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Vulvitis

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What is vulvitis?
Vulvitis is not a disease, but refers to the inflammation of the soft folds of skin on the outside of the female genitalia, the vulva. The irritation can be caused by infection, allergic reaction, or injury. The skin of the vulva is especially susceptible to irritation due to its moistness and warmth.



Who is affected by vulvitis?
Any woman of any age can be affected by vulvitis. Girls who have not yet reached puberty or post-menopausal women may be at higher risk of vulvitis. Their lower estrogen levels may make them more susceptible to the condition due to thinner, dryer vulvar tissues.


What causes vulvitis?
Vulvitis can be caused by many factors or irritants, including:
The use of colored or perfumed toilet paper
An allergic reaction to bubble bath or soap used to clean the genital area
Use of vaginal sprays or douches
Irritation by a chlorinated swimming pool or hot tub water
Allergic reaction to spermicide
Allergic reaction to sanitary napkins
Wearing synthetic underwear or nylon pantyhose without a breathable cotton crotch
Wearing a wet bathing suit for extended periods of time
Bike or horseback riding
Fungal or bacterial infections including scabies or pubic lice
Herpes
Skin conditions such as eczema or dermatitis



What are the symptoms of vulvitis?
The symptoms of vulvitis can include:
Extreme and constant itching
A burning sensation in the vulvar area
Vaginal discharge
Small cracks on the skin of the vulva
Redness and swelling on the vulva and labia (lips of the vagina)
Blisters on the vulva
Scaly, thick, whitish patches on the vulva
The symptoms of vulvitis can also suggest other disorders or diseases of the genitals. If you are experiencing any of these symptoms, you should consult your healthcare provider.

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Vaginal Discharge during Pregnancy

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White discharge is a fairly common occurrence for a woman but for some first-time mothers, it became a cause of concern when they start having more of the white discharge during pregnancy in the second trimester.

Why there is a white discharge during pregnancy in the second trimester?
There are many possible causes of having thick white discharge in the second trimester of pregnancy. Most of the time it is normal, but it could also indicate something serious.

Leucorrhoea:
The most common reason woman might experience increased white discharge during pregnancy in second trimester is leucorrhoea. It is a normal part of pregnancy and happens to many women. In fact, this is the same white discharge they might have seen before their periods. The only difference is this time it is thicker and more in amount. Leucorrhoea is a thick white discharge with a mild smell. It is made up of secretions from the cervix and vagina.

When pregnant, the estrogen production in body increases causing a greater flow of blood to vagina. More mucus is produced from cervix glands as a result. This then comes out of vagina as a white discharge.”

This white discharge is important because it helps protect developing baby by maintaining a healthy balance of helpful bacteria in birth canal and vaginal area.

Yeast Infection:
If you experience vaginal itching and a burning sensation during urination along with a thick, white discharge resembling cottage cheese, then it might be the sign of a yeast infection in your vagina. Yeast infection is common in women but its chances of occurring increase during pregnancy. During pregnancy, hormonal changes disrupt the pH balance of the vagina causing yeast infection. It is not dangerous and doesn’t harm the baby.

Sexually Transmitted Infections:
Sexually Transmitted Infections are bacterial or viral infections transmitted through genital, oral or anal sex. It causes a yellow or white discharge but with a foul smell and woman might also experience pain during sex and urination. Sexually Transmitted Infections are harmful to woman and her baby and hence, require immediate treatment. The most common STI is gonococcal infection. In most cases, these infections can be treated with antibiotics. Whenever woman notice that white discharge has a foul smell or is associated with itching then consult the doctor immediately.

Bacterial Vaginosis:
As the name suggests, Bacterial Vaginosis is caused by an imbalance in the normal bacteria existing in a woman’s vagina. It is unclear what causes the imbalance. Bacterial vaginosis is a serious concern during pregnancy. It leads to an increased risk of preterm birth or miscarriage thus needs immediate medical attention.

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Vaginal Cancer

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What is vaginal cancer?
Vaginal cancer happens when malignant (cancerous) cells form in the vagina. It is a very uncommon disease. The vagina, also known as the birth canal, is a hollow channel that goes from the opening of your uterus to the outside of your body.


There are two types of vaginal cancer:
Squamous cell carcinoma: This is by far the more common of the two. It happens when cancer forms in the flat, thin cells that line the vagina. This type spreads slowly and tends to stay close to where it starts. But it can move into other organs including the liver, lungs, or bones. Older women are most likely to get this form of the disease. Nearly half of all cases occur in age group of 60 & more.

Adenocarcinoma: This type starts in the glandular cells in the lining of the vagina. These cells make mucus and other fluids.

Of the two main types, Adenocarcinoma, the more likely to spread to other areas. These include the lymph nodes (organs that filter harmful substances in the body) in the groin area and the lungs.

