Bacterial vaginosis (BV) is the most common cause of abnormal vaginal discharge. One in ten will have BV at some time in their life.
WHAT CAUSES BV?
BV is caused by a change in the number and type of bacteria found in the vagina. A healthy vagina contains many different kinds of bacteria. In BV, there is a decrease in the number of a particular bacteria called lactobacillus and an increase in other bacteria called anaerobic bacteria. The most common of these anaerobic bacteria is Gardnerella.
The increase in the anaerobic bacteria in the vagina changes the chemistry of the vaginal fluid, making it more alkaline. BV is not the same as vaginal thrush and is caused by different organisms.
IS BV A SEXUALLY TRANSMISSIBLE INFECTION?
BV is associated with sex but is not considered a sexually transmissible infection. However, having a new sexual partner or multiple sexual partners increases the risk of BV. Using condoms is known to reduce the risk of BV.
WHAT ARE THE SYMPTOMS?
50% of people with bacterial vaginosis will have no symptoms. If symptoms do occur, they include:
Increased or changed vaginal discharge (often white or grey watery).
A change in vaginal odour - usually slightly offensive or ‘fishy’.
The odour may be more noticeable after sex.
Vulval itching or irritation.
HOW IS IT DIAGNOSED?
A doctor usually diagnoses BV based on symptoms and an examination and is generally confirmed by collecting a vaginal swab.
DO I NEED TREATMENT?
In up to one-third of cases, BV resolves without treatment, however, treatment is advised in the following circumstances:
To relieve symptoms that don’t go away.
If you are having a gynaecological procedure.
If you are pregnant.
WHAT IS THE TREATMENT FOR BV?
BV is treated with antibiotics. These antibiotics reduce the anaerobic bacteria and allow the lactobacilli to increase in number and restore normal balance in the vagina. Antibiotics can be given as oral tablets, vaginal creams, or vaginal gels.Please discuss your preferred method with your doctor.
ARE THERE SIDE EFFECTS FROM BV TREATMENT?
Some people may experience side effects such as abdominal pain, cramps, nausea & vomiting, flushing, or headache when taking oral bacterial vaginosis treatment.
You may be advised to avoid alcohol during treatment and for up to 3 days afterward.
The vaginal preparations weaken latex condoms, so using non-latex condoms or avoiding sex is advised during treatment.
WHAT HAPPENS IF BV IS NOT TREATED?
BV is a common condition, and most of the time, there are no problems if it is not treated.However, there are situations where complications can occur:
If you have BV when you are pregnant, you may be at higher risk of late miscarriage, premature birth, and developing a womb infection after birth.
If you undergo a gynaecological procedure when you have BV, you are at greater risk of developing a pelvic infection.
You are more likely to contract a sexually transmitted infection if you have untreated BV.
CAN BV RECUR?
About a third who respond to treatment will have another BV episode within three months; more than half will have a recurrence within a year.
HOW CAN I REDUCE BV RECURRING?
The best ways of preventing BV are not known. Avoiding anything that changes the balance of vaginal bacteria may help.You may reduce the chance of getting BV if you avoid the following:
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Menopause is the stage of life when your periods stop.It occurs when your ovaries are no longer producing eggs and is a natural life event. Menopause has three phases:
Perimenopause: this is the time from the first onset of any symptoms to 12 months after your last menstrual period and can vary in length but is usually around 4 to 6 years.
Menopause: the last menstrual period.
Post-menopause: from 12 months after your last period.
WHEN DOES MENOPAUSE USUALLY OCCUR?
Natural menopause can occur at different ages, but periods usually stop between 45 and 55.
Premature menopause occurs when your periods stop before the age of 40. This may happen naturally or from medical treatments affecting your ovaries, such as surgery, radiotherapy, or chemotherapy, resulting in early menopause.
WHAT HAPPENS DURING MENOPAUSE?
For some people, the menopause transition has little impact on their lives; however, many do experience symptoms which are caused by the changes in hormone levels that occur during this time. Some may experience symptoms severe enough to affect their health and well-being and to disrupt their lives.
