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Few data are available on how women manage recurring bacterial vaginosis BV and their experiences of the clinical care of this condition. A descriptive, social constructionist approach was chosen as the framework for the study. Thirty-five women of varying sexual orientation who had experienced recurrent BV in the past 5 years took part in semi-structured interviews.
The majority of women reported frustration and dissatisfaction with current treatment regimens and low levels of satisfaction with the clinical management of BV. Overall, women disliked taking antibiotics regularly, commonly experienced adverse side effects from treatment and felt frustrated at having symptoms recur quite quickly after treatment. Issues in clinical care included inconsistency in advice, misdiagnosis and Housewives seeking real sex Central Somers diagnostic approaches and insensitive or dismissive attitudes. Women were more inclined to report positive clinical experiences with sexual health physicians than primary care providers.
In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect. Clinical management of BV could be improved through the use of standardised diagnostic approaches, increased sensitivity and understanding of the impact of BV, and the provision of evidence based advice about known BV related risk factors.
The symptoms of BV include an abnormal malodour and increased discharge [ 89 ]. Adverse sequelae associated with BV includes miscarriage, preterm delivery and increased risk of sexually transmitted infections STIs and HIV [ 11 — 13 ]. Recommended first line treatment for BV includes oral metronidazole or topical clindamycin cream and while effective in the short term, adverse side-affects are common and include nausea, vomiting, an unpleasant taste in the mouth and vaginal candidiasis [ 1415 ] and symptom relief is often short lived.
It remains unclear whether recurrence reflects reinfection or persistent infection [ 1416 ]. In an attempt to treat or prevent recurring vaginal symptoms women will often employ their own self-help remedies such as douching, taking yoghurt orally or vaginally, probiotics or vitamin supplements, using over the counter yeast infection treatment products and antiseptic creams, wearing cotton underwear and avoiding hot baths and perfumed soaps [ 18 — 24 ].
Most of these self-help remedies however, have little effect, with studies consistently showing douching to be associated with a higher incidence of BV [ 125 — 28 ]. Data on the efficacy of alternative treatments for BV are generally of poor quality, however there is limited evidence to suggest probiotics, lactic acid based treatments and antiseptics may offer some benefit in the treatment of BV [ 242930 ]. Past research has shown women often feel dissatisfied with the clinical care they receive when presenting with vaginal symptoms [ 1821 ] and both patients and clinicians frequently misdiagnose BV [ 202331 — 34 ].
Detailed methods for this study have been outlined in an earlier paper [ 10 ]. This study has been reported in accordance with the Consolidated criteria for reporting qualitative research COREQ guidelines [ 35 ]. A social constructionist approach was chosen as the framework for the study. Semi-structured interviews were chosen as they allowed the opportunity for women to tell their lived experiences and personal realities of recurrent BV while also allowing for the exploration of key clinical areas of interest.
To be eligible for the study women had to be aged 18 to 45 years, have experienced two or more diagnosed episodes of BV in the past five years and have a good understanding of verbal and written English. Women were purposively sampled to allow for a broad sample of women including heterosexual and WSW, single women and women in a relationship, women who had experienced high and low s of recurrent BV and women from a of recruitment locations.
Participants had the option of being interviewed either by telephone or face to face at MSHC or in their own home. Participants interviewed face to face at MSHC were provided with a written plain language statement PLS and consent form to read and. Participants interviewed by telephone were read aloud the PLS and consent form and asked to provide verbal consent. Verbal consent was obtained for telephone interviews as it was not practical to obtain written consent for this method of interview.
This process of written and verbal consent was approved by the Alfred Hospital Ethics Committee. After women had provided informed consent they were asked a series of 15 structured demographic, sexual behaviour and diagnosis and treatment questions before being asked questions pertaining to their knowledge of BV prior to their first episode, their first and recurrent experiences of BV, the impact of BV on them emotionally, socially, sexually and in their work lives, their beliefs around the causes and triggers of BV, their use of self-help remedies and their experience of antibiotic treatment and the clinical management of BV.
Thematic analysis [ 38 ] was undertaken and data coded using primarily a segmented approach [ 39 ]. Transcripts were imported into N-Vivo 9 for data management and a subset of transcripts reviewed independently by two other research team members to cross check coding and themes MTS, SW.
Analyses of demographic, sexual behaviour and diagnosis and treatment data were conducted using SPSS A total of 35 women participated in the study. Table 1 outlines participant demographics. Overall, women reported very poor levels of awareness about BV prior to first diagnosis with most reporting they had never heard of BV before.
