Alright, this one is for all my folks out there who get yeast infections, bacterial infections, UTIs, or oscillate between all three. We’re going to talk about the difference between these 3 pelvic conditions, and some risk factors.
Female bodied or vaginal carrying humans are more likely to get infections and UTIs because the urethra is shorter between the bladder and urethral exit. IE, it’s easier for bacteria to climb up that shorter passage. This is just some basic anatomy.
Bacterial and yeast infections are more common in individuals with vaginas because 1) this is an additional orifice so, another vulnerable location, 2) it’s close to the rectum, where other bacteria and yeast live, which means sometimes those bacteria and yeast can hop next door and start causing trouble and 3) it’s an orifice that’s often penetrated, which brings in new strains of bacteria and yeast. None of those 3 things are bad. They’re just aspects of anatomy.
I like this image for the most part. My one quibble is that it fails to demonstrate how large the clitoris is (that little orange bean to the left of the urethra), but we can talk more about the clitoris later. This is “generic” anatomy, which means maybe most of the population, but everyone’s anatomy varies. Some people might have a smaller perineum, so the anus is closer to the vaginal canal, some might have a urethra further away or closer.
In individuals who’ve undergone gender affirming surgery from male to female, the anatomy is quite similar, save that there is no uterus at the end of the vaginal canal, and the urethra is still somewhat longer as it passes through the pelvis. The prostate is usually preserved in these surgeries. Individuals who have transitioned often have their vagnial canal constructed from penile tissue, or created from sections of the intestine (this allows a softer tissue that’s more likely to stretch elastically). Neovaginas can also get infections, because guess what, they also have a natural group of bacteria and yeast that live in them.
Vaginas are typically self lubricating, and naturally have bacteria and yeast occurring in them. The vagina is typically around a pH of 4.5 or so, meaning it’s slightly acidic. This is normal, and healthy. However, if the pH is thrown off, or gets too high, you can be vulnerable to yeast infections. Conversely, if it’s too low, you might be prone to a bacterial infection. That’s why at pharmacies, the tests for a bacterial or yeast infection are actually pH tests.
Bacterial Vaginosis: an overgrowth of a particular strain of bacteria in the vagina, with a high pH. These individuals often have an overgrowth of a specific kind of bacteria, anaerobic bacteria (don’t need oxygen to survive). These anaerobic bacteria have replaced the standard Lactobacillius strains that are found in a balanced an balanced bacteria.
Symptoms include: a fishy odor, smooth discharge that’s yellow or green. The discharge might be more noticeable after sex, but the big clue here is the smell. Some people report mild itching or burning, or some pain with sex.
Aerobic Vaginitis is another kind of bacterial infection, again with the overgrowth of a particular species that does consume oxygen. The pH here remains around 5 or so.
Symptoms of AV include yellow/green discharge (no fishy odor here though), inflammation and a more active immune response (this really only matters for diagnostic purposes; there will be immune fighting cells in vaginal smears here). Again, this is caused by the abscence of our friends the Lactobacillus bacteria.
Yeast Infections occur when there’s an overgrowth of the yeast in the vagina.
Symptoms of a yeast infection include: itching, burning, clumpy, chunky discharge that is usually white to off white, and significant pain with sex and potentially pain with urination. There isn’t a smell associated with the discharge.
Urinary Tract Infections (UTIs) occur when there’s an infection of any part of the urinary system, but typically it’s an overgrowth of bacteria in the urethra and bladder. The Mayo Clinic broke it down into a handy chart for us, as seen below:
Kidney Infection: This is one of the more serious ones, and if you suspect you have a kidney infection, get yourself to an MD or the ER immediately, as this is life threatening and is unlikely to go away on its own.
Symptoms: back pain, high fever, shaking and chills, nausea and vomiting.
Bladder: An overgrowth of bladder in the bacteria. This is really important to have treated, as it’s less likely to go away on its own.
Symptoms: Pelvis pressure, lower abdomen discomfort, frequent and painful urination, urine that is cloudy, urge to urinate but little volume is actually voided, urine that’s cloudy or tinged pink.
Urethra: This is the most common, and what people typically think of when they say “UTI.”
Symptoms: Burning with urination, discharge, discolored or cloudy urine, urge to urinate, but little volume is actually voided. You can tell apart a urethral and bladder infection more often by the presence/abscence of lower pelvic pain.
How to distinguish between bacterial and yeast infections?
