What causes dry and itchy vagina with recurring vaginal infection?

Hello,

Welcome to icliniq.com.

I read your query and can understand your concern.

After going through the history and the image provided from your end (attachment removed to protect patient's identity), it is vulvovaginal candidiasis, a fungal infection in the vaginal and private area. It is common among women irrespective of age or history of sexual intercourse, as it is due to changes in the vaginal pH. They also occur due to other factors, including-

Dietary and climate changes.

Any underlying medical conditions or any intake of medications for other medical conditions.

Due to using harsh or too mild chemicals to clean the area.

Due to the stagnation of moisture in the area.

Due to direct contact with an infected person.

Lowered immunity.

Hormonal factors.

Stress.

Decreased water intake, and so on.

They may cause irritation, itching, burning sensation, and white discharge, which may or may not be foul smelling, redness, etc.

The image provided from your end appears to be a normal vaginal secretion common among women. Normal vaginal secretion would be clear or white to creamy and is normal. Candida or fungal vaginitis would be cheesy, thick, white, and often foul-smelling. Therefore, do not worry. However, as you have mentioned, I suggest the following treatment options due to the presence of itching, inflammation, and dryness.

1. Candid V3 VT (Clotrimazole), which are vaginal suppository tablets to be inserted into the vagina for three consecutive nights.

For three consecutive nights only, clean the private area with the solution I will mention below, and dry the area well with a clean towel. Lie down on your back during bedtime and flex your knees close to your chest. And with the help of a sterile glove, which is usually available with the medication itself, kindly insert the tablet deep inside the vagina till you feel resistance. Place yourself in the same position for a few minutes to prevent the tablet from slipping out. Leave it overnight.

This is done during bedtime to avoid slipping out of the tablet during the day.

2. Intimate vaginal wash, a capful diluted in one cup of water, may be used to clean the private parts once or twice daily to maintain pH balance and prevent recurrences of infections.

3. Capsule Vizylac rich (Pre and Probiotics) to be taken one hour before going to bed at night after dinner for seven days. This is a pre and probiotic that helps to balance vaginal pH.

4. Prophylaxis, as you mentioned, in the form of once-per-week Fluconazole, is usually taken in case of recurrent vaginal candidiasis, which is usually assessed by the number of actual infections in a year.

Since you do not have recurrent vaginal candidiasis, they may not be required. However, in case of infection, tablet Fluconazole 150 mg may be taken as a single dose.

And in case of recurrences, it may be taken weekly for six months.

5. Make sure to consume a healthy diet and keep the private areas clean and dry to avoid stagnation of moisture.

6. Candid vaginal tablets may also be used once a month for six months in case of recurrences of the infection.

However, the secretion in the image is not candidal and appears to be normal vaginal secretion.

7. Apart from the above, for confirmatory diagnosis, I would also like to request you to undergo a KOH (potassium hydroxide) or swab test to rule out fungal or bacterial infections in which the secretions are collected and tested for culture and sensitivity to check for the presence of organisms and for knowing the medication they are most sensitive to.

Hope the details provided above were informative and provided clarity.

Thank you and take care.

Hello,

Welcome back to icliniq.com.

I read your query and can understand your concern.

In case of secretions, a swab test may be done. However, in the absence of the same, they are not required.

Yes, absolutely. Clingen Forte capsules may also be used instead of candid V3.

Recurrence requires the symptoms to occur repeatedly. Since the symptoms, except the discharge, have occurred closer to the previous episode, they may be due to incomplete recovery from the first infection. In case of repeated episodes of the same in the future, they may be considered recurrences, and you may use the medications advised above.

Surfaz SN cream (Clotrimazole, Neomycin, and Betamethasone) is to be used on the skin and is not considered safe for mucosal areas like the inside of the vaginal or private areas. However, they may be used in case of skin outside the private area.

As you have already mentioned, suppositories are helpful and reduce the symptoms and may be used for sure.

I am glad to know you have undergone the tests. It is always good to have them tested. You do not have to worry about them.

Hope I have been able to help you with clearing all your concerns. Thank you and take care.

Hello,

Welcome back to icliniq.com

I am glad you are feeling better and your symptoms have reduced. As your doctor has mentioned taking them for three months, kindly continue. Also, vaginal discharge throughout the week is normal. As you said, the presence of white watery discharge is a normal vaginal discharge and nothing to be worried about. Only a thick cheesy white discharge depicts the presence of fungal elements. However, due to recurrence twice, you may continue with the fluconazole tablet once weekly. It will be very helpful for getting rid of fungal elements entirely by the end of three months. Medication, along with lifestyle modifications, would be the most beneficial.

In case of a foul-smelling discharge that is white and cheesy, you may use vaginal capsules for three days only. Since you are devoid of symptoms depicting candida currently, do not worry. Continue to use a vaginal wash as I had previously advised, and continue with a healthy diet. Make sure your private parts are aired under the fan to avoid stagnation of moisture which can trigger fungal infections. Make sure to wear loose-fitting undergarments. Meanwhile, you may also consult your gynecologist for the medication course prescribed from their end to be sure and clear.

Thank you.