When itching, burning and vaginal discharge make their unwelcome appearance, many women assume that they have a yeast infection-an overgrowth of the candida fungus that often is a normal part of the vaginal environment. To end the outbreak, they use a nonprescription anti-yeast medication, such as miconazole (Monistat).

Problem: More often than not, yeast is not to blame. In a recent study, 153 wollen thought they had yeast infections—but in 74% of cases, tests revealed that symptoms actually had a different cause.

This is just one of many common misunderstandings about vaginal infections, a group of conditions collectively called vaginitis. Each misunderstanding can lead to misdiagnosis, ineffective treatment and unnecessary suffering. Here's what you need to know to protect yourself…

The Leading Culprit

  • Bacterial vaginosis (BV). The most common kind of vaginitis, this accounts for 40% to 45% of cases. It is an overgrowth of anaerobic bacteria, a type that doesn't need oxygen. BV develops when (for reasons that are unclear) the vagina's pH changes from a healthy acidic level of 3.8 to 4.2 to a less acidic, more alkaline level of above 45. This allows anaerobic bacteria to thrive.

Signs/symptoms: A thin gray discharge... fishy odor...itching...burning during urination.

Diagnosis: If you suspect BV, see your doctor if you've never had the symptoms before (to ensure an accurate diagnosis) or if recurrent BV occurs more than twice a year (to confirm the diagnosis and discuss prevention strategies). To diagnose BV, the doctor performs a physical exam...does a pH test...prepares a wet mount (a sample of vaginal discharge to examine under a microscope)..and conducts a whiff test by adding a chemical solution to the wet mount that, in the case of BV, releases fishy-smelling proteins.

Treatment: Typically a prescription antibiotic, such as metronidazole (Flagyl), is used orally for seven days or in topical gel form for five days-or longer for recurrent BV.

Soothing: Twice daily, soak for 10 minutes in a sitz bath of lukewarm water mixed with four tablespoons of baking soda.

Prevention strategies…

  • Launder panties, towels and other articles that come in contact with your genital area using dye-free and fragrance-free detergent, such as All Free Clear. If you use a stain remover on these articles, soak and rinse them afterward in clear water, then machine-wash. Skip fabric softener and dryer sheets.
  • Wear white 100% cotton panties and thigh-high nylons, not panty hose.
  • Use non-perfumed soaps, body washes and lotions.

Good brands: Basis, Dove Hypoallergenic, Neutrogena, Pears. Never use bubble bath, bath salts or scented bath oils.

  • Use white, unscented toilet paper. Avoid adult or baby wipes.
  • Do not douche or use feminine hygiene spray.
  • Avoid deodorized sanitary products. Use a tampon only when your flow is heavy enough to soak it within four hours—otherwise, use a pad.
  • To keep the groin area dry, apply moisture-absorbing Gold Bond Powder or Zeasorb powder (not talcum powder) daily...and change your panties if they become damp. Panty liners can keep moisture trapped in-so wear them only on days when menstrual flow is light, not daily.

The Fungi

  • Yeast infections. These account for 20% to 25% of vaginitis cases. Up to 95% of yeast infections are candida albicans...the rest are candida glabrata, candida parapsilosis or another strain. Factors that increase susceptibility to yeast…
  • Weakened immune system (for instance, from stress, high-dose steroids or chemotherapy drugs).
  • Antibiotics, which disturb the normal balance of vaginal flora.
  • Elevated blood sugar due to diabetes or a diet high in potatoes, sugar and/or refined carbohydrates.

Signs/symptoms: A thick, white, cottage-cheese-like vaginal discharge...itching...burning...redness.

Diagnosis: Unlike bacterial infections, yeast infections do not raise vaginal pH-but a normal pH result on an over-the-counter test (such as Vagisil Screening Kit) does not confirm that you have yeast rather than something else. So if you suspect a first yeast infection or if bouts recur more than twice yearly, see your doctor for a yeast culture, physical exam, pH test and wet mount.

Treatment: A doctor-diagnosed first yeast infection or flare-ups that occur twice per year or less can be treated with nonprescription antifungal medication. But for frequently recurring infections, it is better to take a stronger prescription antifungal, such as fluconazole (Diflucan), for one to three days. If symptoms persist, ask your doctor about doing a yeast culture to identify and tailor treatment to the species. Do not try to treat yeast with "natural" douches, such as tea tree oil-vaginal tissues are easily irritated.

Prevention: Follow the BV treatment guidelines above—they also guard against yeast—and reduce dietary sugar.


  • Trichomoniasis ("trich"). Responsible for 15% to 20% of vaginitis cases, trichomoniasis is the only sexually transmitted form of vaginitis--you can't catch" BV or yeast from a sexual partner. Trich is caused by a parasitic protozoan (single-celled organism) that burrows under the vagina's mucous lining.

Signs/symptoms: Heavy, yellow-green, frothy, foul-smelling discharge and intense itching

Diagnosis: Again, you should have a physical exam, pH test and wet mount. Trich is the diagnosis with a pH greater than 45, the presence of large numbers of inflammatory white blood cells and microscopic detection of the pear-shaped protozoa. If you have trich, your risk for other sexually transmitted diseases rises—so get screened for chlamydia and gonorrhea, too.

Treatment: A one-day course of metronidazole eradicates trich. Your sex partner also needs antibiotics so you aren't reinfected.

The Menopausal Misery

  • Atrophic vaginitis. Vaginal tissues are very sensitive to declining estrogen-so this type of vaginitis is common, affecting an estimated 10% to 40% of postmenopausal women to some degree.

Signs/symptoms: Vaginal dryness, itching and burning...smelly yellow discharge...painful intercourse.

Diagnosis: A physical exam reveals dry, thin vaginal and vulvar tissues. When diagnosing atrophic vaginitis, your doctor should rule out other problems that cause similar symptoms, such as lichen planus (a skin disorder that involves vulvar tissue degeneration).

Treatment: Vaginal estrogen rings or tablets. However, they are not appropriate for women with migraines or a history of, or increased risk for, breast cancer or cardiovascular disease.

Natural alternative: Twice daily and also before intercourse, gently rub a dab of vegetable oil or solid vegetable shortening onto the vulvar tissues and inside the vagina.

Within six weeks, women who have suffered for years with atrophic vaginitis and painful intercourse often get complete relief.

Amino Acid Reduces Compulsive Hair-Pulling

Compulsive hair-pulling-known as trichotillomania-primarily affects women. There is no approved medication to treat it.

New study: Trichotillomania patients took 1,200 milligrams (mg) to 2,400 mg of the amino acid N-acetylcysteine (NAC) or a placebo. After 12 weeks, 56% of NAC users and 16% of placebo users rated their symptoms as "much or very much improved."

Theory: NAC acts on the glutamate system of the brain, which controls compulsive behaviors. NAC is sold in health food stores.

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