The postmenopausal phase symptoms, such as hot flushes, can continue for the first couple of years after menopause. For a few people, hot flushes and night sweats may continue into their 60’s and beyond.
Menopause can mean a new lease of life for you, free from concerns about periods, premenstrual syndrome, or the risk of pregnancy. However, some people may find it difficult and may feel anxious about reaching this stage in their life or mourn the loss of their fertility and youth. For almost everyone, menopause is a time of significant change.
During perimenopause, periods commonly change. They may end suddenly but more often become irregular or heavier and longer before eventually stopping.
SYMPTOMS EXPERIENCED MAY INCLUDE
HOT FLUSHES OR SWEATS
Hot flushes may be associated with sweating, palpitations, a sudden ‘wave of heat’ especially around the neck and face, or a ‘crawling’ feeling under the skin. Sweating may be more noticeable at night, which can disturb sleep.
VAGINAL CHANGES
The lining of the vulva and vagina become thinner and less elastic, and there may be less vaginal lubrication. You may find that this means intercourse may be less comfortable or less enjoyable.
URINARY PROBLEMS
Reduced elasticity in your bladder and pelvic floor muscles may affect bladder tone. This means that you may pass urine more frequently or experience leakage when you cough or sneeze. Urgency (feeling the need to rush to the toilet when your bladder is full) can also occur.
BODY CHANGES
There can be body changes such as dryer, thinner skin, increased facial hair, joint pain, and breast tissue loss.
EMOTIONAL OR PSYCHOLOGICAL CHANGES
These vary for each individual but may include symptoms of depression, anxiety, mood swings, tiredness, lower sex drive, and poor concentration or memory.
Emotional symptoms might also be due to life stresses that commonly occur around the same time as menopause. This can include caring for children, young adult children leaving home, caring for aging parents, parents’ death, employment changes, and changes in your health or relationships.
WHAT ARE THE LONG-TERM EFFECTS OF MENOPAUSE?
CARDIOVASCULAR DISEASE
Before menopause, women* are less likely than men* to suffer from heart disease or strokes. Rates of these conditions increase for women after menopause, and by the age of 65, rates in men and women are equal. Cardiovascular disease is one of the major causes of death in women.
OSTEOPOROSIS
Osteoporosis is characterised by thinning bones, leading to a greater chance of a fracture occurring, particularly in the hip, spine, and wrist. Loss of oestrogen after menopause is the primary cause of osteoporosis.
Factors that may increase your risk of osteoporosis include:
Early menopause, a thin build, a history or eating disorders, excessive exercise.
A family history of osteoporosis.
Long-term use of some medications (for example, steroids, epilepsy medications, some antacids, and fluid tablets).
Lifestyle factors such as smoking, high intake of alcohol or caffeine, a diet low in calcium, and lack of exercise.
SEXUALITY AFTER MENOPAUSE
Interest in and feelings about sex sometimes change in midlife. Generally, if sex has been meaningful and enjoyable in your younger years, it will probably continue to be so as you get older.
The quality of your relationship with your partner will also affect feelings about sex. Sexuality involves more than just intercourse and is enhanced when a relationship is supportive, loving, and involves good communication.
Physical changes such as vaginal dryness and thinning of the vaginal walls may lead to discomfort during sex. In this case, vaginal lubricants, oestrogen cream or pessaries, HRT, or alternative therapies may help.
MANAGING MENOPAUSE
INFORMATION & SUPPORT
It is beneficial to understand what is happening to your body at any stage, but especially at times of change, such as menopause. Discussing menopause with others can also be helpful. Partners and other family members will find it easier to support you if they understand what happens during menopause.
DIET AND EXERCISE
Regular exercise and a healthy diet help maintain or improve overall health and feelings of well-being, and exercise may reduce some of the symptoms of menopause. A diet that is low in fat, sugar, and salt but high in calcium and fibre may also help prevent osteoporosis and heart disease and help maintain a healthy weight.
STRESS MANAGEMENT
Using stress management techniques such as relaxation and exercise can help to improve your mental health during menopause. Doing things that you enjoy, not taking on too much, and making time for yourself a priority are also important.
