Oh candida
“Lilies that fester smell far worse than weeds.” — William Shakespeare (1564–1616), English playwright, Sonnet 94. They that have power to hurt and will do none (1.14) (1609)
ONCE, in a drunken lapse, an old friend swore to us that his girlfriend had smelled of anchovies. It was enough to give olfactory memories of hot and spicy Spanish anchoa, best downed with an ice-cold cerveza but certainly not to remind oneself of “lilies that fester” or feminine odor. It reminds me now of vaginitis.
Definitions. Defined, vaginitis is the inflammation of the vagina causing discharge, itching, redness, and pain. The general signs and symptoms are:
•Change in amount, color, and odor from vagina.
•Dyspareunia (pain during sexual intercourse). •Vaginal irritation or itching. •Pain during urination. •Light vaginal bleeding.
What causes it? Most of the time, it results from the change in the normal balance of vaginal bacteria, from a sexually transmitted disease or from reduced estrogen levels because of menopause. Bacterial vaginosis. In this common type, one organism which is part of the normal flora of the vagina overgrows compared to the rest upsetting the bacterial milieu. This is common in pregnant women or those who abuse feminine washes or products. Overdouching can disrupt the balance of normal bacteria present in the vagina. With bacterial vaginosis, the discharge is foul-smelling (some say fish-like), grayish-white, and more noticeable after sex. Women with new or multiple sex partners are at higher risk of developing this type. Yeast Infection. If you can get fungal infection in your feet (athlete’s foot), why not in your vagina? It’s common and the estimate is 75% of women will get it in their lifetime at least once. The offending fungus is Candida albicans. A
vaginal yeast infection is not sexually transmitted. The likelihood of getting it is increased by use and overuse of steroids and antibiotics, uncontrolled diabetes, and hormonal changes of menopause, pregnancy, and the use of birth control pills. As a medical clerk rotating in OB-GYNE in PGH, I will never forget seeing my first case of yeast infection because the discharge was white and thick and looking much like cottage cheese. Trichomoniasis. This kind of vaginitis is sexually transmitted and caused by a parasite (the one-celled trichomonas vaginalis). Usually, women develop the infection in the vagina and men in the urethra (the fluid passageway that includes the penis). The discharge as expected is fishy, foul-smelling, yellowish to green, and sometimes described as frothy. In women, trichomoniasis has been implicated in the two-fold increase in the chance of getting cervical neoplasia (cancer). Atrophic Vaginitis. With menopause (or surgery that removes the ovaries) levels of the essential female hormone estrogen drops and one effect of this are thinner and drier vaginal tissues. There can be vaginal itching, pain, and burning sensation. Another non-infectious vaginitis is caused by irritation or allergy from feminine products like soaps, sprays, and douches, sanitary napkins and tampons. It’s important to pinpoint, then avoid using the irritant.
Diagnosis and Treatment. It’s best to see your favorite OB-GYNE. As with most diseases, I don’t recommend selftreating with over the counter creams and ointments. Using the wrong medicine just complicates things (prolonging treatment and wasting money, etc.). For sure, your doctor will take a sample by swabbing the cervical or vaginal areas. And depending on what type of vaginitis is identified, medications prescribed include antibiotics, antifungals, and estrogen creams or tablets.
Vaginitis is readily treated and cured. But you must go out and see the doctor. Let’s leave the anchovies and cheese in the tapas bar.