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[Emzib0b]

Hi ladies, I had my smear test this afternoon and it was a very unpleasant experience. I’m feeling quite upset. My last one (three years ago) made me wince a little, and I didn’t expect it to be much worse today.

When the nurse inserted the speculum it was fine, but as she began to open it up it was so painful it made me cry out in pain. She apologised, but didn’t stop, and it became more painful the further she opened it up.

I talked to the nurse about it afterwards and she explained that given I’m peri it’s probably VA causing reduced elasticity. The quandary I’m in is I have been dealing with recurrent thrush for the last nine months that isn’t properly responding to treatment, and I’ve been told by one of the GPs not to use any oestrogen vaginally while I have thrush, I can apply estriol cream externally only.

I have an appointment next week with one of the GPs I have a lot of faith in and I’m hoping we can discuss a way forward in terms of treatment options.

What’s surprised me is how I’ve been feeling since I left the doctor’s surgery. I felt ok, although awkward after the test while I was in the consulting room with the nurse, but as soon as I stepped out onto the street I felt like I was going to cry. I’ve been feeling quite shaken up since and keep feeling like I want to burst into tears. I’ve never felt like this after having a medical exam before.

[CLKD]

It's shock.  The Nurse should have stopped!  No one should 'assume' anything  . Quite frankly I would be having a discussion with the Practice Manager.

VA can certainly cause pain on examinations as can any tension.  Have a Good Cry Girl, have a Good Cry - clears the system.

As for recurrent thrush, there will be a reason for this.  What has been suggested and have U been examined by a specialist?

[bombsh3ll]

I can understand you feeling shaken up by that experience.

I have vaginal stenosis and find smears extremely difficult too.

The good news is that self taken cervical screening swabs are hopefully on the horizon.

Regarding your symptoms, are you sure you have persistent thrush? Peri and menopausal women are often treated repeatedly for "thrush" when their symptoms are actually vaginal atrophy.

This responds best to estrogen, which can be applied as a cream and or pessaries, but it is also worth considering systemic HRT as well because if your vaginal area is suffering from lack of estrogen, this will also be having a negative effect in other areas of your body.

Whilst it is not the best idea to apply local thrush treatment at exactly the same time as vaginal estrogen, if you genuinely do have thrush you can get oral treatment for it.

[Ayesha]

Well done the nurse for mentioning it could be VA. Four years ago at my previous surgery with lots of medics, no one had ever heard of the condition with me being sent away three times with a prescription for antibiotics for a UTI that never existed. A phone call from the nurse saying my latest urine sample was clear and asked me if I was still getting the burning, she said she didn't understand why and gave me more antibiotics!

Many years before that I started getting symptoms that I thought were thrush and bought Canesten which relieved symptoms but what I never realised was it was the beginning of GSM (Vaginal Atrophy) a completely unheard of condition and still is to some extent. Whether I would have got the condition with systemic HRT I will never know but its devious because it mimics other conditions, I was put through hell and all I needed was oestrogen.

Hopefully you will find the answer so you can get on with your life with appropriate treatment.


   

[sheila99]

If you're not using oral treatment for thrush (and assuming it really is thrush) you should do so. Years ago I had thrush recurring every month before a bleed, gp said it can live in the bloodstream and went with 3 oral tablets.

[Emzib0b]

Hi CLKD, bombsh3ll, Ayesha and Sheila. thank you for your replies. I was hoping I would feel better after a night’s sleep, but I don’t! I’m trying to figure out what’s at the root of how I feel so I can process it - the pain, the nurse not stopping when I reacted, or the fact that I feel my body has betrayed me!

Unfortunately it is thrush, confirmed by swab multiple times. I have an ongoing thread about it so I’ll try not to turn this into another thread about the same issue (sorry if that has already happened). I’ve been on the six month Fluconazole regimen since May, which isn’t really working (even through the lab says the Candida is sensitive to it) and a Clotrimazole pessary every month (which is doing a better job). I had no thrush symptoms in the fortnight leading up to the smear test and none on the day, so I doubt that thrush could have made the test so painful?

I do know that my vaginal microbiome is in a mess (I bought a test in July out of desperation)! Virtually no good bacteria and an overgrowth of aerobic bacteria (E. coli and E. faecalis) and Candida parapsilosis. Upcoming GP appointment to discuss. I feel stuck - I know having low oestrogen depletes the good bacteria as they have no glycogen food source, but that same glycogen also feeds Candida!

I’ve been on HRT for two years (75mcg patches with a bit snipped off and cyclical Utrogestan). I was using Estradiol pessaries from May - December last year (stopped in December when treating the first bout of thrush, tried to restart the Estradiol at the end of Jan and got thrush a few days later). I’ve never really felt like I have dryness/atrophy internally but I do have other issues including a Urethrocele and intermittent bladder issues. I started using Estriol cream externally in June and this has helped massively with the horrible dry/itchy/irritated feelings I was experiencing on the outer areas after showering, despite only using water/emollient on the area.

Ayesha, I’m very grateful at least some of the staff at my practice are up to date with these issues. I’m so sorry you were dismissed for so long and had to go through what you did.

[CLKD]

Which 'test' did U buy and for which conditions?

How about adding LIVE yoghurt to your diet: large spoonfuls several times a day which will clear the digestive system top to bottom: as well as applying into the vagina to encourage better flora there?  Remember 2 keep the pots separate ;-)

It won't do any harm.  Candida thrives on sugars .......... continue with the estriol twice a day if necessary. 

[Minusminnie]

I do know that my vaginal microbiome is in a mess (I bought a test in July out of desperation)! Virtually no good bacteria and an overgrowth of aerobic bacteria (E. coli and E. faecalis) and Candida parapsilosis. Upcoming GP appointment to discuss. I feel stuck - I know having low oestrogen depletes the good bacteria as they have no glycogen food source, but that same glycogen also feeds Candida!

