Seeing blood spots in your underwear when your period ended days ago can feel puzzling and concerning. Known as intermenstrual bleeding, spotting between periods and ovulation is not normally cause for alarm. But in some cases, it can indicate an underlying vaginal infection needs treatment.

The most common culprits of bleeding between cycles are bacterial vaginosis (BV), yeast infections, and sexually transmitted diseases like chlamydia and gonorrhea. Here’s an overview of how these infections lead to spotting:

  • Bacterial Vaginosis – Caused by an overgrowth of bad bacteria, BV leads to vaginal inflammation and thinning of the lining. This makes the walls more prone to bleeding. A fishy odor is a hallmark of BV.
  • Yeast Infections – Candida fungus irritates the vaginal tissue, causing itchiness and redness. Scratching can disrupt the sensitive lining enough to cause minor bleeding. Yeast infections produce thick, white discharge.
  • Chlamydia and Gonorrhea – STDs like these infect the cervix, which can become friable and bleed easily. Pain during sex is also common with chlamydia and gonorrhea.
  • Trichomoniasis – This STD invades the vagina, creating an environment prone to spotting and bleeding. A smelly, greenish-yellow discharge occurs with trichomoniasis.

Rising oestrogen levels approaching ovulation create an environment in the vagina that promotes the growth of bad bacteria and yeast. The hormonal changes make women more susceptible to infections during this time of the cycle.

While usually not severe, vaginal infections should always be treated properly. The first step is to test for any infections. My preferred options are at a local sexual health clinic, making sure that also include a test for BV, or I can order the Vaginal Ecologix test for you, and you can gain a comprehensive picture of your vaginal microbiome and identify specific infections.

In most cases, vaginal infection-related bleeding is short-lived once treated. But if you ever experience heavy, persistent bleeding between cycles, seek medical care promptly.

So don’t ignore sporadic spotting. It may be your body’s signalling an underlying infection needing attention. With proper treatment, you can restore healthy vaginal flora, tissue, and pH balance.

The UK’s “unresponsive and defensive” healthcare system has failed thousands of women who developed life-changing conditions after pelvic mesh surgery, according to a review into the treatment.

“The report is hard hitting, harrowing and recognises the total failure in patient safety, regulation and oversight in the UK,” Kath Sansom of campaign group Sling the Mesh said in a statement.

The Independent Medicines and Medical Devices Safety Review, led by Julia Cumberlege and announced by then-health secretary Jeremy Hunt in 2018, has involved two years of data gathering from women who received vaginal and other pelvic mesh implants, mostly to treat stress urinary incontinence and prolapse that developed after childbirth.

Many women went on to develop chronic pain, nerve damage, bowel conditions, recurring infections and mobility issues, among others. The mesh can become embedded in surrounding tissues, making it very difficult to remove. The review found that it is unclear whether the mesh can change in shape or size after it is implanted, and whether chemicals from the mesh can trigger immune conditions, which have been experienced by some women.

The number of women affected by these complications is unknown, but thousands have joined support and campaign groups. Many women weren’t told about the risks of the procedure, and describe how their symptoms and complaints were dismissed by doctors as normal consequences of childbirth or menopause, says the review.

“The narrative is common,” says Sohier Elneil, a urogynaecologist and uroneurologist in London, who says she comes across similar cases on a daily basis. “Patient safety must be key to everything we do,” she says. “It should be a given, but, quite clearly from the report, it hasn’t been.”

A specialised microbial community in humans is the vaginal microbiome. Successful human reproduction depends heavily on the correct balance of these microbes.

An optimal vaginal microbiome results in the production of lactic acid and hydrogen peroxide, maintaining a level of acidity that keeps pathogenic bacteria at bay.

When the vaginal community becomes disturbed, on the other hand, acidity decreases. Pathogenic or other opportunistic bacteria may then invade, which can cause bacterial vaginosis. This is best described as a state of dysbiosis rather than infection.

Research suggests that probiotic supplementation may be of benefit in maintaining homeostasis of the vaginal microbiome thereby reducing the risk of infection, dysbiosis and subsequent inflammation and immune dysfunction.

The 24hr fix for vaginal dryness

“What’s the big mystery?
It’s my vagina not the Sphinx.”
– Sex in the City


The 24hr Fix for Vaginal Dryness

The vagina has its own ecosystem, which brings to mind how apt the phrase ‘lady garden’ is. In my imaginary garden there are variety of wonderful plants, which keep the weeds and other nasties at bay. In the vaginal ecosystem, these wonderful plants equate to families of beneficial bacteria that keep the natural system in balance.