Clear cell carcinoma: This is an even rarer form of adenocarcinoma. It is been linked with women whose mothers took a hormone called diethylstilbestrol (DES) in the early months of pregnancy. Between 1938 and 1971, doctors often prescribed this medication to pregnant women to prevent miscarriage and other problems. Doctors stopped using it in 1971. But just how long do you remain at risk if your mother was given DES? That remains unknown.

Women who haven’t been exposed to it can still get vaginal cancer, but the chances are very small. If DES isn’t a factor, clear cell carcinoma is most likely to happen after menopause.


Vaginal Cancer and HPV (Human Papilloma Virus):
About nine out of every 10 vaginal cancer cases are linked to human papilloma virus, or HPV, infection. This is the most common STI, or sexually transmitted infection. There are two different vaccines to prevent HPV. But once you have it, it will most often go away on its own without treatment. When the infection lingers, though, it can cause cancer.


Other Causes
The following things can also increase your chances of developing vaginal cancer:
Drinking alcohol
Having cervical cancer or pre-cancer
Having HIV
Smoking
Many cases of vaginal cancer aren’t linked to any specific causes.



What are the symptoms for Vaginal Cancer?
These can include pain or abnormal vaginal bleeding. But the disease often doesn’t come with any warning signs. Your doctor might find it during a routine exam or Pap test.

Other symptoms can include feeling a lump in your vagina, pain in your pelvis, and painful sex.

If you notice any of these things, it doesn’t mean you have vaginal cancer. You could just have an infection. But it’s important to get it checked out.


What are the diagnosis and treatment for Vaginal Cancer?
If a pelvic exam shows there might be cancer, your doctor may want to take a closer look with a procedure called colposcopy. She’ll use a lighted magnifying instrument, a colposcope, to check your vagina and cervix for anything abnormal.

She might take tissue samples at the same time. A specialist will study the samples under a microscope. This is called a biopsy.

If she finds cancer, your doctor will choose a treatment based on many factors. These include how close the cancer is to other organs, which type of cancer is present, how advanced it is, whether you’ve had a hysterectomy, and if you’ve had radiation treatment in your pelvic area.

Most likely, your doctor will recommend one of the following courses of action:

Surgery: This is the most common treatment. Your doctor may use a laser to cut out affected tissue or growths. In some cases, she may need to remove all or part of the vagina. Or she’ll perform a hysterectomy. This is when the uterus is taken out. Sometimes the cervix or other organs need to be removed, too.

Many women can have a normal sex life after surgery. Your doctor will need to tell you what’s safe and when. Sex can increase the chance of infection, and it can cause bleeding or strain the surgical site. How you’re healing and what kind of surgery you’ve had will make a difference in the effect on your sex life, too.

Radiation therapy: This treatment uses high-powered X-rays or other forms of radiation to kill the cancer. It might be performed using a machine that sends X-rays into your body from outside. Your doctor might also place a protected radioactive substance inside your body on or near the cancer.

Radiation treatments in the pelvic area can damage the ovaries. This cuts off estrogen production, which leads to menopause symptoms like hot flashes and vaginal dryness. If you’ve already been through menopause, these symptoms likely won’t happen.

This type of therapy also can irritate healthy tissue. Your vagina might get swollen and tender. Sex may be painful.

Chemotherapy (“Chemo”): This kills or stops the growth of cancer cells using medications. You might take them by mouth or get them through an IV. If you have squamous cell vaginal cancer, your doctor might prescribe a chemo treatment in lotion or cream form.

Many patients lose their sex drive when they get chemo. Plus, the physical side effects, like nausea, hair loss, and changes in body weight can cause feelings of insecurity. Knowing that the physical side effects will improve when treatment stops can help a lot.


Can you Prevent Vaginal Cancer?
The best way to guard against it is to avoid being exposed to HPV. There are two vaccines, Gardasil and Gardasil 9, available to prevent vaginal cancer. Gardasil protects you from the four most common types of HPV. Gardasil 9 covers nine types of HPV.

If you don’t want the vaccine, you might try the following lifestyle changes. Studies show they may help to reduce your risk of vaginal cancer:
Wait to have sex until your late teen years or beyond
Don’t have sex with more than one partner
Don’t have sex with someone who has more than one partner
Use condoms during sex
Get regular Pap exams
If you smoke, stop. If you don’t smoke, don’t start.

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Skin Discoloration

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Overview
Vitiligo (vit-ih-LIE-go) is a disease that causes the loss of skin color in blotches. The extent and rate of color loss from vitiligo is unpredictable. It can affect the skin on any part of your body. It may also affect hair and the inside of the mouth.

Normally, the color of hair and skin is determined by melanin. Vitiligo occurs when the cells that produce melanin die or stop functioning. Vitiligo affects people of all skin types, but it may be more noticeable in people with darker skin. The condition is not life-threatening or contagious. It can be stressful or make you feel bad about yourself.

Treatment for vitiligo may restore color to the affected skin. But it does not prevent continued loss of skin color or a recurrence.

