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Vaginal Health

Summer 2011

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It's hard to get information about HIV and women's health issues. Yes, I'm talking about birth control, yeast infections and menopause. As a woman living with HIV, what do I need to know about my health down there?

-- E.R., Kamloops, BC

Vaginal Health

Mona Loutfy, M.D., Infectious Diseases Specialist, Women's College Hospital, Toronto

Certain gynecological conditions that are already quite common among women are even more common, severe and difficult to treat in women with HIV. These include vaginal infections, such as yeast infections and bacterial vaginosis; sexually transmitted infections (STIs), such as chlamydia, gonorrhea, herpes and syphilis; and pelvic inflammatory disease, a potentially serious bacterial infection of the reproductive system.

Recurrent yeast infections can be a warning sign for women who have not yet been diagnosed with HIV. For HIV-positive women, recurring infections can be a sign of a weakening immune system.

The treatments for these common infections are generally the same for women with and without HIV. It's important to know that having an STI increases your risk of transmitting both the STI and HIV. Bacterial vaginosis may also increase the risk of passing HIV. You can reduce the risk of many STIs by using condoms during sex.

Women with HIV have higher rates of problematic strains of a common STI known as the human papillomavirus (HPV). These problematic strains can cause genital warts, cervical cancer and cervical dysplasia, an abnormal change in the cervix that can progress to cancer when left undetected.

In the year following your HIV diagnosis, book a pelvic exam, including a Pap test, every six months. Your doctor will do an examination of your inner and outer pelvic area and take a tiny sample of cells from your cervix to check for cervical dysplasia or cancer and various other diseases and infections. If these tests uncover no significant problems, a yearly pelvic and Pap test will suffice.

The condom -- despite its relatively high failure rate at preventing pregnancy (12 percent) -- is the most common and important form of contraception for women with HIV because it is the only one that blocks the transmission of HIV and most other STIs. To prevent pregnancy, a second method of contraception should be used in addition to condoms. This is particularly important in situations where women don't have a great deal of control over when or how they have sex.

Some women choose oral hormonal contraception (the birth control pill). However, women on anti-HIV therapy should be aware that there can be drug interactions between some anti-HIV drugs and the hormones in many birth control pills. Talk to your doctor about your birth control options if you are taking:

  • atazanavir (Reyataz; unboosted or boosted with ritonavir [Norvir])
  • ritonavir-boosted darunavir (Prezista)
  • fosamprenavir (Telzir; unboosted or boosted with ritonavir)
  • Kaletra (lopinavir/ritonavir)
  • nevirapine (Viramune)
  • ritonavir-boosted saquinavir (Invirase)
  • ritonavir-boosted tipranavir (Aptivus)

There are other forms of hormonal contraception, including injections and intrauterine devices, that contain other hormones. Talk with your doctor about whether they might be appropriate for you.


Tasleem Kassam, N.D., Clinic Director, Effective Health Solutions, Calgary

Women with HIV are often plagued by stubborn yeast infections that won't go away. Naturopathic doctors recommend fending off chronic yeast infections by changing your diet. Since yeast feeds on sugar, avoid simple sugars and refined carbohydrates as much as you can; instead choose vegetables and high-protein foods. No diet should be taken to the extreme -- a variety of fresh, unprocessed foods is best for optimal health.

Secondly, probiotic supplements are useful to restore your vagina's flora (healthy bacteria) balance. We are often unaware of our exposure to antibiotics as a regular part of our food supply; this can affect the beneficial bacteria so critical not only to gastrointestinal health but to vaginal health and immune function as well.

During an active yeast infection, I recommend alternating between a probiotic douche and a garlic pessary. To make the douching solution, mix 1⁄8 cup of lukewarm water with 1⁄4 to 1⁄2 teaspoon of probiotic powder. (The powder is available at health food stores or you can simply break open probiotic capsules.) Before showering, flush your vagina with the solution using a vaginal bulb syringe, which can be found in any pharmacy. A large syringe will also work. Make sure you use lukewarm water -- hot water will kill the live bacteria and cold water will feel unpleasant.

I advise my patients to use a garlic pessary on alternate nights. Peel a clove of garlic -- avoid nicking it and releasing any juice that might cause irritation -- and then wrap it in gauze. Form a tail with the gauze to make it easy to remove. Apply coconut or olive oil to lubricate the pessary and then insert it as high as possible into your vagina and leave it there overnight. Allicin, a natural compound in garlic, helps kill yeast. Garlic is an antibacterial agent, so you can also use it to fight off bacterial infections such as bacterial vaginosis.

Naturopathy advocates the importance of addressing the body's ecological balance as part of treating the infection instead of simply taking the standard prescription medications. It's kind of like trying to get rid of dandelions without pulling out the roots -- you may get rid of one infection but you won't stop them from recurring.

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This article was provided by Canadian AIDS Treatment Information Exchange. It is a part of the publication The Positive Side. Visit CATIE's Web site to find out more about their activities, publications and services.
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