Updates in Women’s Health

It’s always exciting to us here at Casco Bay Direct Primary Care when there are significant advancements and new treatment guidelines, particularly for commonly seen ailments. It’s also exciting to see research being done on women’s health issues, as research in these areas was vastly underfunded for decades.

Recent research has changed our approach to the treatment of both bacterial vaginosis (commonly referred to as BV) and the prevention of urinary tract infections (commonly referred to as UTIs).

Re-evaluating bacterial vaginosis as a sexually transmitted infection:

BV is a common vaginal infection - it is estimated that 1 in 3 women will be affected in their lifetime. Symptoms include vaginal irritation, discharge and odor. BV is often difficult to treat, and despite treatment with antibiotics, there is a high recurrence rate. Recurrent symptoms can be frustrating for patients and physicians alike.

A groundbreaking study published in the New England Journal of Medicine has provided compelling evidence that treating male partners of women with BV can significantly reduce recurrence rates.  In a recent study comparing women who were treated with standard antibiotics to women who were treated along with their male partners, the results were striking. Only 35% of women in the partner-treatment group experienced a recurrence within 12 weeks, compared to 63% in the control group, in which only women were treated. We now understand that this is not solely a bacterial imbalance - there is also a sexually transmitted component.  

Vaginal estrogen therapy as a preventive measure against recurrent UTIs:

The American Urologic Association (AUA) has updated its guidelines to recommend vaginal estrogen therapy as first line therapy for peri- and post-menopausal women experiencing recurrent UTIs. This recommendation is based on evidence that vaginal estrogen can restore the vaginal microbiome, reduce vaginal pH, and decrease the frequency of UTIs.

Recent research has also shown that vaginal estrogen therapy reduces the risk of urosepsis (a serious blood stream infection resulting from UTIs that requires hospitalization and IV antibiotics), and even death from urosepsis, among post-menopausal women with recurrent UTIs. A study presented at the 2025 American Urologic Association Annual Meeting reported findings that women over 55 using vaginal estrogen experienced significantly lower rates of urosepsis compared to those not using the therapy.

Importantly, vaginal estrogen therapy has minimal systemic (whole body) absorption and associated risks, and can therefore be used in most female patients in which systemic/oral hormone replacement cannot be safely used. This makes its use safe for the vast majority of post-menopausal women and offers a valuable preventive strategy for our patients. These advancements underscore the importance of continually reassessing and updating clinical practices to enhance women’s health outcomes.

The FDA approves first at-home test as a pap smear alternative for cervical cancer screening:

The FDA recently approved the first at-home human papillomavirus (HPV) self-collection test, marking a significant advancement in cervical cancer screening.  HPV is the virus responsible for nearly all cases of cervical cancer. It is exceedingly rare to develop cervical cancer unless you carry HPV.  This at-home test offers an alternative to traditional Pap smears that are done with a speculum in the doctor's office and aims to increase accessibility and comfort for individuals undergoing cervical cancer screening.

The introduction of at-home HPV self-collection tests provides an additional option, particularly for patients who face barriers to traditional in-office screening, such as discomfort, trauma history, or limited access to healthcare facilities.

Every year, 13,000 women in the US are diagnosed with cervical cancer and more than 4,000 die from the disease. It is estimated that a quarter of US women are behind in their cervical cancer screening, and perhaps home screening can help reduce that number. Another exciting advancement in our care of the female patient!