Solve the Medical Riddle: She Has Embarrassing Symptoms “Down There” After Making Love, Third Week

By Marie Savard MD

Editor’s note: Welcome to our ThirdAge feature that gives you a chance to play medical sleuth as we share the details of what happened when a patient presented with a problem that stumped the physician at first.

The first week of this riddle, the patient reported her symptoms to her gynecologist. The doctor proceeded with the examination using the classic S-O-A-P notes as follows:

S=Symptoms or Chief Complaint

O=Objective Findings

A=Assessment or Analysis

P=Treatment Plan or Recommendations

The second week, the doctor warned Sybil about the risk of making love with a new partner who is not using barrier protection, meaning condoms. The doctor also reported that Sybil’s tests and physical exam showed that she is generally healthy but that a blood test and vaginal smear held clues to what the diagnosis might be. This week, we’ll let you know what some people have suggested as possible diagnoses. Next week, the doctor will reveal the actual diagnosis. Then we’ll begin a new riddle for the following month!

Some Guesses as to What the Diagnosis Will Be

“Sybil mentioned a vaginal discharge with a foul odor, so I was going to say that she might have vaginitis from trichomoniasis. One common symptom is a kind of foamy-looking greenish vaginal discharge with what I would call a moldy smell. Unfortunately, I know this from experience! But you said Sybil’s tests showed she doesn’t have any STDs. Lucky her! I ended up with trichomonas vaginitis after I had unprotected sex with a guy I met through an online dating service. He seemed so nice! It never occurred to me to suspect that he might have trich. Big mistake. I second the doctor’s warning that Boomer women who are back in the game need to make sure any new partner is tested for STDs. Believe me, trich is no picnic – and I’m pretty sure the other STDs are not what you want either! Of course, HIV is even worse. If you’re worried about hurting a man’s feelings by asking him to be tested, get over it! He’s not worth your while if he’s all bent out of shape over that request.”

— Maddy G.

“Maybe Sybil has a yeast infection from Candida overgrowth. Candida is a gut microbe that’s not a problem unless for some reason it morphs into a fungus with long filaments. A gross image, I know, but it’s true! I had this condition and I beat it back just by changing my diet. I had been a sugar addict, and sugar is what Candida eats! I gave up white flour, white rice, and all sugar. The change was amazing. Now I do eat some fruit, which has sugar, but I’ve never gone back to stuffing my face with donuts and cookies and candy. My energy level is terrific. I almost feel like a kid again! Come to think of it, maybe Sybil should change her diet habits for the better even if she doesn’t have Candida overgrowth. She might not be eating a poorly as I was, but plenty of people eat fast food and dessert without realizing how bad that is for them.”

— June R.

“Could Sybil have a urinary tract infection? Probably not, since UTI causes burning with urination but no discharge. I can’t think of any other guesses, though!”

— Betty K.

“Sybil mentioned that she had pain during sex with her husband, so she probably has vaginal atrophy. That’s very common after menopause. However, if she’s using a petroleum-based product such as Vaseline for lubrication, she’s probably getting chemical irritation. That happened to me, and my doctor told me to switch to water-based KY jelly.”

— Donna P.

“Could Sybil have bacterial vaginosis? I had it ages ago when I was in college. I don’t know whether or not older women can get it. Still, the fact that Sybil noticed symptoms after starting a new romantic relationship is what tipped me off. That was my situation. I had been with one boyfriend from my freshman year until the last semester of senior year. I was heartbroken when he dumped me and I just hopped into bed with the next guy who hit on me. My discharge, which happened after the second time we had sex, smelled fishy. Ew! My gynecologist explained that you can have a different reaction to a new partner’s semen. Something about alkaline vs. acidic, but I don’t remember the details. I had to take medication. After that, I was leery of starting any new relationships! Eventually I did get over my reservations and I met the wonderful man I married. I’ve never had BV with him, thank goodness, and it’s been 35 years!”

— Crystal S.

“This is embarrassing to admit, but I once left a tampon in and forgot it was there for months. I finally went to my gynecologist because of a smelly vaginal discharge, and she found the tampon! Sybil is postmenopausal, but I suppose there’s a remote possibility that she left a tampon in a long time ago and the discharge is just now happening.”

— Suzanne M.

To be continued . . .

Come back to ThirdAge.com next Thursday when the dermatologist will reveal the actual diagnosis and treatment plan.

Marie Savard, M.D., a former Medical Contributor for ABC News and a frequent keynote speaker around the world, is one of the most trusted voices on women’s health, wellness, and patient empowerment. She is the author of four books, including one that made the Wall Street Journal list of the best health books of 2009: “Ask Dr. Marie: What Women Need to Know about Hormones, Libido, and the Medical Problems No One Talks About.” Dr. Marie earned a B.S. in Nursing and an M.D. degree at the University of Pennsylvania. She has served as Director of the Center for Women’s Health at the Medical College of Pennsylvania, technical advisor to the United Nations’ Fourth World Conference on Women in Beijing, advisor to the American Board of Internal Medicine Subcommittee on Clinical Competency in Women’s Health, health columnist for Woman’s Day magazine, and senior medical consultant to Lifetime Television’s Strong Medicine. Please visit DrSavard.com.