By Sandra Welner, M.D.
(Updated March 2011)

For several reasons, women with disabilities often cannot find access to good gynecological care. Their doctors don’t believe they could be sexually active, they don’t understand disability concerns, or their exam rooms are not accessible. Here is some hard-to-come-by information.

Vaginal Infections
Vaginal infections such as yeast, Gardnerella and trichomonas are common in all women, but can be more difficult to treat in wheelchair users. Yeast, the most prevalent of three, grows quickly in dark, moist areas that are not well-ventilated — typical of the vaginal area of wheelchair users. Bladder leakage may contribute more moisture.

Preventive measures include keeping the area clean and dry by using absorbent underclothing – cotton instead of nylon – and a pad that can be changed during the day.

If a yeast infection is diagnosed, it should be treated with intravaginal creams or suppositories. Women who have difficulty inserting medication vaginally may be able to use the equally effective oral Diflucan tablet. (Overuse, however, may result in resistant yeast infections that are very hard to treat.) Nontraditional remedies – available over the counter – include intravaginal caproic acid or boric acid capsules, oral and intravaginal acidophilus capsules, and yogurt with live acidophilus cultures.

It has been long presumed that persistent irritation, redness and tenderness in the vaginal area is just a yeast infection that has not been detected. But sometimes, even multiple anti-yeast treatments are not successful. These cases could represent a condition called vulvar vestibulitis. The cause of this disorder is unclear but is thought to have a neurologic component, and thus has been termed neuropathic pain.  Antidepressant medications in doses far lower than those used to treat depression sometimes help alleviate this condition.

UTIs
Urinary tract infections are a common complaint, but prevention depends on the individual situation. If the UTI is caused by bladder muscle dysfunction and inadequate bladder emptying, a simple adjustment in medication may minimize recurrence. Many women, however, find that their bladders require continual vigilance.

Catheterization and sexual activity often introduce bacteria directly into the urethra, and spermicides can decrease resistance to UTIs. Voiding or self-cathing in combination with a one-time dose of an antibiotic such as Macrodantin immediately after sexual activity can help minimize this risk. It has not been substantially proven that cranberry juice prevents recurrence of UTIs, but drinking copious amounts right after intercourse or catheterization has been effective for some women.

UTIs are treated with antibiotics, but when women have had so many infections that they no longer respond to these drugs, surgical reconfiguration of the bladder may be recommended (see Bladder Matters</