Editor's Note: This article is part of a conversation we had with Dr. Diana Currie, who in addition to her work as an OB-GYN and medical advisor for Evvy, is a pioneering advocate for gender-specific and gender expansive care.
Content warning: **This article contains content about sexual assault and sexual violence. **
Vaginal infections, no matter how severe, suck. Not only do they cause physical discomfort but treating them tends to err on the side of embarrassment, whether you’re sliding your suppository across the counter to a middle-aged man at your pharmacy or having someone peer into the depths of your vagina through a speculum.
In addition to an empathetic and knowledgeable provider, one thing that can make the process of dealing with vaginal infections a little bit easier is knowing how to navigate your doctor’s appointment so that you feel empowered to advocate for yourself and ask the questions that will get you the best treatment available.
We sat down with Dr. Dianna Currie, a practicing OB-GYN for over 20 years and one of Evvy’s incredible medical advisors to get her advice on the best way to talk to your doctor about vaginal infections. Read her tips below:
1. Keep a detailed record of your symptoms
Let’s face it: doctors tend to live busy lives with impossibly packed schedules. More often than not, from the time you call to report whatever is going on down there to walking in for your appointment, your symptoms have changed course in one way or another.
That’s one of the reasons Dr. Currie recommends creating a day-to-day timeline with detailed notes about the ‘alert’ signals your vagina is giving off, including everything from discharge to irritation to odor.
“One of the frustrating things from a clinician point of view is that a patient sits there for ten minutes and can’t [recall] or keeps changing their mind about ‘when did they have this symptom or what have they tried, etc.,” explains Dr. Currie.
Because of the way the healthcare system is structured in the U.S., most doctors only have 10-15 minute slots to see a patient, so time is precious!
Doing the ‘prework’ for your appointment goes a long way in communicating effectively and efficiently with your provider so that you don’t waste a minute trying to place which day your symptoms switched from itching to burning. Heck, it’s hard enough remembering where you put down your phone three minutes ago!
2. Document everything you’ve tried—including if it worked or not!
“Along the same lines,” Dr. Currie adds, “actually write down [everything you tried]. Sometimes people will try over-the-counter things, which is fine, but did they do the one-day, the three-day, or the five-day [treatment] for a yeast infection? I hate to come down on any one brand but [for example], Vagisil can cause horrible symptoms for people who have an allergic response. So, [in a case like that], stop using it and you will be better!”
The reason this is so useful for providers is that different types of treatments work better on different strains of bacteria and fungi. For example, over-the-counter antifungals may treat a one-off yeast infection caused by Candida albicans, but if you’re having recurrent yeast infections because a biofilm has formed, OTC products likely won’t do the trick.
Having accurate and detailed information about what you’ve tried and the result will help inform your provider’s decision about the treatment solution they give you.
3. Give them any life updates
Meet someone new or change your birth control? Tell your provider!
“Tell us if there's a new partner or a new form of birth control,” Dr. Currie shares. “Things like that are very helpful because sometimes there is some sort of interaction.”
Why? Sex (especially unprotected) is one of the biggest and most common triggers for a variety of vaginal infections including, aerobic vaginitis, bacterial vaginosis, urinary tract infections, and yeast infections.
Similarly, some hormones, specifically those found in birth control can play a role in vaginal infections.
4. Ask what information is needed from you to avoid having to repeat yourself
We’ve all been there—the nurse comes in, takes your vitals, and asks something along the lines of, “What brings you in today?”
You give them the full download only for the doctor to come in, ask you the same question and have you tell them every detail. All. over. again! This can not only feel annoying at best and emotionally exhausting at worst, but it leaves more room for us to make an error—we’re humans, not robots.
Instead, Dr. Currie suggests asking whichever practitioner comes in first what they need to do.
She explains, “Every doctor-nurse combo is a little different. But what I would say is, if you tell the nurse: ‘I'm here for recurrent vaginal infection, itching, or whatever it is, just ask: Do you want me to give these details to you? Or should I save it for the doctor?”
Most of the time, this will save you from unnecessarily repeating yourself! But, Dr. Currie notes, try not to get too upset if you have to explain things twice. Sometimes that’s just how that particular office works!
5. Discuss the option of alternative therapies or testing
Many of Evvy’s community members seek us out because despite feeling vaginal symptoms (many of them debilitating), the labs or tests they’re getting at the doctor’s office come back “normal.”
