Health: Feminine hygiene or sales hype?: A new gel is said to treat 'fishy' vaginal odour. But are women being encouraged to worry needlessly? Lee Rodwell reports

MOST women's magazines carry advertisements for healthcare and sanitary products, designed to solve a whole range of embarrassing female problems. Or, if you take the cynical view, to encourage women to worry unnecessarily about what is described as 'feminine freshness'.

However, a new product is being advertised in not so coy terms. In fact, a distinct whiff of Billingsgate hangs over the ads, which say bluntly: 'The problem of unpleasant 'fishy' vaginal odour is one that affects the lives of many women.'

The product is Feminesse, a vaginal gel devloped by the US pharmaceutical company Columbia Laboratories Inc and marketed here by its UK subsidiary. 'Just one application,' the ads say, 'will, for over three days, maintain the natural acid balance, so essential for freshness in the vagina. Remember, no amount of washing, douching, spraying and wiping can correct this balance. Only Feminesse eliminates vaginal odour from within.'

Columbia has had to choose its words carefully for the ads and the packaging: it is marketing Feminesse as an over-the-counter product, and therefore cannot claim that it treats a specific medical condition. 'Fishy' is as far as it can go - and even that was too far for some magazines that had to be talked into accepting the ads.

Yet in the coded language of 'feminine products', the word can be justified. Unmistakably fishy odours are often caused by what specialists now call bacterial vaginosis (BV), a condition in which the balance between the different bacteria in the vagina is upset.

Usually, the predominant bacterial species is the protective lactobacillus, and the vagina is acidic with a pH below 4.5 (pH values rise from acidity to alkalinity on a scale of 0-14, with 7 being neutral). Women with BV have fewer lactobacilli, higher levels of other organisms such as gardnerella, and a higher, alkaline pH. But no one knows whether a lower number of lactobacilli causes the pH to rise, or if a rise in pH depletes the

lactobacilli.

Doctors prescribe metronidazole (usually Flagyl) or antibiotics. Feminesse is simply a gel, containing sorbic acid, and works by bioadhesion, a process developed and patented by Columbia for its first product, Replens, a vaginal moisturiser.

Like Replens, Feminesse contains polycarbophil, an inert polymer, which bonds to the cell surfaces inside the vagina, and is shed only when the cells themselves are shed, a process that occurs naturally every 48 to 72 hours. As a result, one application of the gel - using a pre-filled applicator - should go on working for several days. (Packs of two or eight pre-filled applicators retail at pounds 2.75 and pounds 9.85.)

Columbia cannot claim that its product is a treatment for BV. Instead, it points out that the delicate vaginal balance can be upset by many factors, ranging from stress and periods, sexual intercourse and the use of perfumed soap and bubble bath, and thereby neatly targets the vast majority of the adult female population. Feminesse, it says, 'maintains the natural pH balance, which in turn eliminates the development of odour-producing amines'.

Dr Elizabeth Claydon, a consultant in genito-urinary medicine at St Mary's Hospital, Paddington, London, says BV is not thought to be sexually transmitted, because treating a woman's partner makes no difference to recurrence. 'The underlying cause is not known, although something happens to disturb the organisms normally present in the vagina.' Some women tend to suffer for a few days at the same point in their monthly cycle; some get it all the time; and some have identified a trigger, such as using a contraceptive cap.

'We tend to say to women that if it isn't bothering them, there's no need to be treated, although we do advise avoiding things such as strong soap and bubble baths,' says Dr Claydon, who will soon be involved in a large study of BV at St Mary's and Northwick Park Hospital, Harrow.

'BV has always been thought to be fairly benign,' she says, 'but there is some evidence, by no means proven, that it may be associated with problems in pregnancy.' The study will investigate this aspect.

Diagnosis of BV, she says, depends on identifying three specific criteria - a characteristic discharge, lowered acidity, and the fishy smell - and its presence is confirmed if the discharge turns greyish under the miscroscope, after the addition of potassium hydroxide.

'You can change the acidity of the vagina by using a number of products, including acidic gels, but it's generally thought that what you are doing is treating the effect, not the cause. 'However, it's possible, if the technology is different with this particular gel, that the results may be better.'

Linda Blowers, who is handling Columbia's publicity, says trials of Feminesse were carried out in the United States and by Inveresk Clinical Research, of Edinburgh. Of 54 volunteers in the latter trial, 17 were shown to have classic fishy odours, and Feminesse was especially effective in eliminating them.

Dr Claydon has no objection in theory to women being able to buy an over-the-counter-product that would help them to 'sort themselves out', but she is concerned that the advertising of 'feminine freshness' products may make some worry unnecessarily about normal smells or secretions. 'You can't get away from the fact that there are normal breakdown products connected with sex,' she says.

'I would like to see the work that's been done showing Feminesse to be effective, and I would like to know what the manufacturers are putting on the product to alert women to the possibility that a fishy odour may be something else. I certainly wouldn't want women to use the product more than a couple of times if the problem persists. The difficulty comes when people make the wrong self-diagnosis.

'It's amazing how often people say, 'I've got thrush,' and it's something else. I always insist that junior staff at the clinic examine people, because you can so easily get caught out. In fact, the classic reason for a smelly discharge is a retained foreign body, such as a tampon.'

Although the applicator packs claim that with Feminesse 'even the most persistent 'fishy' vaginal odours disappear', women are told to read an enclosed leaflet that says: 'Make sure you visit your doctor if you notice an odour you don't recognise, you develop an unfamiliar discharge, pain, discomfort or any other symptoms that give you concern.'

So is Columbia really offering women a solution to a common embarrassing problem, or is it creating problems of a different kind?

Ruth Grigg, of the Family Planning Association, says it is the women who most dread talking about such intimate matters who are least likely to seek help. 'BV is a recognised condition with recognised treatments, but it is not the only condition that can be accompanied by an offensive odour. So using this product could stop someone from getting the help they need.

'Products that talk about eliminating vaginal odours can increase anxiety in women who are already anxious about their bodies. You never see a product that offers fragranced comfort for the active man. Why should women always be the ones to be made to feel dirty?

'Some women are terrified of having any kind of smell, but during the monthly cycle a healthy vagina produces various secretions. Normal body smells show you are a healthy, functioning woman. If you find a smell particularly offensive, check with a family planning doctor or your GP.

'The trouble is that many women are vulnerable to the kind of advertising that plays on their fears. I suspect buying Feminesse could be an expensive way for many to tackle a problem they probably haven't got.'