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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35717
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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I'm suffering from Bv since January. I have been on Flagyl

Customer Question

I'm suffering from Bv since January. I have been on Flagyl and metro gel. Neither worked. Actually nothing is really working. My MAJOR symptom is a BURNING vagina that sometimes my rectum burns as well. My rectum really burns after my period as well. The gyno said its bv. I am beyond frustrated. Not sure how I got it either. I Only feel slight comfort when I'm not wearing underwear or a long skirt. I'm not in pain per se just constant burning all the time. I've tried vinegar baths,sea salt sitz baths,I take probiotics.etc. I don't know what to do anymore. Do I need to get bloodwork Do u think it's still bv? HELP!!!! By the way it's not burning when I urinate just a constant burning feeling all the time.i find it hard to believe there isn't sometging I can do that doesn't always have to be antibiotics
Submitted: 2 years ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 2 years ago.
I am Dr. Arun and will be helping you today.
I am sorry that your question was unanswered for long.

I am not challenging the diagnosis of your doctor as I have not examined you but you need to explore the other diagnosis too. The clinical diagnosis of bacterial vaginosis is made if three of the four following signs are present:

1) A grayish-white vaginal discharge;

2) A vaginal pH exceeding a value of 4.5;

3) The presence of so-called clue cells on saline wet mount;

4) A fishy or amine odor after the addition of a 10% potassium hydroxide solution (positive whiff or sniff test).

Treatment of the bacterial vaginosis is cumbersome. Following are the treatment modalities;

1) Metronidazole (flagyl) and clindamycin have been the drugs of choice. Since you have tried flagyl, you may try clindamycin.

2) Azithromycin too is effective, especially if there is recurrence or persistence. Secnidazole, ornidazole and tinidazole are also used in the case of antibiotic resistance.

Recurrence reflects resistance, recurrence and/or reinfection.

3) Antiseptics as vaginal suppositories;

a) benzydamine,

b) chlorhexidine,

c) dequalinium chloride,

d) polyhexamethylene biguanide,

e) povidone iodine

f) hydrogen peroxide

4) Probiotics

5) Stop douching or bubble bath, if you do.

6) Avoid liquid soaps and body wash.

Having said that your doctor may consider other diagnosis if these treatment do not respond and get a vaginal swab done.

One of reason of this kind of burning in vagina and rectum is pelvic floor problems and weakness. Several organic and functional disorders of the urinary bladder, reproductive tract, anorectum, and the pelvic floor musculature cause pelvic burning etc. One of the cause to be considered for your pain is levator ani syndrome. Ask your physician to consider this entity and get the following investigations;

1) defecography,

2) pelvic MRI

3) nerve-conducting velocities and needle-electromyographic studies are used to help evaluate compression or entrapment neuropathy and pelvic floor function.

The treatment is following;

1) electrogalvanic stimulation,

2) biofeedback training,

3) digital massage of the levator ani muscles

4) sacral nerve stimulation

5) physical therapy for the pelvic floor muscles

Please read about this on this resource;

Pelvic congestion syndrome, Pelvic floor relaxation disorders, Pelvic floor dysfunction too need to be considered for the pain. Though treatment is essentially same.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Expert:  Dr. Arun Phophalia replied 2 years ago.
Hello Rachel,

Please let me know if you have further queries or unanswered questions.

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Thank you.

Wishing you all the very best in life.