Vaginal Infections, Abdominal Pain, and Fertility Concerns

Vaginitis and left lower abdominal discomfort along with fertility issues?

Hello Doctor, I previously had inflammation in my genital area only once (10 years ago with a Candida infection).
This month, after moving back to my boyfriend's house (which he keeps very dirty and does not clean), I stayed there for a few days.
After having sexual intercourse, I was so tired that I didn't rinse my external genitalia with water and fell asleep.
As a result, I started to itch.
The doctor diagnosed me with vaginitis and a fungal infection, and prescribed me Dalacin vaginal tablets (7-day extended release), iodine solution for sitz baths, Calamine lotion, and a topical cream.
I would like to ask:
1.
I later found out that my boyfriend had experienced balanitis twice in the past two months and had seen a doctor for medication, but he said he had been fine for three weeks.
Could he have transmitted the infection to me, or could it be due to the dirty environment in his house where I wore underwear while sleeping?
2.
I tend to apply the topical cream a little inside the vagina (less than one fingertip).
Is this okay?
3.
After using the Dalacin vaginal tablets, I felt a lot of itching inside the next day, but there was very little discharge, and it seemed a bit gritty with tiny particles.
Is this normal?
4.
While using the vaginal tablets, I applied a lot of topical cream inside; should this cause any harm to the vagina?
5.
When doing yoga, I once felt pain in my lower left abdomen when raising my legs, and the next day I had a small amount of bright red discharge.
After that, sometimes I feel a dull ache in my lower left abdomen, but the doctor did not mention any abnormalities during the Pap smear, so I should be fine, right?
6.
I want to get pregnant, and all my tests have come back normal, except for the hysterosalpingography, which I was afraid to do because of the pain.
If I have no significant discomfort, can I infer that my fallopian tubes are normal? I am quite afraid of pain and hesitant to undergo tests.

7.
My boyfriend suspects he has premature ejaculation; does premature ejaculation affect fertility?
Thank you, Doctor.

Ye Fu Lin, 30~39 year old female. Ask Date: 2017/10/28

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
I later learned that my boyfriend had experienced balanitis twice in the past two months and had seen a doctor for medication, but he said he had been fine for three weeks.
Could he have transmitted the infection to me, or could it be due to his dirty living conditions since I wore underwear while sleeping? Answer: Both are possible; it's hard to determine the exact cause.
2.
I tend to apply the topical ointment a little inside the vagina (less than one fingertip deep).
Is this okay? Answer: Not advisable.
3.
The day after using the vaginal tablet, I experienced significant itching inside, but there was very little discharge, and it seemed a bit gritty with small particles.
Is this normal? Answer: Not quite normal.
4.
While using the vaginal tablet, I applied a lot of topical ointment inside.
Shouldn't this harm the vagina? Answer: It's better to use the vaginal tablet with clean water.
5.
During yoga, I once felt pain in my lower left abdomen while raising my legs, and the next day I noticed a small amount of bright red discharge.
Sometimes, my lower left abdomen feels uncomfortable, but the doctor didn't mention anything abnormal during the Pap smear, so I should be fine, right? Answer: You should be fine.
6.
I want to get pregnant, and all my tests have come back normal, except for the hysterosalpingography, which I avoided due to fear of pain.
If I'm not experiencing any discomfort, can I conclude that my fallopian tubes are normal? I'm quite afraid of pain and hesitant to undergo testing.
Answer: You cannot conclude that the fallopian tubes are normal just because you have no discomfort.
7.
My boyfriend suspects he has premature ejaculation.
Does premature ejaculation affect fertility? Answer: Premature ejaculation does not affect fertility.

Reply Date: 2017/10/28

More Info

Understanding vaginal infections, abdominal pain, and fertility concerns can be complex, especially when multiple factors are involved. Based on your description, it seems you are experiencing a combination of symptoms that may be linked to both a vaginal infection and potential fertility issues. Let's address your questions one by one.

1. Transmission of Infection: It is possible that your boyfriend's previous episodes of balanitis (inflammation of the glans) could have contributed to your vaginal infection. Fungal infections like candidiasis (yeast infections) can be transmitted through sexual contact, especially if one partner has an active infection. However, environmental factors, such as poor hygiene in his living space, can also play a significant role in the development of infections. It’s important to maintain good hygiene practices for both partners to minimize the risk of transmission.

2. Application of Creams: Applying topical creams inside the vagina is generally not recommended unless specifically instructed by a healthcare provider. Most topical treatments are designed for external use, and inserting them can disrupt the natural balance of the vaginal flora, potentially worsening the infection or causing irritation.

3. Symptoms After Using Vaginal Tablets: Experiencing itching and changes in discharge after using antifungal tablets can be common as your body reacts to the treatment. The presence of small particles or a "curd-like" consistency in your discharge may indicate that the treatment is working, as the yeast is being expelled. However, if the itching persists or worsens, you should follow up with your healthcare provider.

4. Safety of Combining Treatments: Using topical medications in conjunction with vaginal tablets should be done cautiously. If you have applied a significant amount of external cream before inserting the vaginal tablet, it may not cause harm, but it could interfere with the effectiveness of the treatment. Always follow the instructions provided by your healthcare provider regarding the use of multiple treatments.

5. Abdominal Pain and Discharge: The left lower abdominal pain you experienced during yoga could be related to various factors, including muscle strain or ovulation pain. The presence of a small amount of bright red discharge could be a sign of ovulation or a minor irritation. Since your Pap smear results were normal, it is likely that there are no significant underlying issues, but if the pain persists or worsens, further evaluation may be warranted.

6. Fertility Concerns: If you are planning to conceive and have had normal fertility evaluations, it is reasonable to assume that your fallopian tubes are likely functioning properly, especially if you are not experiencing any significant discomfort or symptoms. However, a hysterosalpingogram (HSG) is the most definitive way to assess tubal patency. If you are concerned about the pain associated with this test, discuss your fears with your healthcare provider; they may offer options to manage discomfort during the procedure.

7. Impact of Premature Ejaculation on Fertility: Premature ejaculation does not directly cause infertility. However, if it leads to difficulty in achieving pregnancy due to timing issues, it could indirectly affect fertility. Open communication with your partner and possibly seeking advice from a sexual health specialist may help address these concerns.

In conclusion, it is essential to maintain open communication with your healthcare provider regarding your symptoms and treatment options. Regular check-ups and following medical advice can help manage infections and address any fertility concerns you may have. If symptoms persist or worsen, do not hesitate to seek further medical evaluation.

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