“I was all right while using the medicine, but I feel uncomfortable again.” When the same problem comes back, it is easy to wonder whether the treatment was wrong or whether you did not manage your care well. Repeated symptoms alone are not enough to decide which it is.
In the earlier column on changes in discharge, discharge that differed from usual and the symptoms that came with it were observed. This time, using those observations, we will look at what to test, how to interpret the results, and what to check when the discomfort returns.
If you feel uncomfortable again after medicine, is it always a recurrence?
First, separate cases that stayed uncomfortable throughout treatment from cases in which the discomfort went away and then returned. Both may need reassessment, but the questions to check are somewhat different.
If itching had remained from the beginning, we look at whether the diagnosed cause sufficiently explains the current symptoms, and at how long the medicine was used and what the response was. If you were comfortable for a time, we check how long you had no symptoms and when they started again. If odor was the main problem last time but only the outer skin stings this time, that difference matters too.
We do not group every cause together under the term “recurrent vaginitis.” For example, when Candida keeps returning and when bacterial vaginosis keeps returning, the diagnosis and the treatment plan differ. Checking what the previous diagnosis was and whether it is the same problem now is as necessary as counting how often it returns.
What does a vaginitis test look for?
It is a test to narrow down the cause of the symptoms and to choose treatment that fits that cause. Not every test is done all at once for every person.
| How it is checked | What it looks for, and the limits |
|---|---|
| Talking about symptoms, and an examination | We look at whether the discomfort is inside the vagina or on the vulvar skin, and whether there are signs of irritation or inflammation. The cause is not settled from a description of symptoms alone. |
| pH of the discharge, and microscopy | The vaginal environment and the appearance of cells and microorganisms are used as a reference. pH alone cannot make the diagnosis, and not seeing something on microscopy does not exclude every infection. |
| Culture, or genetic testing when it is needed | The suspected microorganism is checked. If Candida keeps returning, or the response to treatment is poor, a test that distinguishes the type may help. |
A microorganism’s name on the result does not mean that all of it has to be removed. Because Candida can also be present without symptoms, whether it was detected is judged together with the current discomfort and the examination findings. On the other hand, if the test is negative and symptoms continue, the target and method of testing, and causes other than infection, should be reviewed again.
Can similar itching have a different cause?
Yes. Not only problems related to fungi and bacteria, but also skin irritation and hormonal changes, can cause similar discomfort. That is why an antifungal is difficult to choose from itching alone.
- Vulvovaginal candidiasis is related to Candida, a kind of fungus. When it recurs, the type of organism, the response to treatment, and related factors such as recent antibiotic use or diabetes are reviewed. Even so, many people have no clear accompanying factor found, so recurrence is not immediately judged to be reduced immunity or insufficient care.
- Bacterial vaginosis is related to a change in the bacterial composition inside the vagina. Treatment differs from that for Candida, so do not simply reuse a previous medicine for similar discomfort.
- Sexually transmitted infections such as Trichomonas, or inflammation of the cervix, can also cause changes in discharge. Questions about sex are not meant to assign blame to anyone. They are how the needed tests are chosen.
- Causes other than infection also exist. Irritation from scented products, skin disease of the vulva, and hormonal changes related to menopause or breastfeeding can cause itching, burning, and a dry feeling.
Being told it is vaginitis does not mean every case is a sexually transmitted infection. Treatment and any further checks differ by cause, so there is no need to judge yourself or a partner by one symptom or one test name.
What is useful to bring when you are seen again?
Please bring previous test results, the medicines you used, and the order in which the symptoms changed. You do not need to use exact medical terms.
- The last results and prescription If you have a photo of the result sheet or the medicine packet, please have it ready. If you do not know the name of the medicine, tell us whether it was an oral medicine, a vaginal tablet, or an ointment, and how long you used it.
- The difference before and after treatment Separate whether the odor decreased but stinging remained, and whether there was a time when you were completely comfortable. It also matters whether it felt more irritating right after the medicine was applied or inserted.
- Your health and products you newly used Share whether pregnancy is possible, whether you are breastfeeding or have reached menopause, medicines you take, and underlying conditions. Please also mention products that touch the skin, such as a new cleanser or lubricant.
If you are uneasy about the examination or specimen collection, ask for an explanation first. You can ask to stop if you feel uncomfortable during the test. If you have used a vaginal tablet or ointment recently, say so before the test, and check with the clinician how to prepare for testing rather than stopping a prescribed medicine on your own.
Will a longer course, or washing more often, make it go away?
How long treatment lasts is decided from the confirmed cause and the response, and washing more cannot replace it. For recurrent vulvovaginal candidiasis, a clinician may consider longer treatment or maintenance treatment. This is a plan for controlling symptoms. It is not a guarantee that it will not recur in the future.
Vaginal tablets and creams can cause local burning or irritation, and oral antifungals can cause nausea, abdominal pain, and other effects. Oral antifungals can interact with other medicines and can rarely affect liver function, so please say which medicines you are taking. In particular, if pregnancy is possible, do not take a previous oral medicine again on your own. Some vaginal creams and vaginal tablets can reduce the strength of latex condoms, so check the product directions and the clinician’s advice as well.
Day to day, do not wash inside the vagina; gently wash the outer skin with water and dry it well. Avoid strongly scented products, and if friction during sex causes pain, do not force it. Adding probiotic supplements or a cleanser does not replace finding the cause and treatment.