A recurrent vaginal irritation or infection can be a nightmare for some women.
She may have tried various treatment regimes from different healthcare professionals, but her symptoms may not disappear, and instead, continue to recur.
The days are filled with discomfort, and the nights with sleeplessness.
Therefore, it is vital to understand this condition in order to pursue an effective solution.
One common reason for recurrent vaginal irritation is a fungal infection of the vagina known as vulvovaginal candidiasis.
When it occurs over and over again, it is known as recurrent vulvovaginal candidiasis.
In fact, vulvovaginal candidiasis is considered to be the second most common genital infection in women after bacterial vaginosis.
At least three-quarters of all women would have experienced at least one episode of this vaginal fungal infection in their lifetime.
Disrupting the balance
This infection is caused mainly by the Candida species, which is a yeast – yeast are a type of fungi.
Actually, yeast is present on your skin and gut, as well as in your respiratory tract and vagina.
Usually, a trigger causes the yeast to overgrow.
However, in the majority of women, no trigger can be identified.
When a trigger factor can be identified, it is usually related to the individual’s health status or lifestyle.
One of the main triggers is overexposure to the female hormone oestrogen.
This happens during puberty, pregnancy and consumption of hormonal birth control pills or hormone replacement therapy in menopausal women.
The change in oestrogen levels upsets the body’s natural balance, including the amount of normal flora or “good” bacteria in the vagina, which keeps everything under control.
Consumption of a course of antibiotics during an illness can be a trigger too.
Exposure to a broad-spectrum antibiotic can change the harmony of normal vaginal bacteria and predispose women to vaginal yeast overgrowth.
Other common triggers that many are unaware of is the unintentional usage of irritants such as perfumed bath soap, wet wipes and chemically-strong fabric conditioners.
Even the usage of contraceptive spermicidal gels can predispose certain women to yeast infections.
Uncontrolled diabetes and iron deficiency anaemia predisposes women to recurrent yeast infections too.
A recurrent vaginal yeast infection, which is essentially a chronic or long-term infection, can tremendously affect the quality of a woman’s life, as well as her productivity.
It has a negative effect on interpersonal relationships, especially with her sexual partner.
This can lead to psychosexual problems, not to mention the psychological impact it causes due to the woman feeling self-conscious about her body, with the corresponding loss of self-esteem and self-confidence.
The mild form of the infection may not cause vaginal discharge or irritation.
However, if the infection worsen, the first symptom the woman may feel is vaginal irritation or itchiness, which may persist for days or weeks.
She may start noticing vaginal discharge.
The discharge is usually described as white, curd-like or thick.
She will then develop soreness or a burning sensation in the vagina or on the skin of her vulva.
In more severe infections, due to inflammation, the woman can develop tears or cracks on the vulva called fissures.
In a long-standing infection, the vulval area will become swollen with redness, causing pain.
See the doctor
The first step in the treatment of recurrent vaginal yeast infection is to stop self-diagnosis and self-treatment.
This practice may lead to a delay in instituting the appropriate treatment regime, or worse, it may exacerbate the situation by inappropriate consumption of unnecessary antibiotics.
See your doctor, who should take a thorough medical history, including any past over-the-counter or prescribed medications, as well as any complementary or alternative therapy you have taken to treat the infection.
Your doctor will also try to identify your trigger factors and other symptoms that may suggest a different diagnosis for your underlying condition.
These can include bacterial vaginosis or Trichomonas vaginalis infection.
A pelvic examination will be performed using a vaginal speculum (similar to the type of examination you do for your Pap smear test).
A high vaginal swab test will be performed.
This is when the doctor takes a sample of the discharge to be sent to the laboratory to confirm and identify the yeast.
Sometimes, bacterial infection can co-exist along with a yeast infection.
In this scenario, the woman may need anti-fungal treatment, along with the appropriate antibiotics, as suggested by the results of the high vaginal swab test.
In recurrent vaginal yeast infection, your doctor may also screen for diabetes and anaemia based on your risk factors.
Treat and avoid
The first-line treatment for a vaginal yeast infection is a vaginal anti-fungal pessary, with or without oral anti-fungal tablets.
A pessary is a small device meant to be inserted into the vagina for structural support (e.g. in cases of pelvic organ prolapse) or to deliver drugs.
In recurrent infections, a prolonged course of treatment of up to six months may be needed.
In resistant infections, supplementary therapies in the form of anti-histamine medications and oral probiotics to improve gut and skin flora will be considered.
The patient will also need to avoid known trigger factors that increase the risk for the fungal infection.
Local irritants such as perfumed bath soaps, shampoos, bubble baths, fabric softener and wet wipes, should no longer be used.
Tight-fitting garments that might irritate the genital area should also be avoided.
Consider using breathable underwear instead.
Until the infection is under control, consider using alternatives to sanitary pads during menstruation, as pads prevent aeration.
Avoid vaginal douching as it is associated with recurrent vaginal infections through the disruption of normal vaginal flora.
Do not wash your vulval or vaginal area too often – once or twice a day should be sufficient, at least until the infection is under control.
If you are using condoms as your sole contraceptive method, then it is advisable to consider other options for contraception as vaginal anti-fungal treatment may affect the effectiveness of condoms in contraception.
Up to one-third of pregnant women have asymptomatic vaginal yeast infection.
However, symptomatic yeast infection is also common in pregnancy.
The safety of anti-fungal treatment in pregnancy is not well established.
But epidemiological studies of thousands of women taking short courses of anti-fungal treatment shows no increase in foetal malformation.
The current recommendation is to use a vaginal anti-fungal pessary (clotrimazole 500mg) daily for four to seven days.
The treatment duration can be longer for recurrent infections.
Vaginal yeast infection, either acute or recurrent, can be best treated by a combination of identifying the correct diagnosis, appropriate initiation of treatment by a medical doctor, and avoiding trigger factors as much as possible.
This will ensure the woman gets to rest peacefully and blissfully at night once again.
Dr Agilan Arjunan is an obstetrician and gynaecologist, and fertility specialist. For more information, email email@example.com. The information provided is for educational purposes only and should not be considered as medical advice. The Star does not give any warranty on accuracy, completeness, functionality, usefulness or other assurances as to the content appearing in this column. The Star disclaims all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.