Managing PCOS, Vaginal Infections, and Skin Issues: Your Questions Answered

Polycystic Ovary Syndrome, Vaginitis, Vulvar Foreign Body

I have polycystic ovary syndrome (PCOS) and am experiencing persistent acne on my face.
I have been seeing a dermatologist for a long time and have been using topical retinoids and topical antibiotics.
The doctor advised me to take oral doxycycline twice daily for seven days when I have inflammatory acne, with follow-up appointments every two weeks.
My condition has not improved over the past six months, and I have been taking medication every month, with the longest continuous use being over ten days.
Recently, I developed two painless, non-itchy lesions in the genital area that resemble closed comedones, measuring about 3-4 mm in diameter.
They are only visible when the skin is stretched and are the same color as the surrounding skin.
I can feel a slight granular texture when I press on them, but there are no other symptoms.
After observing them for two weeks without any changes, I visited a gynecologist.
After an internal examination, the doctor diagnosed me with vaginitis and folliculitis due to increased vaginal discharge and prescribed oral metronidazole, vaginal suppositories of nystatin, and topical isocort.
After one week of treatment, the doctor noted a reduction in discharge, but the lesions in the genital area did not show significant improvement, so an additional three days of medication was prescribed.
I would like to ask the following questions:
1.
Could the intermittent use of doxycycline lead to antibiotic resistance? Could prolonged use of doxycycline cause vaginitis?
2.
My vaginal discharge is not excessive, but the doctor indicated that it is increased during the examination.
Does this mean I may not be able to perceive it myself, and could I have been experiencing inflammation for a long time? Could prolonged inflammation lead to other diseases? How often should I schedule regular check-ups?
3.
Regarding the two lesions, since there has been no improvement with medication, is surgical intervention an option, or is treatment unnecessary as long as they do not affect my daily life?
4.
I am considering hormonal treatment to improve my acne symptoms.
The gynecologist mentioned options for menstrual regulation medication (covered by insurance) and contraceptive pills (out-of-pocket).
The menstrual regulation medication may be more effective.
How should I choose between these options?
I am feeling very anxious about my health condition, and these questions are ones I did not have the opportunity to ask during my appointments.
I would greatly appreciate your guidance.
Thank you.
🙏

Jiao lü de ren, 20~29 year old female. Ask Date: 2017/11/15

Dr. Huang Jianzhong reply Obstetrics and Gynecology

1.
Will intermittent oral doxycycline lead to antibiotic resistance? Can prolonged use of doxycycline cause vaginitis?
Ans: Oral doxycycline does not lead to antibiotic resistance and will not cause vaginitis.
2.
My vaginal discharge is not excessive, but the physician stated that I have increased discharge during the examination.
Does this mean I may not be able to perceive it myself? Could it be that I have been inflamed for a long time? Can prolonged inflammation lead to other diseases? Is there a recommended schedule for regular medical check-ups?
Ans: There is no recommended fixed schedule for regular medical check-ups; you can seek medical attention as you notice symptoms.
3.
Regarding the two lesions, if there is no improvement with ongoing medication, can they be addressed surgically? Or is treatment unnecessary as long as they do not affect daily life?
Ans: If they do not affect daily life, treatment is not necessary.
4.
I am considering hormonal therapy to improve my acne symptoms.
The gynecologist mentioned that there are hormonal medications (covered by insurance) and contraceptive pills (out-of-pocket) available, with hormonal medications potentially being more effective.
How should I choose?
Ans: You can opt for hormonal medications (covered by insurance).

Reply Date: 2017/11/15

More Info

Managing conditions like Polycystic Ovary Syndrome (PCOS), vaginal infections, and skin issues can be quite challenging, especially when they intersect. Let’s address your questions systematically.

1. Concerns about Doxycycline and Antibiotic Resistance
Doxycycline is a broad-spectrum antibiotic commonly used to treat various bacterial infections, including acne. While it can be effective, prolonged use can indeed lead to antibiotic resistance. This means that over time, the bacteria may become less susceptible to the drug, making it less effective. Additionally, long-term antibiotic use can disrupt the natural flora of the vagina, potentially leading to yeast infections or other types of vaginitis. If you are concerned about the duration of your doxycycline treatment, it would be wise to discuss this with your healthcare provider. They may suggest alternative treatments or a break from antibiotics to allow your body to restore its natural balance.

2. Vaginal Discharge and Inflammation
Regarding your vaginal discharge, it’s important to note that some women may not notice changes in their discharge until it becomes significant. The presence of inflammation can sometimes be subtle and may not always correlate with noticeable symptoms. Chronic inflammation can lead to various complications, including recurrent infections or other reproductive health issues. Regular gynecological check-ups are essential, especially if you have a history of infections or other reproductive health concerns. A general recommendation is to have a gynecological exam at least once a year, but if you experience symptoms like unusual discharge, pain, or discomfort, you should seek care sooner.

3. Management of the "Lumps" in the Vaginal Area
The two lumps you described, which feel like closed comedones (similar to acne), could be a result of folliculitis or another benign condition. If they are not causing pain or discomfort and have not changed in size or appearance, they may not require immediate intervention. However, if they persist despite treatment or if you notice any changes, surgical options such as drainage or excision could be considered. It’s essential to weigh the risks and benefits of any surgical procedure, so discussing this with your gynecologist is crucial.

4. Choosing Between Regulating Menstrual Cycles and Birth Control Pills
When it comes to managing PCOS and associated symptoms like acne, hormonal treatments can be very effective. The choice between menstrual regulation medications and birth control pills often depends on your specific symptoms and health goals. Birth control pills can help regulate your menstrual cycle and reduce acne, but they may not be suitable for everyone, especially if you have contraindications like a history of blood clots. On the other hand, medications specifically aimed at regulating your cycle may have different side effects and benefits. It’s essential to have a thorough discussion with your healthcare provider about your options, including potential side effects, benefits, and how they align with your health goals.

Conclusion
Your concerns about PCOS, vaginal infections, and skin issues are valid and deserve attention. It’s crucial to maintain open communication with your healthcare providers, ensuring that all your questions are addressed during your visits. Regular check-ups, appropriate use of medications, and a tailored approach to managing your symptoms can significantly improve your quality of life. If you feel overwhelmed, consider seeking support from a counselor or support group specializing in chronic health conditions. Remember, you are not alone in this journey, and there are resources available to help you navigate these challenges.

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