A bad-smelling vagina

 Many women complain that they havea
bad smell coming from the vagina, even after
washing frequently. This can be very
distressing, particularly if it is noticed and
commented on by someone else.
Genital odour is due to the combination of
vaginal secretions, eccrine and apocrine sweat
and external sources (urine, faeces, topical
applications).
What symptoms should lead to concern?
A bad smell could be due to genital infection or
disease. Clues include:
- excessive vaginal discharge
- itching (pruritus vulvae)
- pain and soreness.
What conditions cause vaginal malodour?
Sometimes the apparently bad vaginal smell is
actually normal, as vaginal secretions in every
adult woman have a rather musty odour. The
smell can vary throughout the menstrual cycle.
There is also a wide variation in what is
considered acceptable.
Bad smell is however often associated with
infectious or non-infectious causes of vaginitis
or less often, vulval disease.
Malodorous vaginal infections include:
- Bacterial vaginosis (the most common reason
for genital malodour, a fishy smell)
- Trichomoniasis (this is foul-smelling in only
about 20% of infected women)
- Vulval ulceration of any cause, particularly if
due to donovanosis or chancroid
- Vaginal discharge associated with pelvic
inflammatory disease
- Forgotten foreign bodies such as tampons,
diaphragms or sponges
- Fistulas or passageways linking the vagina
with the rectum or bladder following childbirth,
injury or surgery
- Hidradenitis suppurativa.
Although candidal vulvovaginitis (thrush) is very
common, it causes a yeasty smell, which is not
considered particularly unpleasant by most
women.
Noninfectious causes of vaginal malodour
include:
- Excessive perspiration ( hyperhidrosis leading
to bromhidrosis) especially associated with
obesity
- Chronic constipation and bloating or dietary
factors leading to release of smelly rectal gases
- Urinary incontinence, releasing ammonia
- Faecal incontinence
- Poor hygiene, often in women who are elderly
or mentally unwell
- Vulval cancer, when it is due to necrosis
(death of tissue)
- Discharge or necrosis of other genital cancers
- Trimethylaminuria (fish-odour syndrome)
- Olfactory hallucinations, e.g. associated with
temporal lobe epilepsy
- Psychiatric conditions.
What tests should be done?
Women complaining of genital malodour should
undergo careful external and internal
examination after a careful history has been
taken. Tests may include pH, vaginal and/or
vulval swabs for microbiology and sometimes
skin biopsy.
Treatment
Treatment depends on the underlying cause.
Antibiotics should be prescribed for confirmed
infection.
General measures should include:
- Avoid wearing tight or occlusive underwear
- Change underwear frequently
- Bathe gently using non-soap cleanser once or
twice daily
- Attempt to lose weight, if relevant
- If incontinent of urine, copper acetate
impregnated incontinence pads may help to
reduce the smell.
The hazards of self-treatment
Excessive washing, antiseptics, deodorants and
douching (rinsing out the vagina) may irritate
the vagina and vulva, potentially resulting in
increased irritation and discharge from vulvitis,
chemically-induced vaginitis or secondary
infection. Don’t do it!