I Housewives seeking real sex Central Somers nobody knows anything about itlike I had never even heard of it until I had it. I had never read anything or heard about talk about t or you knowseen it anywhere.
So nobody really knows. Women were more likely to have heard of BV if they worked in the health industry, sex industry, attended sexual health clinics or participated in the longitudinal BV study. Women commonly thought they had thrush when they experienced BV for the first time and treated themselves for such. Consequently, many women did not seek medical assistance for up to a few weeks after symptoms first presented, however, sought treatment sooner with subsequent episodes. Women who immediately feared their symptoms of BV were indicative of an STI rather than thrush were more likely to seek medical assistance quickly.
In general, most women felt that current clinical treatment options for BV were extremely limited, often ineffective and unacceptable in the long term. Women commonly experienced adverse side effects from antibiotic medication including nausea, stomach cramps, diarrhoea, thrush and a metallic taste in the mouth. Despite seven day antibiotic treatment Housewives seeking real sex Central Somers being effective at the time of treatment, many women felt frustrated and distressed at having BV recur, often quite quickly after treatment.
A couple of women felt their BV had never really gone away despite receiving treatment while others reported having episodes spanning over several months, the symptoms of which could be exacerbated by various factors [ 37 ] and the severity of which would influence whether they sought medical treatment or tried to self-manage symptoms.
Most women disliked taking antibiotics, especially on a regular basis, and felt frustrated at the lack of alternative effective treatment and preventative options. Consequently, a handful of women either no longer or rarely used antibiotics to treat BV either because they disliked taking repeated antibiotic treatment, could not tolerate the side effects or would rather use alternative therapies unless it was a symptomatic or severe episode.
Home remedies included salt or vinegar baths, the internal or external use of yoghurt or garlic and inserting tampons soaked in various products. Women also commonly reported having frequent showers, changing their underwear, using sanitary products and perfumes or deodorants to try and mask the symptoms of BV.
Approximately a quarter of women had not tried any self-help remedies as they did not think they would be useful, feared they would make the symptoms worse or knew they were not recommended in the treatment of BV. Table 2 provides examples of the self-help remedies women tried to treat symptoms of BV. Some women reported their self-help remedies were very helpful and these women were more likely to feel in control of their BV because they felt they were able to treat it somewhat effectively themselves.
Most women however reported their self-help remedies did not help, and for some simply exacerbated their symptoms. So the more I wash myselfthe worse it gets Participant 30age In addition to self-help remedies to treat the symptoms of BV, many women had made longer term sexual and non-sexual lifestyle modifications in an attempt to prevent further recurrences. Women commonly tried to improve their diet, reduce alcohol intake and increase their amount of exercise either because they felt these factors may have been contributing to their susceptibility to BV or simply to see if the changes would help.
Other non-sexual lifestyle changes included wearing cotton underwear only, avoiding tight clothing, avoiding soaps or using soap free washes and improving their general hygiene practices. A of women also changed some sexual practices and behaviours they felt may be contributing to or triggering episodes including improving levels of sexual hygiene, no longer sharing sex toys and minimising the exchange of bodily fluids. Single women, who blamed themselves for acquiring BV through sex with casual partners, were most likely to report reconsidering their future perusal of casual sexual partners.
Approximately one third of women had not implemented any long term lifestyle modifications as they felt there was little point given there was no evidence to suggest they would be useful in preventing recurrences. A few women, who strongly believed they knew what triggered their BV, reported no further episodes since implementing these lifestyle changes however these women were more likely to Housewives seeking real sex Central Somers their regular female sexual partner had been treated for BV or they had changed sexual partners. For most women, long term lifestyle modifications had little effect on recurrences, resulting in a strong sense of frustration and for some women a sense they would always have BV.
Commonly however, women reported clinicians in general often said they simply did not know what caused BV, which women found very frustrating. A of women acknowledged however, that despite their frustrations they understood clinicians could only provide them with the information currently available about BV, which was very limited in terms of the cause and preventative behaviours.
While many women acknowledged they are seeking information that is not yet available, they still felt there needed to be increased awareness of BV both publicly and professionally. Women very clearly expressed they wanted improved knowledge and support from clinicians—in particular primary care providers—including consistency in advice, and greater acknowledgement and sensitivity around the impact of recurrent BV. Women strongly indicated they want better treatment and preventative options so that they do not have to regularly take antibiotics.
