Private health

Expert answers to your most intimate health questions

Why isn’t my yeast treatment working?

Q:

I’m so tired of running to the drugstore for yeast remedies—since hitting perimenopause, I get at least three infections a year! I don’t douche or use scented products and I keep myself clean and dry. What gives?

A:

Hormonal changes that occur during perimenopause can alter vaginal pH, making you more susceptible to yeast infections. And though Candida albicans is the type of yeast that’s responsible for the majority of vaginal infections, if yours keep recurring despite treatment with OTC remedies, you could be harboring Candida glabrata, a different species of yeast. Both are part of the normal vaginal microflora and only become problematic when their numbers climb. And while drugstore antifungal medications are effective against C. albicans, C. glabrata is highly resistant to them. In fact, Swedish researchers found that C. glabrata can survive even when treated with 10 times the medication dose typically used for C. albicans infections.

The good news: Boric acid has antifungal properties that can defeat both species of yeast. So if you develop another infection, I advise using a vaginal suppository that contains it (like Queen V The Eraser, Walmart stores) daily for two weeks. And to lower your risk of repeat episodes, try limiting sugar and refined foods—the glucose they release can help yeast thrive. Finally, to promote the growth of healthy bacteria in the vagina that keep yeast in check, I suggest taking a daily probiotic and enjoying fermented foods such as yogurt, kefir and sauerkraut several times a week

But if you continue to experience problems despite these strategies, see your doctor. She can conduct tests to determine exactly what organisms are causing your infections and recommend targeted treatments.

Help for tenderness “down there”

Q:

My husband and I were intimate in our new hot tub last night, and now my vagina is really sore. Should I be worried?

A:

Having sex underwater washes away natural lubrication, increasing friction that triggers inflammation and soreness—plus, chemicals used in pools and hot tubs can irritate tissues, which worsens pain. But please don’t worry—several strategies can help:

To ease soreness, I advise taking an anti-inflammatory like naproxen or acetaminophen and smoothing a thin layer of aloe vera gel onto affected skin two to three times a day. (You can apply it both inside and outside the vagina.) Aloe vera inhibits the action of enzymes that produce inflammation and pain, according to research in the Journal of Ethnopharmacology. Also smart: Avoid tight underwear and scented personal hygiene products as both can increase irritation.

These steps should have you feeling better in a few days. But if not or if you develop signs of infection like itching, discharge or fever, see your doctor.

Q

My sister’s doctor advises a mammogram every other year, but my doctor wants me to go yearly. I’m 55 and not at high risk, plus I find the exam to be so painful. Is a yearly

scan necessary?

A

Your sister’s doctor may be following the American Cancer Society’s guidelines, which state that women 55 and older can transition to having mammograms every other year. But early detection is key in fighting breast cancer. And annual screening has been shown to detect 85 percent of cancerous masses before they’re big enough to feel. For that reason, I still recommend annual mammograms.

If pain is the main factor in your reluctance to get screened, there are ways to make the test more bearable. Some facilities use breast cushions that can ease discomfort by 50 percent. (You can find a provider at MammoPad.com.) I also suggest taking an OTC pain reliever before your appointment. Finally, tension can worsen pain, so remember to breathe slowly and deeply during the exam.