What to know about Vaginal Infections 

While the symptoms of bacterial vaginosis (BV) and vaginal yeast infections (VYI) seem similar, there is a difference between these two diagnoses. BV is an imbalance of bacteria that is associated with an increased risk of getting HIV, pelvic inflammatory disease and adverse pregnancy outcomes [8]. VYI are more common due to antibiotic use breaking down healthy bacteria within the body. [See chart for causes, symptoms and treatment for VYI and BV]

While CF clinics may prescribe antifungal remedies while a patient is on antibiotics, clinicians may overlook other conditions, such as BV and sexually transmitted infections (STIs), because diagnosis requires pelvic exams and/or specialized testing [9, 10]. Yet the latter testing may be necessary, not least of which because women with CF can have multiple infections at the same time. Baldwin believes that additional research is needed to better understand the incidence of bacterial vaginosis (BV) and vaginal yeast infections (VYI) in the female CF population [9]. 

There is a dearth of extant scientific literature about STIs in cystic fibrosis (CF). Unfortunately, human papillomavirus (HPV) infection has a very high prevalence rate worldwide, with over 80% of sexually active adults infected at some point in their life, and is a well-known, necessary (but insufficient) cause for cervical cencer [11, 12]. For its part, herpes simplex virus (HSV) is another very common STI; because of the physical and psychological morbidities associated with it, women with CF should take precautions to prevent its acquisition [13]. These common infections likely impact the lives of sexually active members of the CF community. While women with CF might not want to seek additional specialty care, Dr. Baldwin encourages routine gynecological care to ensure proper diagnostic testing.

A CFReSHC snap poll revealed that 22 of 61 respondents use an antifungal (oral or vaginal cream) routinely or as needed to treat their VYI. Twenty-nine respondents preferred an OTC treatment; 10 used other options such as modifying their diet or using homeopathic treatments [14].

As you age, so does your vagina  

In October 2016, Healthline writer Annette McDermott described how the vagina is a complex organ that plays a role in sexual pleasure and childbirth. She writes  that as you age, your vagina will too [13].

There is a variety of information available about vaginal health and aging, including: 

• Estrogen is responsible for keeping the vagina lubricated, elastic, and acidic. 
• The vagina is designed to be self-cleaning but women may have a normal white or clear discharge. 
• Hormonal changes during a woman’s menstrual cycle affect the amount and type of discharge her/their vagina produces. 
• Unless a woman is having symptoms– such as pain during sex, itching, a foul-smelling discharge, or burning— her vagina needs little maintenance other than daily washing with mild soap and water. 
• After a vaginal birth, the vagina may lose some of its elasticity and stretch more than usual but over time, most vaginas will return to almost prebirth size. 
• Kegel exercises can help strengthen pelvic floor muscles and restore vaginal tone. 
• The inner labia may darken due to hormonal changes after age 29. As estrogen levels in the body decrease, the vaginal walls become thinner and drier. 
• Moisturizers or creams may help combat vaginal dryness and lubricants may help with intercourse [16].
• During menopause, the vulva may appear shrunken; vaginal atrophy is a common problem for many women. 
• Atrophy may occur in the urethra and can lead to urine leakage, overactive bladder, and urinary incontinence [17].
• Low estrogen may change the acidity in the vagina and may increase the risk of infection due to bacterial overgrowth. It can also impact the urinary tract [16].

Although CFReSHC patient-partners stated they experienced vaginal dryness, it is unclear if this occurs more frequently amongst the CF female population or why [18].