Most importantly though, women want answers—they want to know what causes BV and what they can do to prevent further episodes so that they do not have experience recurrent BV any longer. As one participant summed up:. I want an answerI want a cure! Participant 25age As part of the study we explored possible differences in the experiences of heterosexual women and WSW, single women and women in a relationship and sex industry workers and non-sex industry workers. Differences have been reported ly [ 10 ], however briefly, in relation to the data presented in this paper, we found women who worked in the sex or health industries, attended sexual health clinics or participated in the longitudinal BV study had higher levels of knowledge about BV.
WSW were also more likely than heterosexual women to report working with their partner to prevent further recurrences, mainly through partner treatment or a change in sexual practices thought to have triggered BV onset or recurring symptoms. In this study we found women had low levels of knowledge of BV prior to first diagnosis, commonly misdiagnosed and treated themselves for thrush in the first instance and often did not seek medical assistance for a of weeks as a result.
Women frequently reported high levels of frustration and dissatisfaction with current treatment options and clinical care management, often experiencing adverse side effects and high rates of recurrence and reporting a dislike of taking regular antibiotic treatment. Women were more inclined to report positive experiences with sexual health physicians. The majority of women had tried various self-help remedies and made lifestyle modifications in an attempt to treat symptoms or prevent further recurrences, however with little effect.
Only a few women reported their self-help remedies or lifestyle modifications were successful in treating symptoms or preventing recurrences and these women were more likely to feel in control of their BV. In a context of considerable uncertainty about the aetiology of BV, high rates of recurrence, sub-optimal treatment options, often insensitive and inconsistent clinical advice, and distressing symptoms, it is not surprising women are desperately trying all Housewives seeking real sex Central Somers of self-help remedies in an attempt to prevent further BV recurrences.
data have shown women commonly feel dissatisfied with the efficacy of current antibiotic treatment options for BV and associated side effects and want more effective, alternative treatments [ 1524 ]. Contributing to their frustration and dissatisfaction with current treatment regimens for BV, is their inability to get answers from clinicians about why they are getting BV or what they can do to prevent it recurring. In a study by Dowd et al [ 23 ] of women presenting with vaginal symptoms in primary care, researchers found only half the women were examined vaginally when presenting with symptoms indicative of BV, most were informed they had thrush and almost all treated with antifungal medication.
Further studies have found even when using recommended diagnostic methods errors in the diagnosis of BV can be high [ 4041 ]. The strengths and limitations of this study have been outlined in detail in publications from this study [ 10 ]. Briefly, the strength of this study is the in-depth data collected on how women manage recurrent BV and their experiences of clinical care of BV—no other study we are aware of to date has specifically examined this area in such detail.
A limitation of this study is that women were only recruited from an urban area and therefore the findings may not be generalizable to women living in other populations i. It is also important clinicians provide evidence-based advice regarding the use of self-help remedies and lifestyle modifications given the extraordinary lengths women are taking to prevent recurrences.
Despite being a well-known risk factor, it is concerning the of women in this study and others that continue to douche to treat symptoms of BV. Women need to be informed about the scientific uncertainty around BV to assist them in understanding why treatments may not be highly effective and to hopefully reduce intensive self-help approaches which may be exacerbating recurrences. We would like to thank all the women who kindly participated in this study and shared their time and experiences with us.
National Center for Biotechnology InformationU. PLoS One. Published online Mar Brenda A Wilson, Editor. Author information Article notes Copyright and information Disclaimer. Competing Interests: The authors have declared that no competing interests exist.
Received Oct 1; Accepted Feb This is an open access article distributed under the terms of the Creative Commons Attributionwhich permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. This article has been cited by other articles in PMC. Associated Data Data Availability Statement Data are available from the Alfred Hospital Ethics Committee for researchers who meet the criteria for access to confidential information, due to restrictions outlined in the consent form.
Abstract Background Few data are available on how women manage recurring bacterial vaginosis BV and their experiences of the clinical care of this condition. Methods A descriptive, social constructionist approach was chosen as the framework for the study.
Conclusion In the face of considerable uncertainty about the cause of BV, high rates of recurrence, unacceptable treatment options and often insensitive and inconsistent clinical management, women are trying their own self-help remedies and lifestyle modifications to prevent recurrences, often with little effect.Housewives seeking real sex Central Somers
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