Persistent Vaginitis: Causes, Treatments, and Solutions

Q: Persistent Vaginitis: Causes, Treatments, and Solutions

Hello： Recurrent vaginal infections are not uncommon. <br>If you have been treated multiple times, you should consider testing for Chlamydia. <br>If the result is positive, your sexual partner should also be treated. <br>Li Yueyuan

Recalcitrant Vaginitis

Hello Doctor: I have been undergoing treatment for vaginitis for seven years.
I only stop taking medication when instructed by my doctor and have never stopped on my own.
However, after treatment, I typically have no discharge for two to three days, and then it returns! My symptoms do not include itching or odor; the discharge is slightly yellow, and I experience pain during intercourse.
I had never tested the discharge before; I was just prescribed medication after a pelvic examination.
After such a long treatment period, I decided to give up since there was no itching or odor.
Recently, however, I experienced dull pain and a feeling of heaviness in my lower abdomen, so I sought medical attention again.
After a pelvic examination, the doctor suggested it might be pelvic inflammatory disease, which could lead to infertility.
This prompted me to pursue more aggressive treatment! Over the past seven years, I have visited seven or eight clinics/hospitals.
Currently, I am seeing a doctor at a private clinic in Taipei.
I have had five visits so far, and while I have not fully recovered, there has been some improvement.
During the earlier visits, tests showed the presence of fungi, E.
coli, and Staphylococcus.
By the fourth treatment, only Staphylococcus remained, and the doctor said I did not need to return.
After my menstrual period, I noticed sticky, slightly yellow discharge again, which led me to return for a fifth visit.
The doctor mentioned a slight presence of E.
coli and advised me on proper hygiene.
I received an injection and was given medication for a suppository, and I was told that a follow-up was unnecessary since there was only a small amount of E.
coli.
However, after completing the treatment, I had no discharge for two days, and today I have strong, sticky, slightly yellow discharge again.
I am unsure where the problem lies! I wear silk underwear, do not wear tight clothing, eat unsweetened yogurt and kefir with probiotics daily, and exercise regularly.
I feel very frustrated with the ongoing injections, medications, and suppositories.
I would like to ask the doctor, is vaginitis really that difficult to treat? There is no itching or odor, and I am actively treating it while maintaining a healthy lifestyle, yet I still do not know what the issue is.
I would appreciate your help in clarifying this.
Thank you!

Emma, 20~29 year old female. Ask Date: 2016/07/04

Dr. Li Yueyuan reply Obstetrics and Gynecology

Hello: Recurrent vaginal infections are not uncommon.
If you have been treated multiple times, you should consider testing for Chlamydia.
If the result is positive, your sexual partner should also be treated.
Li Yueyuan

Reply Date: 2016/07/04

More Info

Understanding persistent vaginitis can indeed be frustrating, especially when symptoms persist despite ongoing treatment. Your experience highlights several important aspects of managing this condition, and I will address your concerns in detail.

Causes of Persistent Vaginitis
Persistent vaginitis can be caused by a variety of factors, including:
1. Infections: Common culprits include yeast infections (often caused by Candida), bacterial vaginosis (BV), and sexually transmitted infections (STIs) like trichomoniasis. The presence of E. coli and Staphylococcus aureus in your tests suggests that bacterial infections may be contributing to your symptoms.

2. Hormonal Changes: Fluctuations in hormone levels, particularly estrogen, can affect the vaginal environment. Low estrogen levels can lead to vaginal atrophy, which may cause dryness and discomfort.

3. Allergic Reactions: Sometimes, irritants such as soaps, detergents, or even certain fabrics can provoke a reaction leading to inflammation and discharge.

4. Underlying Health Conditions: Conditions such as diabetes or autoimmune disorders can predispose individuals to recurrent infections.

5. Lifestyle Factors: Stress, poor diet, and lack of sleep can weaken the immune system, making it harder for the body to fight off infections.

Treatment Options
Given your history of persistent symptoms, it’s crucial to adopt a comprehensive approach to treatment:
1. Accurate Diagnosis: Since you have not undergone thorough testing for all potential pathogens, it may be beneficial to request a comprehensive evaluation, including cultures for specific bacteria and tests for STIs. A pelvic ultrasound may also be warranted to rule out any structural issues.

2. Targeted Antibiotic Therapy: If bacterial vaginosis or another bacterial infection is confirmed, a targeted antibiotic regimen may be necessary. It’s essential to complete the full course of antibiotics even if symptoms improve.

3. Antifungal Treatment: If yeast infections are suspected, antifungal medications may be required. Sometimes, a longer course of treatment is necessary for chronic cases.

4. Probiotics: Incorporating probiotics, either through supplements or dietary sources like yogurt, can help restore the natural flora of the vagina.

5. Lifestyle Modifications: Continue with your healthy habits, such as wearing breathable cotton underwear, avoiding irritants, and maintaining a balanced diet. Staying hydrated and managing stress through relaxation techniques can also be beneficial.

6. Hormonal Treatments: If hormonal imbalances are suspected, discussing options such as vaginal estrogen therapy with your healthcare provider may be appropriate.

Follow-Up and Monitoring
Given the complexity of your case, regular follow-ups with your healthcare provider are essential. Documenting your symptoms, any changes in your discharge, and your response to treatments can provide valuable information for your doctor. If you feel your current provider is not addressing your concerns adequately, seeking a second opinion from a specialist in gynecology or infectious diseases may be beneficial.

Conclusion
Persistent vaginitis can be challenging to treat, but with a thorough understanding of the underlying causes and a tailored treatment plan, improvement is possible. It’s essential to remain proactive in your healthcare, communicate openly with your provider, and advocate for the tests and treatments you believe are necessary. Remember, you are not alone in this journey, and many women face similar challenges. Seeking support from healthcare professionals and possibly joining support groups can also provide comfort and additional resources.

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