Southpoint Medicine & Women's Health Associates
6216 Fayetteville Road, Suite 105 Durham, NC 27713
Phone: (919) 405-7000
Fax: (919) 405-7006

It Ain’t Always Yeast

Unusual vaginal discharge is the most common complaint that leads to appointments in the gynecologist’s office. Women spend millions of dollars annually for over the counter remedies to treat their symptoms. Unfortunately, the symptoms are often misdiagnosed and subsequently mistreated.

The vagina has it’s own system of defense that maintains a healthy environment. This environment includes lactobacillus, the normal predominate bacteria that assists in promoting an acidic environment. Lactobacillus competes with unhealthy bacteria for nutrients and prevents proliferation of these unwanted microorganisms. The body’s own general immune system contributes to this defense.

There are circumstances whereby this balance may be upset creating a perfect environment for the proliferation of pathologic bacteria. The most well known is the administration of antibiotics that kills not only unwanted bacteria, but lactobacillus as well. We also know that douching washes out desired bacteria allowing an opportunity for pathologic bacteria to grow.

However, ejaculate (from intercourse), menstrual flow and foreign bodies, such as tampons and diaphragms can also change the environment of the vagina so that it is less acidic allowing infections to occur.

Loss of estrogen production (as in menopause) is also a big contributor to vaginal infections as estrogen maintains a healthy and thick vaginal lining.

Contrary to popular belief, yeast is NOT the most common type of vaginal infection. The most common infection is called bacterial vaginosis. This, like yeast is an infection that occurs when the normal balance of vaginal bacteria is disturbed. The symptoms not only include an abnormal discharge but an unpleasant odor most commonly described as “fishy”. Rarely does itching accompany this infection. Women often douche to rid themselves of these symptoms and in reality only increase the problem as more healthy bacteria are washed away.

Two very important points must be made about this problem. Firstly, THIS INFECTION IS NOT SEXUALLY TRANSMITTED. There is no one to blame when this occurs and it is not an indication of infidelity in a relationship. Secondly, THERE IS NO OVER THE COUNTER MEDICATION TO TREAT THIS INFECTION. Do not waste your time and money on creams and tablets you can purchase at the drug store. They are not going to be effective.

Yeast infections, have a different set of symptoms. They typically include what is described as a thick, white, “cottage cheese” discharge. The other very common symptom is itching. Circumstances that contribute to the development of a yeast infection include antibiotic use, oral contraceptive use, uncontrolled diabetes and pregnancy.

Yeast infections are often successfully treated with over the counter medication and many women are experts at diagnosing and treating this problem without the assistance of a health care provider. There are, however over 100 different species of yeast, many of which are resistant to the medication available without a prescription.
If unsuccessfully treated by the drug store remedies, a trip to a health care provider is warranted.

There are women who have a tendency to have repeated episodes of both infections for a variety of reasons. This is not necessarily the result of misdiagnoses or treatment. Often, both infections coexist and until the most obvious is diagnosed and treated, the other cannot be identified and adequately managed. An individualized treatment plan must be developed when the patient continues to be plagued by the problem despite adequate therapy.

Patients can assist in the diagnosis and treatment of their problem. We do not recommend douching as the vagina has it’s own system of cleansing. If you must douche, we recommend you do so no more the twice monthly. Do not leave tampons and diaphragms in the vagina for extended periods of time. They will raise the pH of the vagina thereby creating an environment that promotes the growth of unhealthy bacteria.

If you have a good idea that yeast is the problem, it is fine to use over the counter therapies. If, however, the symptoms are unresponsive, you either have a resistant strain of yeast or have misdiagnosed yourself and in either case should seek professional help. Remember, sexually transmitted infections can also present as vaginal discharges and if exposure is a possibility you absolutely must be evaluated by a health care provider.

Lastly, if you have an appointment for an evaluation, it is important that you do not douche, do not have intercourse, and do not use any kind of medication in the vagina for minimum a 48 to 72 hours prior to your appointment. Any of the above will confuse the picture and make it impossible for a diagnosis to be made.

Remember, seek help when necessary because it ain’t always yeast.