Symptoms
The main sign of vitiligo is patchy loss of skin color. Usually, the discoloration first shows on sun-exposed areas, such as the hands, feet, arms, face and lips.

Vitiligo signs include:

Patchy loss of skin color
Premature whitening or graying of the hair on your scalp, eyelashes, eyebrows or beard
Loss of color in the tissues that line the inside of your mouth and nose (mucous membranes)
Loss of or change in color of the inner layer of the eyeball (retina)
Vitiligo can start at any age, but often appears before age 20.

Depending on the type of vitiligo you have, the discolored patches may cover:

Many parts of your body. With this most common type, called generalized vitiligo, the discolored patches often progress similarly on corresponding body parts (symmetrically).
Only one side or part of your body. This type, called segmental vitiligo, tends to occur at a younger age, progress for a year or two, then stop.
One or only a few areas of your body. This type is called localized (focal) vitiligo.
It's difficult to predict how your disease will progress. Sometimes the patches stop forming without treatment. In most cases, pigment loss spreads and eventually involves most of your skin. Rarely, the skin gets its color back.

When to see a doctor
See your doctor if areas of your skin, hair or eyes lose coloring. Vitiligo has no cure. But treatment may help to stop or slow the discoloring process and return some color to your skin.

Causes
Vitiligo occurs when pigment-producing cells (melanocytes) die or stop producing melanin — the pigment that gives your skin, hair and eyes color. The involved patches of skin become lighter or white. Doctors don't know why the cells fail or die. It may be related to:

A disorder in which your immune system attacks and destroys the melanocytes in the skin
Family history (heredity)
A trigger event, such as sunburn, stress or exposure to industrial chemicals
Complications
People with vitiligo may be at increased risk of:

Social or psychological distress
Sunburn and skin cancer
Eye problems, such as inflammation of the iris (iritis)
Hearing loss

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Skin Allergy

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Irritated skin can be caused by a variety of factors. These include immune system disorders, medications, and infections. When an allergen is responsible for triggering an immune system response, then it is an allergic skin condition.

Atopic Dermatitis (Eczema)
Eczema is the most common skin condition, especially in children. It affects one in five infants but only around one in fifty adults. It is now thought to be due to “leakiness” of the skin barrier, which causes it to dry out and become prone to irritation and inflammation by many environmental factors. Also, some people with eczema have a food sensitivity which can make eczema symptoms worse. In about half of patients with severe atopic dermatitis, the disease is due to the inheritance of a faulty gene in their skin called filaggrin. Unlike with urticaria (hives), the itch of eczema is not only caused by histamine so anti-histamines may not control the symptoms. Eczema is often linked with asthma, allergic rhinitis (hay fever) or food allergy. This order of progression is called the atopic march.

Allergic Contact Dermatitis
Allergic contact dermatitis occurs when your skin comes in direct contact with an allergen. For instance, if you have a nickel allergy and your skin comes in contact with jewelry made with even a very small amount of nickel, you may develop red, bumpy, scaly, itchy or swollen skin at the point of contact.

Coming in contact with poison ivy, poison oak and poison sumac can also cause allergic contact dermatitis. The red, itchy rash is caused by an oily coating covering these plants. The allergic reaction can come from actually touching them, or by touching clothing, pets or even gardening tools that have come in contact with the oil.

Urticaria (Hives)
Hives are an inflammation of the skin triggered when the immune system releases histamine. This causes small blood vessels to leak, which leads to swelling in the skin. Swelling in deep layers of the skin is called angioedema. There are two kinds of urticaria, acute and chronic. Acute urticaria occurs at times after eating a particular food or coming in contact with a particular trigger. It can also be triggered by non-allergic causes such as heat or exercise, as well as medications, foods, insect bites or infections. Chronic urticaria is rarely caused by specific triggers and so allergy tests are usually not helpful. Chronic urticaria can last for many months or years. Although they are often uncomfortable and sometimes painful, hives are not contagious.

Angioedema
Angioedema is swelling in the deep layers of the skin. It is often seen together with urticaria (hives). Angioedema many times occurs in soft tissues such as the eyelids, mouth or genitals. Angioedema is called "acute" if the condition lasts only a short time such as minutes to hours. Acute angioedema is commonly caused by an allergic reaction to medications or foods. Chronic recurrent angioedema is when the condition returns over a long period of time. It typically does not have an identifiable cause.

Hereditary angioedema (HAE)
Hereditary angioedema (HAE) is a rare, but serious genetic condition involving swelling in various body parts including the hands, feet, face, intestinal wall and airways. It does not respond to treatment with antihistamines or adrenaline so it is important to go see a specialist.

Skin conditions are one of the most common forms of allergy treated and managed by an allergist/immunologist, a physician with specialized training and expertise to accurately diagnose your condition and provide relief for your symptoms.

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Dr. Neeti Gujar
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Dr. Mukund Ghodke
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Dr. Vrushali Sarode
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Dr. Akash Kadam
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