The Vagina-Mental Health Connection: Exploring the Impact of Genitourinary Conditions on Mental Health
Chronic and recurrent genitourinary conditions such as bacterial vaginosis (BV), vulvovaginal candidiasis (VVC, also known as thrush), and urinary tract infections (UTIs) affect millions of women and those assigned female at birth (AFAB) worldwide annually. And while the physical symptoms are relatively well-documented, we don’t often discuss the psychological and emotional toll that these conditions take on patients. In fact, physical and psychological impacts of such conditions are often overlooked, dismissed, or disregarded as insignificant and non-life-impacting, which - as research even tells us - couldn’t be further from the truth.
In this blog, we’re going to discuss the profound impact that chronic and recurrent genitourinary conditions have on mental health, quality of life, and the necessity for a holistic approach when supporting people in this area.
Beyond just the physical
The persistent nature of symptoms associated with chronic and recurrent genitourinary conditions, such as itching, burning, discomfort and pain, unusual discharge, and odour in and of themselves have a significant impact on mental wellbeing by creating a constant state of frustration, apprehension, and shame in sufferers. Research also demonstrates that patients experiencing chronic and recurrent genitourinary infections, like thrush for example, are at significantly higher risk of developing anxiety disorders, clinical depression, low self-esteem, and have poorer self-esteem, low overall life satisfaction, and perceive their lives to be more stressful.
Social drivers of distress
It’s also important to consider the role that social stigma plays in mental health outcomes. Women’s and AFAB reproductive health issues have long been shrouded in shame with many people - healthcare practitioners included - erroneously associating genitourinary conditions with poor personal and sexual hygiene. This stark misunderstanding perpetuates a cycle of stigma and prevents open discussions, leading to feelings of shame and embarrassment. And worse, this stigma has been shown to lead to misdiagnosis and inadequate treatment approaches.
It’s also appropriate to mention here how societal expectations can drive this cycle. For example, media representation of perceived femininity, hygiene practices, and how a vulva should look or smell only perpetuate those feelings of shame and embarrassment experienced by so many people in this area. Inadequate education about women’s and AFAB health overall further contributes to this misinformation and stigma, disempowering people and limiting their capacity for proactive health management.
Challenges and barriers in navigating healthcare
So, we’ve established that there is often significant social stigma associated with genitourinary conditions. And this means that people seeking support are often faced with challenges in seeking and receiving appropriate care, whether it be because they feel embarrassed to candidly discuss their issues or because of healthcare practitioner-driven taboo.
Research suggests that healthcare practitioners demonstrate poor or inconsistent understandings of genitourinary conditions, delaying a diagnosis and thus, patients frequently receive poor, inadequate, or incorrect treatment. The lack of support of patients in this space leads to them feeling helpless, frustrated, and let down by their overall management. Furthermore, overall inadequate treatment also means that patients undergo frequent dietary and lifestyle modifications, further adding to the psychological burden.
Healthcare providers also often overlook underlying drivers of chronic and recurrent infections such as hormonal factors, immune system function, blood glucose management, pelvic floor tone, health of the vaginal tissue, and microbial colonies within the vagina. This adds to the burden of such conditions whereby patients frequently undergo interventions - often alternating treatments - and thus, experience incomplete symptom resolution and are often forced down a path of self-education and self-treatment.
Impact on relationships
The impact on quality of life due to recurrent genitourinary conditions is multifactorial, and there’s no denying their impact on social, professional, and intimate relationships. Research tells us that the sexual and emotional relationships of these patients are significantly affected often due to fear that partners may detect their symptoms. Aside from painful intercourse that can occur in chronic and recurrent vulvovaginal conditions, feelings of embarrassment, shame, and self-consciousness are also common. This leads to avoidance of sexual activity, reduced experiences of pleasure, difficulty maintaining sexual relationships, decreased sexual satisfaction, fewer orgasms, and added strain to relationships.
