   
Clear, white vaginal
discharge
This doesn't sound like a yeast infection because you don't describe
vulvar itching and burning or a whitish thick discharge usually
characteristic of yeast. Therefore I don't think using yeast
medication will help.
Itching and dry skin - is
it yeast?
Itching is often a sign of a contact allergy. The fact that it is
happening during your menses would prompt me to ask if you are wearing
any type of pads or liners (as opposed to a tampon). Could you be
sensitive to a certain brand? Yeast usually produces burning rather
than itching but not always. Sometimes there are other fungal
infections such as tinea species that can produce itching on the "dry"
skin. If this persists or worsens it should be checked out.
It can be. We see reactions to vaginal foam that contains nonoxynol
9 but it's hard to tell if its that specifically or some of the other
carrying agents used. The only way to tell with the condom is either
going back to a brand you previously used or abstinence for long
enough to tell if the problem goes away. This is an area where you
will need to be your own detective with trial and error of different
materials/substances that that area comes in contact with.
Odorous vaginal discharge
An odorous vaginal discharge can sometimes be a symptom of bacterial
vaginitis. It should be checked out. I know you may feel uncomfortable
talking about this with your doctor, but that's what the doctor is
there for. This is a common problem that your doctor has heard many
times before. If you avoid bringing it up, the poor doctor will go out
of business! In general, vaginitis doesn't cause sterility. If you get
a sexually transmitted disease, that can cause sterility. The doctor
checks for that by doing a cervical culture or smear at the time of a
vaginal exam. As far as home remedies, the only thing I know of would
be douching. In this process you are rinsing out any vaginal or
cervical secretions so that bacteria have less material on which to
produce odorous causing chemicals. There actually is evidence that
regular douching seems to increase the incidence of vaginal
infections. However, if you already have a problem, douching is often
effective in reducing the symptoms. Betadine douche is one still
recommended by many physicians. If the symptoms don't clear up after
douching 3/week for one or two weeks, you really should see your
doctor.
Recurring yeast infections
- milky white discharge
A milky white discharge is usually normal. It represents cervical
and vaginal secretions that contain old vaginal wall cells
(epithelium). As long as there is no vulvar burning/itching, this does
not represent a symptomatic yeast infection.
Allergic reactions (contact) of the vaginal or vulvar epithelium are often confused
with yeast infections because they cause a histamine release in the
skin of the vulva with subsequent itching or burning. That is one
reason why culture for yeast is so important because you may assume
it's a yeast infection when in fact it is allergic. The most common
allergens are feminine hygiene sprays, contraceptive foam and jelly, even carrying agents in anti-yeast preparations,
lubricants on condoms, or soaps or bath oils. It doesn't sound as if
these are a problem in your case but you have to be your own detective
with allergens. The fact you are sensitive to terazole does make
allergy more likely.
Make sure this is yeast. Sometimes women with sensitive skin will
react to any normal vaginal secretions when they get on the vulva
because the secretions are naturally acidic. You can try petrolatum
jelly (Vaseline) to coat the vulva (a small layer) to protect it from
acidic discharge or you can use a tampon to block the discharge from
getting to the vulva and irritating it. These would be tests to see if
it is just an acidic (but normal) discharge you are reacting to or a
yeast infection. These things will usually not prevent the reaction to
a yeast infection.
Some women will get more yeast infections on certain birth control
pills. I think it has to do with the specific progestogen in the pill.
I would suspect that Levelen would be worse than Ortho Tricyclen
because it has a stronger progestogen than Ortho- Tricyclen. Sometimes
when we have women discontinue pills, recurrent yeast infection gets
better; other times there is no difference in the rate of infection.
It would take a 3 month trial off of the pills to tell.
Boric acid as treatment for
recurring yeast infections
Boric acid vaginal suppositories have been used in the past for
resistant, recurrent yeast infections. Many experts in vaginitis
clinics use them still. Unfortunately in the U.S. we don't have any
commercial vaginal suppositories with boric acid. Perhaps in Europe
there are some if that's where you are. We have to have the pharmacist
mix them up. Find an experienced pharmacist who remembers the
formulation.
These recurrent infections usually run their course after several
years. Something in the biochemistry of the vagina changes and they
disappear or at least get much less frequent as long as there is not
an underlying disease. Have hope. At the risk of losing you due to
repetition, make sure this is recurrent yeast infection by culture and
not just by visual diagnosis of the physician. I can't count how many
women I've seen who thought they were having recurrent yeast infection
when in fact their cultures were negative and their discharge was just
irritative, but not infectious.
Resistance to Diflucan®?
Resistance of candida (yeast) species to Diflucan are becoming more
and more a problem, probably because it is being used so much to treat
yeast instead of topical, vaginal medications which usually don't
develop as many resistances. Terazol® which you react to, is
actually the most effective topical medication with the least
resistance. That being said, it is still extremely important to make
sure of the diagnosis. Vaginal and vulvar irritation can be due to
causes other than yeast. (See our news
about cultures
for yeast. Assuming that you and your doctor are absolutely sure
of the diagnosis of recurrent yeast infection and there are no
predisposing factors such as diabetes, antibiotic use, immune disease
or immunotherapy use, then the treatment becomes problematical trial
and error. You need to work with the physician to find medication to
use periodically to keep it in check. Dietary change and douching may
also play a role.
Clumpy vaginal discharge
with white cells
Vaginal discharge varies in its nature and consistency from one
person to another and even for one person throughout the menstrual
cycle. Commonly the discharge is grayish white or clear. The cells
come from the vaginal lining and fluid from the vagina and the cervix.
It often gets thin (non clumpy) at mid cycle of the menses because the
cervical mucous is thin and copious if ovulation has taken place that
cycle. In the 2nd half of the cycle it becomes thickened and sometimes
clumpy under the effect of progesterone. These are all normal
mechanisms to help a woman become pregnant at the mid cycle time of
ovulation and then "block" the cervix in the 2nd half of the
cycle so that if a pregnancy occurs there won't be any ascending
infection.
When a woman is anovulatory, there is less discharge and not the
monthly variation in consistency. It sounds as if, in some respects,
what you describe is normal now (for ovulation) and was just different
when you were anovulatory.
The white cells in the discharge change things a little. Usually
there are not too many white blood cells (WBCs) in vaginal discharge.
It's difficult to know if what your doctor has seen is "too much"
or not. WBCs can indicate infection but usually of the cervix, not the
vagina. If the cervical mucous is clear or white, not yellowish, there
usually is not an infection that needs treatment. All that being said,
there have been instances where doctors have just treated with
antibiotics for a "cervicitis" just because of the amount of
vaginal discharge. Sometimes it gets better and other times it doesn't
change because there really wasn't any infectious process in the first
place. Usually, if I see numerous white cells on vaginal wet prep, I
treat with an antibiotic cream (Cleocin®) vaginally or and
erythromycin or Zithromax® oral antibiotic as an empirical trial.
I would say it clears up the problem about 50% of time.
|
