors.