Many women have had that not so comfortable feeling in the past. It starts as itching in the vagina and then can be followed by discharge that can burn or have a foul odor. Sometimes the cause is clear, perhaps we used an antibiotic for another infection unrelated to the vagina or other times we don’t have a reason at all. Often times it is assumed that a woman has a yeast infection (known as candidiasis) and an antifungal medication is given, something like Monistat (a cream) or Diflucan (an oral antifungal).
In the correct scenario this is enough to help the symptoms resolve. However, there is an entire world of vaginal discomfort out there that has nothing to do with yeast.
Once bacterial vaginosis, candidiasis and STDs (sexual transmitted diseases) have been excluded there are more rare conditions that may be contributing to the symptoms.
There are two conditions that are considered less frequently and as a result can lead to a delay in diagnosis:
- Cytolytic vaginitis
- Very rare condition that is considered to be related to the acidic environment in the vagina.
- Symptoms include itching, pain with intercourse, pain along the labia with urination and perhaps worsening of symptoms after ovulation and prior to menses.
- Women can also have thick white discharge that is sticky
- Risks for this condition include long time use of birth control pills
If a woman is concerned about this condition she needs to make an appointment with her doctor for a thorough pelvic exam which may include a wet mount (a test of the vaginal discharge that is examined under a microscope).
TREATMENT: can include baking soda douches which have been recommended 2-3 times per week and/or Estrogen vaginal cream may also be suggested.
- Desquamative inflammatory vaginitis: this is a noninfectious cause of inflammatory vaginitis .
- This condition can cause a great amount of vaginal discharge and pain. Though this is considered a non infectious reason for vaginal symptoms it does cause a disruption of the normal bacteria found in the vaginal canal.
- Symptoms can include pain with intercourse, burning or vaginal pain, yellow/gray/green vaginal discharge
- Risks for developing this condition include estrogen deficiency or an immunologic abnormality
- This can impact both menstruating and nonmenstruating women.
If a woman is concerned about this condition she needs to make an appointment with her doctor for a thorough pelvic exam that may include tests for STDs, vaginal pH test and/or a wet mount.
TREATMENT: usually includes a combination of vaginal antibiotic cream and vaginal steroid suppository for up to 6 weeks. The antibiotic cream is not to treat an infection but is used for its anti-inflammatory properties.
Vaginal itching and discharge is often a result of yeast (candidiasis) but it can also be a result of less common vaginal conditions.
If any symptoms persist after an attempt at treatment a follow up appointment should be requested to exclude other less common conditions.
I am a Ob/Gyn practicing in Orange County, California. My area of focus since completing my training at USC has been Minimally Invasive Surgery and pelvic pain. My goals as a physician have included educating and being transparent with my patients about their diagnosis and treatment options. A team approach to pelvic pain and endometriosis has been proven to be most effective therefore, empowering my patients with accurate and evidence based information is essential to demystifying this often misunderstood condition.