HOT FLUSHES
If you are experiencing hot flushes, it may help to anticipate and minimise situations that may trigger hot flushes. These may include reducing or stopping smoking, avoiding some foods (such as very spicy foods), and reducing caffeine or alcohol intake. Wearing clothing in layers so you can easily remove the top layers as needed is also helpful.
PROFESSIONAL HELP
Professional help may include assessment, information, counselling, medical treatments, and complementary or alternative therapies.
Medical treatments include menopause hormone therapy (MHT). MHT is the most effective treatment for symptoms related to the hormonal changes of menopause, is also beneficial for bone health, and may decrease cardiovascular disease. Non-Hormonal Menopause Treatments are also available for women who for medical reasons or reasons of choice, wish to avoid MHT.
THE CANBERRA MENOPAUSE CENTRE
The Canberra Menopause Centre is a specialised service for people seeking information, support, and medical management of menopause. It is staffed by experienced female doctors who have a particular interest in this area.
MAKING AN APPOINTMENT
You may self-refer to the service or request a referral by your treating GP. We request that you complete a medical information questionnaire prior to attending the initial doctor’s appointment. To ensure that our doctors with a special interest in menopause have the opportunity to discuss your concerns, we offer longer appointments. For more information about Menopause contact us (make an appointment) or call 02 6247 3077 or email This email address is being protected from spambots. You need JavaScript enabled to view it.
FOR OTHER HEALTH SERVICES AND INFORMATION This email address is being protected from spambots. You need JavaScript enabled to view it. OR CALL 02 6247 3077
Safe sex is sexy. Sex is meant to feel good and be fun, but it can be risky if not treated with respect.
When entering into sexual relations with someone, the first thing you should do is talk about it and make sure you seek consent. Always ask someone before you start touching them or engaging in intercourse. This article talks about: safe sex, consent, decision making, STIs, unplanned pregnancy, emergency contraception, and where to go if you need advice or help.
Vulvar lichen sclerosus is a long-term skin condition that affects the genital skin. It usually starts around menopause but may occur at any age. It occurs in at least 1 in 1000 women and may occasionally affect men and children. If lichen sclerosis is left untreated for a long time, there can be an increased risk of skin cancer in the vulva.
What causes it?
The cause of lichen sclerosus is unknown. It can sometimes be associated with autoimmune diseases. Autoimmune diseases occur when the cells and proteins that your body uses to fight off infection start to damage your body’s own tissues and prevent their normal actions. Your health care provider may do some blood tests to check for autoimmune diseases if they think this may be the case. Sometimes the disease may also occur in family members, but the risk of this is unknown.
What does it look like and what are the symptoms?
Lichen sclerosis usually appears as pale, white, fragile skin patches that can sometimes look crinkled, but can also have a shiny smooth surface. These ca appear as individual patches or may involve the entire vulva, extending down to the skin around th anus. Lichen sclerosis does not involve the vagina.
Itching is the most common symptom. This can sometimes be quite severe and may disturb sleep.
Some people experience soreness and burning, particularly with intercourse
Small cracks in the skin (fissures) and ulcers can occur because of scratching the skin. These can become very sore. If the anal skin splits, there can be pain with bowel movements.
Some purplish/red areas may be also seen on the white background. These are bruises due to tiny areas of bleeding into the skin, often because of scratching.
Scarring may occur due to the loss of vulvar tissue (the inner lips) or shrinkage of skin at the entrance to the vagina. This can cause pain and may interfere with sexual intercourse. It can sometimes cause pain with urination.
In about 10% of individuals with vulvar lichen sclerosus, white patches may be seen on the skin elsewhere. The common sites for this are on the back, waist area, and under the breasts.
Some people have no symptoms, and the diagnosis is made when the area is examined for another reason.
How is it diagnosed?
Health care providers familiar with the condition may diagnose vulvar lichen sclerosis by looking at your skin. The diagnosis is sometimes then confirmed by taking a skin biopsy. A biopsy involves numbing the skin with a local anesthetic, then removing a small piece of skin. This piece of skin is then looked at under the microscope. This is a simple procedure that can be done in the doctor’s office.