One of the most important family of bacteria is Lactobacillus. Lactobacillus keeps the vaginal pH low by producing lactic acid, which in turn, prevents less vagina-friendly yeasts, bacteria, and other organisms from getting a foothold and causing problems. Members of the Lactobacillus family also help to keep the vaginal wall healthy by promoting mucus production and providing a protective barrier against other bacteria, yeasts, and viruses including HIV.

What’s the connection to oestrogen? Oestrogen promotes the release of a sugar called glycogen from the vaginal walls. Glycogen breaks down to glucose which the Lactobacilli use as food, to then produce lactic acid and mucus. Certain strains of Lactobacillus also produce hydrogen peroxide which repels unfriendly vaginal flora such as Candida, E. coli and Gardnerella vaginalis.

At menopause, oestrogen levels decrease and glycogen production in the vaginal walls comes to gradual and complete halt. When Lactobacilli have nothing to feed on their numbers dwindle, leading to vaginal dryness. Low numbers of Lactobacilli means low lactic acid which leads to a more alkaline environment. This leads to colonisation by faecal flora and other pathogens, resulting in a loss in the quality of vaginal health.

Fix Vaginal Dryness with Honey

  • Yes honey. Replacing glycogen with honey as a food source for Lactobacilli is the way to avoid vaginal dryness, infection and inflammation. Honey is a source of prebiotic sugars that can take the place of glycogen. Honey can naturally moisturise tissues and feed beneficial bacteria so that they crowd out vaginal pathogens. For my clients, I recommend that they take a small dab of set organic pasteurised honey, apply it to the vaginal wall daily and then use as needed. It’s like moisturising your face – only lower – and on the inside. You should results within 24 hours.
  • Pasteurised honey is best, as it has been treated to remove any bacteria – the last thing you need is foreign bacteria in your vagina. Set honey is easier to use than runny honey. Organic is better as it will have minimal toxic pesticides.

Take Prebiotics

  • Taking probiotics that maintain the health of the vagina can also be really helpful. I like Women’s Probiotics from Optibac, and usually recommend 2 capsules taken at night. One client reported that not only did her vaginal symptoms normalise, but that her pubic hair became lush and regained its colour from being grey! If you would like to buy them, you can take advantage of my 10% practitioner discount at the Natural Dispensary on-line, using the code SAND10: https://naturaldispensary.co.uk/products/For_Women_90_s-17520-0.html.

Keep well,

Sandra

PS. Don’t forget: this article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment and should never not be relied upon for specific medical advice.

Hahaha - oops! Is Your Pelvic Floor as Weak as a Kitten? Then Try This.

It used to be called a jumpoline ’til your mum got on it.
– Anon


Hahaha – oops! Is Your Pelvic Floor as Weak as a Kitten? Then Try This.

The prevailing view of our reproductive organs is that while they get some action, they don’t actually do anything themselves. This idea is debunked in this article:

“The pelvic floor muscles play a pivotal role with respect to vaginal and sexual function, their contractions facilitating and enhancing sexual response. They contribute to arousal, sensation during intercourse and the ability to clench the vagina and firmly “grip” the penis. The strength and durability of their contractions are directly related to orgasmic potential since the pelvic muscles are the “motor” that drives sexual climax and can be thought of as the powerhouse of the vagina. During orgasm, the pelvic floor muscles ‘shudder.’

There is great variety in the bulk, strength, power and voluntary control of the pelvic floor muscles that support the vagina. Some women are capable of powerfully “snapping” their vaginas, whereas others cannot generate even a weak flicker.”

The most obvious signs of a weak pelvic floor are leaking when coughing, sneezing, running and even worse, laughing. Other symptoms include:

  • failing to reach the toilet in time
  • uncontrollably breaking wind from either the anus or vagina when bending over or lifting
  • reduced sensation in the vagina
  • tampons that dislodge or fall out
  • a distinct bulge at the vaginal opening
  • a sensation of heaviness in the vagina.

The most common advice is to strengthen the pelvic floor with Kegel exercises – regularly  squeezing the vaginal and anal sphincters to build up muscle strength. After I give birth to my daughter I found that I sometimes had the dribbles and so I did these religiously for weeks. They didn’t make any difference at all. It was quite a terrifying prospect to think that I would stuck with this hopeless pelvic floor forever, but then something wonderful happened.

