Seeing blood spots in your underwear when your period ended days ago can feel puzzling and concerning. Known as intermenstrual bleeding, spotting between periods and ovulation is not normally cause for alarm. But in some cases, it can indicate an underlying vaginal infection needs treatment.

The most common culprits of bleeding between cycles are bacterial vaginosis (BV), yeast infections, and sexually transmitted diseases like chlamydia and gonorrhea. Here’s an overview of how these infections lead to spotting:

  • Bacterial Vaginosis – Caused by an overgrowth of bad bacteria, BV leads to vaginal inflammation and thinning of the lining. This makes the walls more prone to bleeding. A fishy odor is a hallmark of BV.
  • Yeast Infections – Candida fungus irritates the vaginal tissue, causing itchiness and redness. Scratching can disrupt the sensitive lining enough to cause minor bleeding. Yeast infections produce thick, white discharge.
  • Chlamydia and Gonorrhea – STDs like these infect the cervix, which can become friable and bleed easily. Pain during sex is also common with chlamydia and gonorrhea.
  • Trichomoniasis – This STD invades the vagina, creating an environment prone to spotting and bleeding. A smelly, greenish-yellow discharge occurs with trichomoniasis.

Rising oestrogen levels approaching ovulation create an environment in the vagina that promotes the growth of bad bacteria and yeast. The hormonal changes make women more susceptible to infections during this time of the cycle.

While usually not severe, vaginal infections should always be treated properly. The first step is to test for any infections. My preferred options are at a local sexual health clinic, making sure that also include a test for BV, or I can order the Vaginal Ecologix test for you, and you can gain a comprehensive picture of your vaginal microbiome and identify specific infections.

In most cases, vaginal infection-related bleeding is short-lived once treated. But if you ever experience heavy, persistent bleeding between cycles, seek medical care promptly.

So don’t ignore sporadic spotting. It may be your body’s signalling an underlying infection needing attention. With proper treatment, you can restore healthy vaginal flora, tissue, and pH balance.

The UK’s “unresponsive and defensive” healthcare system has failed thousands of women who developed life-changing conditions after pelvic mesh surgery, according to a review into the treatment.

“The report is hard hitting, harrowing and recognises the total failure in patient safety, regulation and oversight in the UK,” Kath Sansom of campaign group Sling the Mesh said in a statement.

The Independent Medicines and Medical Devices Safety Review, led by Julia Cumberlege and announced by then-health secretary Jeremy Hunt in 2018, has involved two years of data gathering from women who received vaginal and other pelvic mesh implants, mostly to treat stress urinary incontinence and prolapse that developed after childbirth.

Many women went on to develop chronic pain, nerve damage, bowel conditions, recurring infections and mobility issues, among others. The mesh can become embedded in surrounding tissues, making it very difficult to remove. The review found that it is unclear whether the mesh can change in shape or size after it is implanted, and whether chemicals from the mesh can trigger immune conditions, which have been experienced by some women.

The number of women affected by these complications is unknown, but thousands have joined support and campaign groups. Many women weren’t told about the risks of the procedure, and describe how their symptoms and complaints were dismissed by doctors as normal consequences of childbirth or menopause, says the review.

“The narrative is common,” says Sohier Elneil, a urogynaecologist and uroneurologist in London, who says she comes across similar cases on a daily basis. “Patient safety must be key to everything we do,” she says. “It should be a given, but, quite clearly from the report, it hasn’t been.”

A specialised microbial community in humans is the vaginal microbiome. Successful human reproduction depends heavily on the correct balance of these microbes.

An optimal vaginal microbiome results in the production of lactic acid and hydrogen peroxide, maintaining a level of acidity that keeps pathogenic bacteria at bay.

When the vaginal community becomes disturbed, on the other hand, acidity decreases. Pathogenic or other opportunistic bacteria may then invade, which can cause bacterial vaginosis. This is best described as a state of dysbiosis rather than infection.

Research suggests that probiotic supplementation may be of benefit in maintaining homeostasis of the vaginal microbiome thereby reducing the risk of infection, dysbiosis and subsequent inflammation and immune dysfunction.

Postmenopausal vulvovaginal atrophy is associated with age-related changes in the vaginal microbiome, with a shift from Lactobacillus-dominated strains in premenopause to a predominance of anaerobic organisms, new research shows.

“We have not yet identified specific interventions, but we are interested in pursuing personalized selections of probiotics and prebiotics for a given woman,” said lead investigator Rebecca Brotman, PhD.

“We have been advocating probiotics or prebiotics to improve vaginal health for almost 30 years,” said Gregor Reid, PhD.

“I 100% support the conclusions of this work. It is nice to see confirmation of work we published in 2011, with an aberrant microbiota associated with some cases of vulvovaginal atrophy,” Dr. Reid told Medscape Medical News (PLoS One, 2011;6:e26602).

Get notified about new editions

Subscribe to the Sunday Supplement

Connecting women, science and spirit, the Gynelogic Sunday Supplement delivers a bi-monthly dose of  news, views and reviews, as seen through my lady lens.