DoctorOnCall.com.my FEATURE ARTICLE
Introduction, Incidence and Common Causes
Vaginal itch. Just that statement could make a lady squirm with embarrassment at the thought of having to constantly ease the urge to soothe an itch in an area where it isn’t exactly easy to just scratch anytime anywhere without looking..well..awkward.
The commonest cause for vaginal itch, which is also the commonest genital infection affecting women worldwide is Vaginal Candidiasis. This is a yeast infection caused by a fungus known as Candida albicans. This condition goes by other names too, as such vaginal thrush, monilia and vulvovaginal candidiasis.
About 20% of women between ages 15 to 55 harbour Candida albicans in the vagina as part of their normal vaginal flora. The majority of these women have no symptoms. However, when an overgrowth of Candida albicans happens, a woman would start to experience symptoms of vaginal candidiasis, such as a heavy white vaginal discharge which looks like curd or cheese, itching inside the vagina or on the surrounding skin area, as well as a burning sensation. An itchy rash may also be present in the groin and thigh folds.
Factors that increase this fungal colonization include a change in the vaginal pH level, increased estrogen level, or when there is an imbalance of organisms living in the vagina.
Pregnancy in particular is the most common period of time in a woman’s life for her to experience one or recurrent episodes of yeast infection. The reason for this is the elevated level of estrogen, as well as a higher than normal sugar level in vaginal secretions on which fungal organisms feed on and multiply. The incidence of vaginal candidiasis is specifically high during the second trimester of pregnancy.
Similarly, women who take high doses of oral contraceptive pills or estrogen-based therapy are at higher risk. Candidiasis also tends to present in patients with a weakened immune system. Diabetic patients commonly get infected due to this in conjunction with the presence of higher sugar levels in their system.
Another instance is when a patient is on a prolonged course of antibiotics that were given to treat other infections. These antibiotics were meant to kill bad bacteria, but collateral damage could occur when normal “good” bacteria in the vagina also gets killed in the process. Candida then becomes the reigning colonization in the vagina and hence symptoms of candidiasis show up. Obese women are also prone to being infected with Candidia albicans because excess body fat may be converted to estrogen which as we know promotes the growth of Candida.
Yeast infection is not spread through sexual contact. But some men might experience rashes or itchiness on the penis after having sexual contact with an infected person.
Apart from Candidiasis, vaginal discharge can be caused by other infections such as Bacterial Vaginosis, Trichomonas Vaginalis, Gonorrhoea and Chlamydia. For this reason, a doctor will obtain full history from the patient, inspect the genital area and may take a vaginal swab test to come to a diagnosis and treat with the right medications. For recurrent Candidiasis infection, a repeated swab might be done after completion of treatment to ensure that the fungus is no longer present in the vagina.
Diagnosis & Treatments
Antifungal medication is the mainstay of treatment for Candidiasis, and these come in a variety of forms from oral tablets, vaginal pessaries and creams. Based on the severity and frequency of infection, as well as if the woman is pregnant, the doctor will decide on the safest and most appropriate mode of treatment. It is important for pregnant ladies to get treatment because if left untreated, Candida infection can be passed to the baby’s mouth during delivery. Additional treatment may also be required if the patient also has concurrent irritant dermatitis, which is an allergic skin rash caused by infested vaginal discharge.
Here are a few tips to prevent Vaginal Candidiasis.
- Keep your genital area clean and dry, because fungi thrive in moist areas.
- Wear cotton underwear instead of silk or nylon ones as the latter traps moist.
- Avoid tight fitting shorts or pants, or pantyhose.
- Do not wear wet bathing suits nor sweat drenched workout clothes for long periods of time.
- Only rinse private areas with water. Don’t use soap, and don’t use perfumed sanitary pads, tampons or toilet papers as the chemicals they contain can cause a pH imbalance.
- Lastly, if you are diabetic, ensure that your blood sugar levels are under good control.
Dr Adeline Carol Peters practices in Mediviron UOA, KL and on DoctorOnCall. She loves playing the piano in her spare time.
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