One of my favourite things in life is trampolining, and as soon as I was up to it post-birth, I got out my mini trampoline and had my first joyful bounce. What I wasn’t expecting was that I would instantly wet myself all down my legs and all over my beloved trampoline. It was quite shocking. Undeterred, and after a tiresome clean-up job, I bought a maxi pack of maxi pads (I think they were the maternity ones) and started again. I usually bounce for about 20 minutes every other day, and the first few times I had to change pads 2-3 times. But after a couple of weeks I only had to change pads once and after 3 weeks I realised that I didn’t need them at all. At the same time the day-to-day leaks stopped and after a while I realised that the old girl was back to her old self – plumped, moisturised, responsive and happy. I also lost weight and got my glow back.  I can safely say that I now have the pelvic floor and vaginal musculature of my teenage years. I think that the movement against gravity and the focus on balance and stability while trampolining forces big and small muscles to contract, toning the whole area.

The pelvic floor is made of 2 muscles that intertwine under the bladder, the bowels and uterus, holding these organs in place. The phrase ‘pelvic floor’ suggests that this is something that is flat, solid and rigid, like a floor. In fact its the opposite of a floor – it is exactly like a trampoline! These muscles should be taut but stretchy and precisely the right length. When the pelvic floor* is weak, it’s like a hammock instead of a trampoline – it has lengthened and weakened, and lost its purpose. 

I suppose that once upon a time the idea of Kegel exercises made sense: if a muscle is weak then it’s necessary to strengthen it by exercising it regularly. But the pelvic floor is not like a bicep or a stomach muscle, which improves as it gets ever shorter and bulkier. The pelvic floor has to be flexible, and it has to adapt to all kinds of daily movements. If it gets shorter then it will get weaker, which is why Kegel exercises are not really the solution, and can make things worse.

Trampolining can not only resolve pelvic floor issues, but its also wonderful for overall health: it moves the lymphatic system which helps to flush out potential poisons (dead cells, excess fat, viruses, bacteria, yeasts, heavy metals and other toxic junk), helps the blood to circulate and so increases oxygenation, builds bone density (as determined by NASA), and burns fat. It’s fun and easy to do, although I would avoid it if there was even a hint of uterine prolapse or other health conditions. I still use my trusty Urban Rebounder, but there quite a few to choose from. It’s great to have a 5 minute bounce when taking a break from working at home or just from sitting down for ages. I’m not an advocate of wearing bras, but a bra in this case is really helpful – I’ve had my ShockAbsorber for years and it has held up very well under pressure.

There is a wonderful kind of congruence that the act of trampolining helps to tone the pelvic trampoline, but what if you can’t bounce? Or don’t want to? Then you can do something that women have been doing since forever, and are still doing now all over the world while working in the fields, or feeding children or cooking or socialising: whole body squats. Squatting 4 or 5 times a day will tone and contract the muscles in your buttocks which positively impacts the pelvic floor. Its easy to do: pretend that you are peeing in the woods while out camping. If you’re not that fit then starting with a few repetitions a day and building up is the way to go. The key thing is not to think of it as exercise, but make it part of day to day movement: a couple of squats in the morning before getting dressed, a few in the evening before going to bed, a few more at the weekends. Putting up a few post-it notes around the house can be a useful reminder to do a few squats here and there.

Having a weak pelvic floor is not the depressing disaster that it seems. All that is required is a little pelvic TLC via trampolining or squatting or both. Are you thinking of bringing your pelvic floor back to life? Let me know how you get on if you do.

*The pelvic floor should really be called the pelvic trampoline, but because it’s not, I have to keep calling it the pelvic floor. I might have to start one of those petitions to get that changed.

PS. Don’t forget: this article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis or treatment and should never not be relied upon for specific medical advice.

Postmenopausal vulvovaginal atrophy is associated with age-related changes in the vaginal microbiome, with a shift from Lactobacillus-dominated strains in premenopause to a predominance of anaerobic organisms, new research shows.

“We have not yet identified specific interventions, but we are interested in pursuing personalized selections of probiotics and prebiotics for a given woman,” said lead investigator Rebecca Brotman, PhD.

“We have been advocating probiotics or prebiotics to improve vaginal health for almost 30 years,” said Gregor Reid, PhD.

“I 100% support the conclusions of this work. It is nice to see confirmation of work we published in 2011, with an aberrant microbiota associated with some cases of vulvovaginal atrophy,” Dr. Reid told Medscape Medical News (PLoS One, 2011;6:e26602).

Get notified about new editions

Subscribe to the Sunday Supplement

Connecting women, science and spirit, the Gynelogic Sunday Supplement delivers a bi-monthly dose of  news, views and reviews, as seen through my lady lens.