How do you treat it?
There is no cure for lichen sclerosus, but the symptoms can usually be controlled very well using strong steroid ointments. Using these ointments, the appearance and texture of the vulvar skin can improve. However, if there is already scarring, these changes may not be reversed. Proper treatment should prevent the development of further inflammation and scarring.
The treatment can be used safely in the genital area for this condition. Your health care provider will instruct you on how to use it correctly. It is important not to stop your treatment unless advised to by your health care provider, as lichen sclerosus can recur or progress without it.
Lichen sclerosis can be made worse by skin irritation, like scratching, or infections such as yeast or bacteria. Therefore, it is important to avoid skin irritation as much as possible. Any infections from yeast or bacteria need to be treated as soon as possible.
It is preferable to gently clean the vulva using water only over the skin surface, and avoiding any soap, gels, body wash etc. Some people prefer rinsing with a saline solution (a quarter of a teaspoon of salt dissolved in a cup of water).
How do I manage the symptoms?
Managing the itch:
You may feel itchy at times. This may be worse at a particular time of the day, usually at night. Scratching causes itchiness which makes you scratch more. This is called the itch-scratch response.
The itch-scratch response is normal but treatment with the steroid ointment will help this. Scratching the genital area is potentially harmful as it can damage the skin and keep the symptoms going or quite some time.
There are two strategies used for the itch:
Firstly, the condition needs to be managed properly. this is a shared responsibility between you and your health care provider.
Secondly, distraction can be very useful. This is something only you can do. For example, if the itch becomes unbearable when you are in bed, don’t lie there feeling uncomfortable and unable to resist scratching. Instead, get up and find something to do which occupies your hands and your attention. When you feel the tension from the itch is reduced, try going back to bed.
An antihistamine taken at bedtime may also help to control the itching. It is best to keep your nails short so scratching in your sleep does not damage the skin. If intercourse is painful, using a lubricant may help.
If dryness is a problem, and you are around the age of menopause, ask your health care provider about using vaginal oestrogen cream or pessaries to help with this. It’s safe to have sexbut painful intercourse should be avoided as it can further irritate the affected skin.
GENITAL HERPES BROCHURE PDF
Last updated November 2020
SHFPACT is a health promotion charity (HPC) assisted with funding from the ACT Government..
Contraception means prevention of pregnancy. There are a number of different methods of contraception available. It is important to choose a method that best suits your needs at the time. Using contraception gives you more control, allows you to decide if, and when, to have children, and allows you to enjoy sex without having to worry about an unplanned pregnancy.
WHICH CONTRACEPTIVE IS RIGHT FOR ME?
Many factors may affect your choice of a contraceptive method including:
How effective the method is.
Your stage of life.
Your lifestyle.
Ease of use of the method.
Any possible side effects.
Cost and availability.
How easily you can stop it.
Any health issues that may limit some choices.
Protection against sexually transmissible infections.
Talking with a SHFPACT nurse or doctor about contraceptive methods will ensure that you have enough information to choose the one that suits you best.
The contraceptive methods in this information brochure are listed from the MOST effective to the LEAST effective.
LARCs
First a word about Long Acting Reversible Contraceptives (LARCs). LARCs are methods of contraception that are highly effective, work for a long time, need very little action by you, and are quickly reversible when you stop using them.
THE CONTRACEPTIVE IMPLANT
The contraceptive implant (Implanon®) is a small flexible rod which is inserted under the skin on the underside of your upper arm.
It continuously releases a hormone called progestogen. The contraceptive implant is a LARC and works for 3 years.
IT WORKS BY:
Preventing ovulation (egg release from the ovary).
Thickening the mucus in the cervix so that sperm cannot enter the uterus (womb).
HOW EFFECTIVE IS IT?
The contraceptive implant is over 99% effective.
INTRAUTERINE DEVICES (IUDS)
Intrauterine devices are small devices that are placed in the uterus (womb) to prevent pregnancy. There are two types of IUDs in Australia: the hormone releasing IUDs, and the copper IUD. IUDs need to be inserted by a doctor who has been trained in doing this.
