I am 31. How will I manage my vaginal itching and discharge?

Question

Hi doctor,

I am 31 years old. I noticed that I have been experiencing vaginal itching around the lip area with a thick discharge, but not a smelly discharge, for a week now. What can I do?

Please help.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

The condition you describe, of intense itching with thick, white, non-smelly discharge, the most likely cause is an uncomplicated vaginal yeast infection (vulvovaginal candidiasis). This can usually be confirmed with simple bedside tests like vaginal pH and a potassium hydroxide (KOH) wet mount.

The main causes we consider are yeast infection (most likely here), bacterial vaginosis (usually with thin, fishy-smelling discharge), trichomoniasis (frothy, foul-smelling discharge, often sexually transmitted), allergic or irritant reactions (soaps, wipes, tight clothing), and, less commonly, skin conditions like lichen sclerosus.

To confirm, your doctor may do a pelvic exam with pH testing and a swab. If the result is unclear, a vaginal culture or molecular test may be needed. If you are sexually active with new or multiple partners, tests for trichomoniasis and other sexually transmitted infections may also be done. A pregnancy test is important before starting oral medicines, as only creams are safe in pregnancy.

Treatment in non-pregnant women is usually either a short course of antifungal cream (Clotrimazole or Miconazole for three to seven days) or a single oral Fluconazole 150 mg tablet. In pregnancy, only vaginal creams are used for seven days, and oral Fluconazole is avoided.

If your symptoms do not match a yeast infection but turn out to be bacterial vaginosis or trichomoniasis, antibiotics such as Metronidazole or Clindamycin may be needed. In case of trichomoniasis, your partner also needs treatment to prevent reinfection.

For relief, avoid irritants like fragranced soaps, wipes, and tight clothing. Cotton underwear and keeping the area dry can help. A mild soothing cream may be used if irritation is severe.

Follow-up is not required if symptoms improve; however, if they recur frequently (three or more times a year), your doctor may suggest longer treatment, such as weekly Fluconazole for several months. In such cases, it is essential to check for diabetes or low immunity.

Prevention includes

Avoiding vaginal douching.
Limiting unnecessary antibiotics.
Managing diabetes well.
Treating partners when infections are sexually transmitted.

I hope this helps.

Thank you.