Have you tried Optibac for Women probiotic which is for the vaginal area. Reading their bumph it is ok to take two of the capsules which in your case might be an idea to start with.
I take them daily & there are some good reviews on it keeping thrush at bay.

[Emzib0b]

Which 'test' did U buy and for which conditions?

How about adding LIVE yoghurt to your diet: large spoonfuls several times a day which will clear the digestive system top to bottom: as well as applying into the vagina to encourage better flora there?  Remember 2 keep the pots separate ;-)

It won't do any harm.  Candida thrives on sugars .......... continue with the estriol twice a day if necessary.

Hi CLKD,

I bought a vaginal microbiome test from a company called Healthily. I wanted information that I wasn’t going to be able to get from the NHS, such as how much, and which species of beneficial bacteria I had, and a more detailed report on other potential harmful bacteria/fungi. I knew that something had to be very imbalanced for me to be having these ongoing issues, and was getting fed up of doctors/nurses shruggling their shoulders and saying “it’s weird that it’s not going away, we don’t know why”. Since getting the results and doing some research, it seems that the NHS don’t have any guidelines for treating aerobic bacteria overgrowth, they only focus on BV causing bacteria, which are anaerobic. There’s a lot more research going on in other countries. It apparently can increase the risk of cervical cancer and pelvic inflammatory disease.

Thanks for the suggestion about the live yoghurt. I eat it 2 - 3 x a day. I’ve been taking two different brands of probiotics that have the strains of bacteria found in the vagina for the last month or two. I’m slightly skeptical that they could reach the vagina from the digestive tract (and a bit grossed out at the thought of the route they would take!!!) but, what have I got to lose? I also recently tried a week long course of vaginal probiotics (inserted) that I ordered in from Germany.

[Emzib0b]

I do know that my vaginal microbiome is in a mess (I bought a test in July out of desperation)! Virtually no good bacteria and an overgrowth of aerobic bacteria (E. coli and E. faecalis) and Candida parapsilosis. Upcoming GP appointment to discuss. I feel stuck - I know having low oestrogen depletes the good bacteria as they have no glycogen food source, but that same glycogen also feeds Candida!

Have you tried Optibac for Women probiotic which is for the vaginal area. Reading their bumph it is ok to take two of the capsules which in your case might be an idea to start with.
I take them daily & there are some good reviews on it keeping thrush at bay.

Hi Minusminnie,

Thank you for your message and suggestion. I was a bit conscious of putting too much information in my opening post as it was already getting quite long! Optibac for Women is in fact one of the probiotics I recently started taking, as well as Perfect V by VJJ health. I wanted to cover as many good strains as possible! I started the Perfect V at the beginning of July after sending my swab off, and the Opticac at the end of July, I started off with two capsules like you suggested and recently dropped down to one. It’s hard to say whether the probiotics have helped or it’s the monthly Clotrimazole. I have a few other things to try but I’m going to wait until I’ve had my GP appointment on Monday. I’m prepared to throw what I can at this as long as it doesn’t have any negative effects!

[CLKD]

It's not that the yoghurt will reach the vagina via the digestive tract but that any bugs will be cleansed away via the tract out by the bowel.  Thrush can be passed from the bowel to the vagina/urethra if good hygiene isn't used, i.e. wiping front to back.  As well as rinsing after a bowel movement or using wipes. 

Which is why I have successfully used LIVE yoghurt on the vagina, inserting a little internally at night, laying on a thick towel.  My dog had heart burn when on chemotherapy so I gave her LIVE to lick from a spoon.  It really helped.  I find the Greek yoghurt the best thus far.

Tnx for your info about other products  . 

[Emzib0b]

Update on this morning’s GP appointment:

High vaginal swab from last week (taken during the smear test) was negative for thrush (hooray, finally!).

I’m still not allowed to use vaginal oestrogen for the time being 

The GP said there’s nothing they can do regarding the E. coli/E. faecalis overgrowth because the NHS don’t test for/recognise Aerobic Vaginitis.

On a plus note she has referred me to Gynaecology and let me take a low swab myself because I have been itching since I had the smear test.

I have an in person follow up with my NHS meno specialist next month to review my Tostran prescription. My GP and I don’t know if she’ll be able to discuss this additional issue (I’ll still ask though just in case). My initial consult with her in January was a telephone call, was very brief and only focused on Testosterone.

[CLKD]

I would query why you are unable to use appropriate VA treatment,  ........  it would take a strong woman to prise my tubes from me  .  Good that U R clear of thrush.

How long B4 you get an appt.?

Even if the NHS does't treat Aerobic Vaginitis - what ever that might be - the GP should be able to advise 'off licence' products that will help. 

Where is the itching?  What was the swab to be taken for?

I think that you should be seen by a dedicated menopause clinic because Gynaes often don't know any more about VA and/or thrush than GPs seem to do!  Let us k now how you get on and    4 the update.  Keep on with the LIVE yoghurt ;-)

[Ayesha]

Aerobic Vaginitis seems another condition that is poorly researched but at least you are getting somewhere with your forthcoming appointments. I suppose with little knowledge of the condition they are reluctant to complicate matters by prescribing any meds at this stage, I am assuming!

[CLKD]

I can't find a date - PUBLISHED in the BMJ:

How to diagnose and treat aerobic and desquamative inflammatory vaginitis

Mark J Mason, Andrew J Winter

Correspondence to Mark J Mason, Sandyford Sexual Health Services, 2-6 Sandyford Place, Glasgow G3 7NB, UK; [email protected]