Why your yeast infection is not going away.

I think it is a good thing that women do not need to see a doctor for every ailment, that they can self-diagnose and treat with over-the-counter medications. But sometimes, self-diagnosis leads to the wrong treatment and worsening symptoms.

Case in point: chronic yeast infections. Yes, there are definitely women who have frequent and recurrent yeast infections, but more often their symptoms are caused by something else. If you have frequent episodes of itching or discharge, please read on. Even if your symptoms seem to temporarily get better after self-treatment, read on.

The following are the great imitators of yeast:

Bacterial vaginosis. "BV" is a very common vaginal infection that is characterized by a fishy odor and increased discharge. The odor tends to get worse after sex. It is more common in sexually-active women, but sexual activity is not a prerequisite and it is not considered an STI. Sometimes, a woman will not have a noticeable odor but will just feel irritated, leading her to think she has yeast.

Anti-fungal (yeast) medication will not get rid of this. There are a lot of natural remedies such as hydrogen peroxide or boric acid but in my experience, antibiotics are the most effective treatment.

Contact dermatitis. This is the medical term for a mild skin allergy to something in the environment. Common culprits are condoms, soaps, detergents, and lubricants. Just because you have been using Dr. Bronner's Peppermint Castile soap for the last ten years, you could still develop a sensitivity. In fact, the more we are exposed to something, the more likely we are to mount an immune response.

"Natural" products are no less likely to cause a reaction. I've had two patients react to lavender. Also, some yeast medications such as Monistat can cause irritation, leading to a vicious cycle. Vagisil is also notorious for briefly alleviating symptoms, but then they come back with a vengeance.

Over-cleaning. This is kind of in the same category as contact dermatitis. Many women with vaginal symptoms assume it is a hygiene issue and clean the bejeeezus out of their vaginas. DO NOT DO THIS. As a wise mentor once told me, the vagina is like a self-cleaning oven. Vigorous cleaning with soaps and "feminine hygiene" products strips away natural oils and causes further irritation. Just don't do it.

Lichen Sclerosis and other vulvar skin disorders. This is an important one, and I will devote a whole blog post to this in the future. This is a chronic skin condition that affects 1-2% of women. We do not know the cause, but it is possibly autoimmune and characterized by chronic focal itching. It is more common in women who have other autoimmune syndromes and is treatable with topical steroids.

Vulvar cancer. I hate to mention the c-word because I really do not like to increase anxiety. In fact, I feel part of my job as a gynecologist is to decrease anxiety and say, "Hey, you're okay! Don't worry so much!"

Vulvar cancer is a rare cause of chronic itching and is more likely to affect women who are in their 5th or 6th decade. I had a 55 year old patient last year who saw me for a "yeast infection" and she had a thick white area on her vulva that turned out to be squamous cell carcinoma. We caught it early and last I heard, she is doing well.

Herpes. I hate to mention this one too, but I must. I probably see one patient a month with a "severe yeast infection" that turns out to be herpes. Herpes can be very itchy.

Crabs, aka Pubic Lice. I almost never see this. Maybe it is because so many of my patients have removed their pubic hair, but even the ones that are au naturel don't seem to get this as often as one would think.

Other STIs. Trichomonas, chlamydia and gonorrhea can cause discharge and sometimes irritation. Fortunately, most itching is NOT caused by an STI.

If you have frequent itching or discharge or both, do not assume it is yeast. Get thee to a doctor, Stat!


Dr. Cynthia McNally, MD

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