THE HORMONE RELEASING IUDS
The hormone releasing IUDs (Mirena® and Kyleena®) are small plastic T shaped devices that have a progestogen hormone called levonorgestrel in their stems, which is released continuously. Kyleena® is slightly smaller and contains less progestogen hormone than Mirena®.
The hormone releasing IUDs are LARCs and last for 5 years.
IT WORKS BY:
Thickening the mucus in the cervix so that sperm cannot enter the uterus (womb).
Thins and stabilises the lining of the uterus making it unsuitable for pregnancy.
HOW EFFECTIVE IS IT?
The hormone releasing IUD is over 99% effective.
THE COPPER IUD
The copper IUD is a small plastic T shaped device that has copper wrapped around the stem.It does not contain any hormones.
The copper IUD is a LARC and lasts 5 or 10 years depending on the type.
IT WORKS BY:
Preventing fertilisation by interfering with sperm movement .
Preventing implantation of a fertilised egg.
HOW EFFECTIVE IS IT?
The copper IUD is over 99% effective.
STERILISATION
Sterilisation is a permanent method of contraception.
VASECTOMY
Vasectomy involves a minor surgical procedure performed by a specially trained doctor that involves cutting the vas deferens (the small tubes leading from the testes to the penis). It becomes effective three months after the procedure.
IT WORKS BY:
Preventing sperm entering the ejaculate.
HOW EFFECTIVE IS IT?
Vasectomy is over 99% effective.
TUBAL LIGATION
Tubal ligation is a surgical procedure done under general anaesthetic and performed in hospital by a surgeon. It involves blocking the fallopian tubes that transport eggs to the uterus. It is effective immediately.
IT WORKS BY:
Preventing fertilisation by stopping the sperm reaching the egg.
HOW EFFECTIVE IS IT?
Tubal ligation is over 99% effective.
THE CONTRACEPTIVE INJECTION
The contraceptive injection or DMPA (Depot Medroxyprogesterone Acetate) is a hormonal contraceptive containing a progestogen. It is given by an injection in the buttock or upper arm every 12 weeks.
IT WORKS BY:
Preventing ovulation (release of an egg by the ovary).
It also thickens the mucous in the cervix.
HOW EFFECTIVE IS IT?
The contraceptive injection is 96% effective. It is more effective if given on time every 12 weeks.
THE COMBINED ORAL & CONTRACEPTIVE PILL (THE PILL)
The combined oral contraceptive pill is commonly referred to as ‘the pill’. It is a pill that contains two hormones: oestrogen and progestogen, and must be taken every day. The active hormone pills are usually taken for three weeks then the inactive non-hormone pills are taken for one week, before starting a new pill pack.
There are many different types of the pill available and your doctor can help find one that suits you.
IT WORKS BY:
Preventing ovulation (release of an egg by the ovary).
It also thickens the mucus in the cervix.
HOW EFFECTIVE IS IT?
The pill is 93% effective.
THE CONTRACEPTIVE VAGINAL RING (NUVARING®)
The vaginal ring is a plastic ring that is placed in the vagina. It is similar to the pill and contains two hormones, oestrogen and progestogen. It is placed into the vagina for 3 weeks, removed for one week then replaced with a new ring.
IT WORKS BY:
Preventing ovulation (release of an egg by the ovary).
It also thickens the mucous in the cervix.
HOW EFFECTIVE IS IT?
The contraceptive vaginal ring is 93% effective.
THE PROGESTOGEN ONLY PILL (MINI PILL)
The mini pill is a pill that contains only progestogen. It must be taken every day and at the same time each day. It is taken continuously with no break.
IT WORKS BY:
Thickening the mucous in the cervix.
HOW EFFECTIVE IS IT?
The mini pill prevents 93% of possible pregnancies.
CONDOMS
Condoms are a barrier method of contraception that work by stopping semen entering the vagina during intercourse. They are the only contraception that also provide protection from sexually transmissible infections.