Similarly, people suffering from chronic and recurrent infections tend to withdraw from social settings. Research has suggested that this is both due to emotional and behavioural responses to social stigma, but also because of a decreased ability to actually partake in social settings, say due to pain or discomfort. The resulting isolation and loneliness which accompanies genitourinary conditions contribute to their overall burden.
Additionally, chronic and recurrent genitourinary conditions have been shown to have an impact on productivity, with people missing work for various reasons including pain and discomfort, embarrassment around odour, and reluctance to use communal restrooms. One study demonstrated that approximately 50% of working people experiencing recurrent thrush lose work because of their condition equating to around 33 working hours lost per person per year. Another study estimated that the burden of BV alone costs the economy US$4.8 billion dollars per year.
So how can naturopathy help?
Aside from incredible functional testing, herbal, nutritional, dietary, and lifestyle interventions we can employ to address chronic and recurrent genitourinary conditions, a naturopath can help by -
Addressing the underlying drivers and taking a holistic, root-cause approach. As mentioned earlier, things like hormones, immune function, and blood sugar regulation contribute to chronic and recurrent presentations of genitourinary conditions, and taking a holistic approach which explores individual drivers of recurrence offers our patients both short-term relief and a long-term solution.
Providing a safe, judgment-free space in which patients are heard, held, and met with empathy. Creating a supportive space where patients can speak openly and share their experiences can significantly reduce some of the psychosocial impacts of chronic and recurrent genitourinary infections.
Educating our patients. Education is one of the leading principles of naturopathic medicine, and empowering our patients with knowledge about their bodies enables them to seek and find adequate support, to make informed decisions, to advocate for their needs, and to adhere to treatment plans.
Referring on when necessary to provide a multi-pronged approach because naturopathy is only one avenue of support. Psychologists and counsellors, sexologists, and pelvic floor physiotherapists are among the many modalities that can provide appropriate support in this area. And naturopaths can work alongside these practitioners to co-manange your care and ensure you’ve got the right team behind you!
The impact of chronic and recurrent genitourinary conditions on mental health is undeniably profound and multifaceted. Moving beyond the physical discomfort, there are a plethora of factors that drive the emotional and psychological impact of these conditions. Addressing social taboos, challenging stigma, promoting open conversations around genitourinary health, focusing on adequate education of both practitioners and patients, and leading with empathy are crucial steps to improve the quality of life of people experiencing chronic or recurrent genitourinary conditions.
If you’ve been on the hamster wheel of practitioners, creams, medications, antibiotics, and weird diets and are looking for a practitioner who will listen to you, I am so passionate about this area and would be honoured to hear your story and support you. Click the button below to book a complimentary discovery call and let’s chat about how we can support you!
References
Bradfield Strydom, M., Walpola, R., McMillan, S., Khan, S., Ware, R., & Tiralongo, E. (2022). Lived experience of medical management in recurrent vulvovaginal candidiasis: A qualitative study of an uncertain journey BMC Women’s Health, 22(1), 384. https://doi.org/10.1186/s12905-022-01973-x
Fukazawa, E., Witkin, S., Robia, R., Vinagre, J., Baracat, E., & Linhares, I. (2019). Infuence of recurrent vulvovaginal candidiasis on quality of life issues. Archives of Gynecology and Obstetics, 300(1), 647-650. https://doi.org/10.1007/s00404-019-05228-3
Irving, G., Miller, D., Robinson, A., Reynolds, S., & Copas, A. J. (1998). Psychological factors associated with recurrent vaginal candidiasis: A preliminary study. Sexually Transmitted Infections, 74(5), 334–338. https://doi.org/10.1136/sti.74.5.334
Rathod, S. & Buffler, P. (2014). Highly-cited estimates of the cumulative incidence and recurrence of vulvovaginal candidiasis are inadequately documented. BMC Women’s Health, 14(43). https://doi.org/10.1186/1472-6874-14-43
Thomas-White, K., Navarro, P., Wever, F., King, L., Dillard, L., & Krapf, J. (2023). Psychosocial impact of recurrent urogenital infections: a review. Women’s Health, 19(1). https://doi.org/10.1177/17455057231216537