This can be disorienting, and if you don’t have an empathetic provider, it’s easy to feel like you are being gaslit. Having seen thousands of patients, this is not a new phenomenon for Dr. Currie.
So, what’s a person with a vagina to do?
Don’t be afraid to ask about treatment options that may be ‘outside the norm.’ But try not to get frustrated with your doctor when you do present it—there is not a lot of peer-reviewed material for them to work with when it comes to vaginal health.
“It’s very frustrating for patients,” she sympathizes. “Typically they’ve gone through all the antifungals and all of the antibiotics. What I usually do in those cases is think of all the alternative therapies and all the things they might be doing differently such as a new type of condom, spermicide, or partner.”
“I try to go back through all of the medications they’ve tried and review it with them. Then I go into second or third-line treatments, like boric acid and gentian violet. Things that are not as well grounded in western medicine but things we always try when things are recurrent.”
Recurrent symptoms? Meet Evvy's at-home vaginal microbiome test, approved by leading OB-GYNs.
6. If you want to try something you’ve heard or read about, bring it up with your doctor—but keep in mind you’ll probably have to pay for it out of pocket
There’s no shortage of misinformation about vaginal health. Whether you’re in the drugstore looking at scented douches that promise to turn your labia into rose petals or reading about treating a strain of bacteria in an online forum, it’s really hard to know what’s scientifically grounded when it comes to vaginal health—especially if you’re feeling desperate for an answer.
But the truth is it’s okay, even good, to do your own research and bring it to your doctor to discuss (nicely)!
“I’m the type of doctor who will be like, you read about this and it sounds like you think it might help,” says Dr. Currie. “I don’t know whether it will help you, but let’s go ahead and try it if there’s no harm from it. And typically with vaginal preparations, there's very little harm for a lot of them — they just might not work.”
One thing to keep in mind is that doctor’s offices often don’t have the bandwidth to get the preparation, such as a compounded medication, approved (that process can be a 30-90 minute phone call), so if your doctor okay’s something that is not covered by insurance (there’s still limited research on many vaginal treatments, especially ‘alternative’ ones), you have to be willing to pay for it yourself.
7. Remember, they’ve seen it all!
It’s easy to feel self-conscious the second you put your feet into the stirrups at the OB-GYN’s office. You’re lying there, spread eagle with some harsh lighting—how could you not run through the doomsday questions about what your doctor may be thinking about your bits?! The relieving truth is, they really don’t care.
“I joke to people that looking at vaginas is like looking at your elbow for me,” Dr. Currie explains. “When they say, ‘I didn’t shave or I didn’t shower,’ I say, ‘Did you get a pedicure? Because I’ll also be looking at your toes!”
It’s your doctor’s job to make you feel comfortable at your appointment. But if you’re feeling a little more nervous than usual, it’s okay to say so out loud—that will remind your doctor to do the extra work to make you feel at ease!
8. If a gynecological exam can be triggering for you, disclose it before the exam and do what you need for emotional support
For many people with vaginas, a gynecological exam can be scary or even triggering.
Because doctors really only have 10-15 minutes per patient, Dr. Currie recommends doing what you need to make yourself feel comfortable because realistically, though they may want to, the doctor can’t spend additional time with you because of your past. And while many doctors are taught trauma-informed care, not all of them are great at it!
Dr. Currie reveals, “I appreciate it when patients will say to me, ‘I have a history of sexual abuse, this is not easy for me. But here’s what I’ve done to prepare: I have this person here, they’re going to hold my hand. I have my stuffed animal.’ I see all of these things.”
A few other things to keep in mind:
- If you need a provider of a certain gender, make the arrangement beforehand, not the day of.
- Self-swabs can be done, even for HPV pap testing, but if there are recurrent infections the doctor will likely have to put the speculum in and look at the cervix to see what’s going on.
Between limited time with your provider to sub-par research on vaginal health to the inherent power dynamics that exist between doctor and patient, we know how hard it can be to talk to your doctor openly and honestly about vaginal infections.
Hopefully, hearing and applying these tips will make you feel more confident when you step into the exam room. And know that the Evvy community, from our coaches to your fellow test-takes, is here to support you throughout your vaginal health journey, whatever that may entail.