THE CONDOM
Also called the external condom this is a sheath made of thin, strong latex or polyurethane, which is rolled onto the erect penis before vaginal, anal or oral sex. It can only be used once and is then discarded.Condoms are available from supermarkets, pharmacies, clinics, sex shops, and vending machines.
HOW EFFECTIVE ARE THEY?
Condoms are 88% effective.
THE INTERNAL CONDOM
This is a polyurethane sheath which is inserted into the vagina before sexual intercourse. It is about 15cm long and has two flexible rings to keep it in place. It can only be used once and is then discarded. Internal condoms are available online and from some sex shops.
HOW EFFECTIVE ARE THEY?
Internal condoms are 79% effective.
THE DIAPHRAGM
The diaphragm is a dome of soft silicone with a flexible rim which is placed inside the vagina to cover the cervix (the lower part of the uterus or womb). It is inserted before intercourse and is then left in place for a minimum of six hours afterwards because that is how long it takes for sperm to die in the acid environment of the vagina.
Diaphragms should always be fitted by a specially trained nurse or doctor to make sure that the type or size is correct for you. They are then ordered online.
IT WORKS BY:
The diaphragm provides a barrier that prevent sperm getting into the uterus and fertilising an egg.
HOW EFFECTIVE IS IT?
The diaphragm is 82% effective.
FERTILITY AWARENESS METHODS (FAM)
These methods use an awareness of the fertile phase in the menstrual cycle to indicate when sexual intercourse should be avoided to prevent pregnancy.
This can include monitoring body temperature and the days of the menstrual cycle, and checking cervical mucus. It is important to learn how to use these methods correctly before using them to prevent pregnancy.
For more information visit the Australian Council of Natural Family Planning website: acnfp.com.au
HOW EFFECTIVE IS IT?
FAMS are between 75% and 93% effective.
LACTATIONAL AMENORRHOEA (LAM)
LAM is the use of breastfeeding as a contraceptive method. For LAM to be effective all three of the following criteria need to be met:
You need to have given birth less than six months ago.
Your menstrual periods should not have returned after the birth.
You must be fully breastfeeding and not giving the baby any formula or solid food.
HOW EFFECTIVE IS IT?
Used correctly LAM is 98% effective
WITHDRAWAL
This is the withdrawal of the penis from the vagina before ejaculation. There are more effective forms of contraception and withdrawal is generally not considered a reliable method.
HOW EFFECTIVE IS IT?
Withdrawal is 80% effective.
EMERGENCY CONTRACEPTION (EC)
Emergency contraception can be used to reduce the risk of pregnancy after unprotected sex (unprotected sex means where semen has entered the vagina, usually when no other form of contraception was used or where a method of contraception failed, such as a condom breaking). There are several methods of emergency contraception available:
LEVONORGESTREL
This is a hormone based EC which contains Levonorgestrel which is a hormone. The sooner you take it the better but works up to 72 hours (3 days) after unprotected sex.
IT WORKS BY:
Preventing or delaying ovulation.
WHERE CAN I GET IT?
You can get it from most pharmacies, SHFPACT, Canberra Sexual Health Centre, The Junction Youth Health Centre (if you are under 25) and Walk in Centres.
Ulipristal (Ellaone)
Uliprista is an emergency contraception that can be used up to 120 hours (5 days) after unprotected intercourse. Ulipristal is more expensive then the Levonorgestrel EC but is considered more effective.
IT WORKS BY:
Delaying or preventing ovulation.
WHERE CAN I GET IT?
Ellaone is available from most pharmacies.
THE COPPER IUD
The copper IUD (intra uterine contraceptive device) is a method of contraception that can be used as emergency contraception. The copper IUD is inserted into the uterus up to 120 hours (5 days) after unprotected intercourse and is the most effective EC. It is useful if you need a very effective EC or are also looking for an ongoing method of contraception. The hormone releasing IUD is not suitable as emergency contraception.
IT WORKS BY:
The copper IUD works by interfering with fertilisation and preventing implantation of a fertilised egg.
WHERE CAN I GET IT?
The copper IUD needs to be inserted by a specially trained doctor or nurse. For further information contact your local family planning, your GP, or SHFPACT on 02 62473077 if you are in the ACT region.
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