Welcome to "Talk with the Doc" - a new series brought to you by Love Wellness that has our favorite medical professionals answering our health questions and addressing curiosities and common misconceptions.
With women's health issues on the minds of 50% of the American population (not to mention women worldwide), we felt it appropriate to have a straight-forward, no B.S. chat about our vaginas with an award-winning OB/GYN. Meet Dr. Lindsay Appel, OB/GYN at Mercy Medical Center in Baltimore, MD.
Hi Dr. Appel! Thanks for chatting with us today. Can you tell us the most common reasons that women come in to see you at your practice?
As an OB/GYN, I see women for a variety of reasons including pregnancy, annual exams, and "problem visits". One of the most common reasons for a "problem visit" is concern about vaginal itching, irritation, dryness, and changes in vaginal discharge.
Do you find that for a lot of women yeast infections and BV are a common, recurring problem?
I often see women who are being diagnosed and treated for multiple yeast and bacterial infections in a single year. Many times, the diagnosis is being made based on symptoms only or in an urgent care setting. Women come to me feeling frustrated with constantly feeling uncomfortable or requiring multiple medications.
If so, why do you think that is?
For one, there are a lot of products (soaps, lotions, lubricants) out there that are marketed towards women that contain harsh chemicals which can increase the risk of vaginal and vulvar irritation. The vagina has naturally occurring bacteria which helps keep it clean, and using products that contain ingredients that decrease "good" bacteria can increase infection rates.
What works for them? A lot of women get trapped in a cycle of using an antibiotic for one issue, then needing an antifungal for an issue that occurs because of antiobiotic use, and so on.
Sometimes, I see patients who are diagnosed with a bacterial infection based on symptoms alone and then treated with antibiotics. As soon as they finish the antibiotic treatment, a yeast infection develops and antifungal medications is prescribed. As a physician, its important to me to know what I am treating before I treat it, which can decrease unnecessary use of antibiotics and/or antifungal medications. Eliminating the use of harsh chemicals in the vagina is essential to improving vaginal health. Also, increasing natural bacteria in the vagina using oral probiotics is very helpful in reducing infection rates.
Can you give us your opinion on the use of boric acid as a treatment for the relief of yeast infections and BV?
Boric acid suppositories are an excellent alternative for women who have failed traditional treatment methods for bacterial and yeast infection or suffer from recurrent infection. One of the difficulties I have had in prescribing boric acid is that it often needs to be either purchased at a compounding pharmacy or made into a capsule by the patient herself which can be burdensome, especially because many women would like to be discreet when performing vaginal hygiene.
Is boric acid safe to use during pregnancy? While nursing?
Unfortunately, there is very little data regarding the safety of boric acid suppositories in pregnancy or while breastfeeding.
In general, what do you recommend to patients who are looking to improve their overall health?
I often recommend the use of probiotics to help support naturally occurring gut and vaginal flora, and improve baseline vaginal health. In addition, I recommend avoiding products that contain harsh chemicals or glycerin because this can definitely increase the risk of vaginal infections, especially yeast infections.
Do you believe that natural formulations are safer to use than drugstore brands? Do you find that patients have success with them?
Again, there are a lot of products on the market that contain harsh chemicals which can increase the risk of vaginal irritation and infection. Using gentle, natural formulations on the external vagina can decrease irritation and infection risk. I have seen many women with improvement in symptoms simply with eliminating harsh detergents, cleansers, and lotions from their regimen.
We know that the vagina cleans itself internally. Used externally, are pH balanced cleansers and wipes made with natural ingredients safe to use? A lot of women, and doctors for that matter, have different opinions about this and we wanted to get your thoughts. There is a lot of confusion regarding the correct use of these products.
Yes, when used externally, it is safe to use pH balanced cleansers and wipes. When used internally, these cleansers can actually change the pH and decrease the "good" natural bacteria in the vagina and increase infection risk. Basically, when used internally, these products don't allow the vagina to be self-cleaning.
Would you recommend Love Wellness to your patients who are looking for natural alternatives to improve their overall health?
I would absolutely recommend Love Wellness to patients. For many women, talking about their vaginas and/or vaginal hygiene causes them to feel embarrassed or afraid that it is taboo. I think it's great that Love Wellness is encouraging women to play an active role in maintaining vaginal hygiene in a natural way. It's also great to have a more accessible resource for boric acid vaginal suppositories.
Thank you for your time and support, Dr. Appel! We wish you the very best.
About Dr. Appel, OB/GYN:
Dr. Lindsay Appel earned her medical degree and completed her Residency in the Department of Obstetrics, Gynecology, and Reproductive Sciences at the University of Maryland School of Medicine where she received multiple awards, including recognition for excellence in teaching.
Dr. Lindsay Appel has participated in several OB-GYN research presentations at professional conferences, including the American Congress of Obstetrics and Gynecology Annual Clinical Meeting.