Is it clumpy or smooth? Clumpy is a big arrow point to a yeast infection
If it smells, that clearly points to bacterial vaginosis, of the anaerobic kind.
How to distinguish between bacterial infections, yeast infections, and UTI?
You’ll note that both yeast infections and bacterial infections often have some discomfort with urination. However, the biggest difference between yeast and bacterial infections is the discharge, and where it’s coming from.
Okay, so now that we have an understanding of the anatomy we’re looking at, and an understanding of the infections that can occur, it helps us understand some of what can drive infection. Risk factors are going to range from exposure, to dietary components.
Risk factors include things that introduce bacteria into the pelvic or change the pH of the pelvis such as:
A shorter distance between the urethra and the vagina
Wiping from back to front (brings bacteria from the anus toward the vagina)
Certain types of birth control, like sprayable spermicides because they alter the microbiome and change the pH.
Recurrent use of antibiotics: When you take oral antibiotics, they wipe out bacteria all over, from your gut to your pelvis.
High alcohol and sugar intake: this increases your blood sugar, and promotes those pesky bacteria to grow.
Using lubes that alter your pH or have a high osmolality (we’ll talk more about this one!)
Boric acid washes: these kill bacteria indiscriminately, including the good ones, leaving you vulnerable to the infection causing kind to bloom.
Use of “feminine washes:” these kill bacteria indiscriminately, including the good ones, leaving you vulnerable to the infection causing kind to bloom, and alter your pH.
Variations in urethra anatomy that can encourage blockages and backing of urine to the bladder
Sex without a shower or wash routine beforehand
I want to emphasize this last one. Many individuals report that “having sex” can exacerbate sex, but I don’t want you to think sex is bad, or that having an infection is just ‘part of it.’ If you’ve had a sweaty day, worked outside, haven’t washed your hands, you’ve got more bacteria on your skin, different type than usual, and if you jump right into sticking those into your more vulnerable places, that just means more bacteria/yeast being introduced, and therefore greater likelihood of the note fun ones flourishing.
This is why I typically recommend individuals shower prior to sex. To be clear, you don’t need to get the soap into your vagina, the opening. What I’m recommending is hot water around the vulva; feel free to use soap around the anus, as more bacteria tend to come out of there. If you want to use soap are the labia and vulva, or the penile head, make sure it’s a “gentler” soap. I’ve had good luck with the Dr. Bronner soap, because it’s essentially just lye with some essential oils. However, that’s my experience; I strongly recommend using what soaps feel best to you.
If you’re going to participate in oral sex (yum!), consider a mouthwash or toothbrush session beforehand to make sure fewer oral bacteria hop in or around.
If you’re having sex, particularly if you’re transitioing from anal to vaginal sex, it is important to wash whatever toys, implements, or body parts that were in contact with the anus before they make contact with the introitus or the vagina. The bacteria of the anus vastly vary from those of the vagina, and can destabilize the microbiome there, so be sure to do a wash if you’re jumping between! This can help reduce risk of infections.
Now, I also want to emphasize that lube is important. I’ll get into more detail later, but here’s a quick break down. Lube is important for not only for making sex more pleasurable and safer, but it can also change the pH of your vagina. The cis female pelvis and vagina typically have a pH of around 4.5, but lubes can actually vary widely in their pH.
The WHO formulated a list of popular lubricants, and made a recommendation for individuals to use lube that as a pH of around 4.5 and a osmolality of 1200 or less. pH makes sense; your body uses it’s pH to support the kinds of bacteria that are supportive. Osmolality is a measure of density of particles, and measures how much water it will draw out from your cells. If the osmolality is higher than normal pelvic secretions, it will cause the tissue to dehydrate, compromising the mucous membrane, and leaving you vulnerable to infection. I’ve had clients who get recurrent infections with any penetration, despite their cleanliness routine. But once we switch their lube, everything changed.
So, please check out your lube, and make sure it has a composition that supports your pelvic health. The best ones, according to the WHO list, are Durex Playmore (it’s pH is closer to 4.7, but that’s closer than most out there, and it has a low osmolality), Fillergyn, Phyto Soya, Good Clean Love. If you’re not sure, I typically recommend Good Clean Love because they avoid complex additives (no, I don’t get paid to say that). You can use the discount code Functional20 to get a 20% discount code off your first order.
Contact us if you have any questions or need support for your pelvis!