Fungal Infections in Gynecology: A Patient's Journey

Mold issues

After exercising and sweating, I developed vulvitis.
When I visited the gynecologist, the external vulva was red, and the inner labia were red and painful, but there was no vaginal infection.
I was prescribed Meikang cream and antibiotics, but after applying the medication for 10 days, there was no improvement, and the infection spread.
When I consulted a dermatologist, I was diagnosed with tinea cruris and was given Jienfu lotion and oral medication, which showed improvement.
However, applying the medication on the inner labia was uncomfortable during the first two applications.
Later, I noticed swelling from the urethral opening to the vaginal opening, which was painful upon pressure and felt warm, but my temperature was normal (I thought it was a cold).
The gynecologist confirmed there was no vaginal infection and advised that the swelling near the urethral opening would not hurt if not pressed and should not be touched or treated with medication.
The tinea cruris medication was not suitable for that area, and the external vulva appeared to be healing.
I was told that the sensation of warmth was not concerning, so I did not receive any medication.
A week later, the swelling and slight redness from the urethral opening to the vaginal opening persisted.
I returned to the gynecologist, who diagnosed me with a vaginal yeast infection and prescribed a cream for the inner labia (no specific name provided), along with three days of Ningstai suppositories and oral medication for cystitis.
I was instructed to continue using the original tinea cruris medication on the external vulva.
After applying the medication, there was slight improvement on the sixth day, but discomfort returned.
On the twelfth day, during a follow-up, the doctor mentioned that only this type of cream was available, and due to the pandemic, an internal examination was not possible for two weeks.
I was prescribed three days of ketoconazole tablets, pain relievers, amoxicillin capsules, Ningstai suppositories, and instructed to use the remaining cream.

I have two questions for the doctor:
1.
Should I continue using the original medication? The entire labia appears wrinkled and damaged, and when I use the suppository, I can still feel swelling inside the vagina.
2.
Is there a medication similar to Jienfu lotion that can be applied to the entire inner labia? Thank you for your assistance.

Lala, 50~59 year old female. Ask Date: 2021/05/18

Dr. Wu Xianghui reply Obstetrics and Gynecology

1.
Vaginal infections can cause abnormal discharge, itching, fever, bleeding, and lower abdominal pain, which are among the most common symptoms in women.
The causes are numerous, and treatment should be accompanied by comprehensive health education.
It is recommended to consult a gynecologist for evaluation in an outpatient setting.

2.
Continue applying the medication; if symptoms persist or worsen, it is advisable to return for further evaluation and treatment.

Reply Date: 2021/05/18

More Info

Understanding fungal infections, particularly in the context of gynecological health, can be quite complex, especially when patients experience overlapping symptoms that may lead to confusion regarding the diagnosis and treatment. Your situation illustrates a common challenge faced by many women dealing with vulvar and vaginal issues, and it highlights the importance of accurate diagnosis and appropriate treatment.

From your description, it appears that you have been experiencing a series of symptoms that include redness, swelling, and pain in the vulvar area, as well as a potential fungal infection. Fungal infections, particularly those caused by Candida species (most commonly Candida albicans), are prevalent among women and can lead to symptoms such as itching, burning, and abnormal discharge. These infections often occur in warm, moist environments, which can be exacerbated by factors such as sweating, tight clothing, and antibiotic use.

In your case, the initial treatment with antibiotics and topical creams did not yield the expected results, which can sometimes happen if the underlying cause of the symptoms is not adequately addressed. The fact that a dermatologist diagnosed you with tinea cruris (commonly known as jock itch) suggests that there may have been a fungal component to your symptoms, but it is also crucial to consider that the vulvar area can be sensitive and may react differently to various treatments.

1. Continuing Treatment: Regarding whether to continue using the original medication, it is essential to follow your healthcare provider's advice. If the medication prescribed for the jock itch is causing discomfort or if the symptoms are not improving, it may be necessary to reassess the treatment plan. The fact that you are experiencing a burning sensation when applying the cream suggests that it may not be suitable for use on sensitive areas like the vulva. It is advisable to consult your healthcare provider before continuing any treatment, especially if you notice worsening symptoms or new developments.

2. Alternative Medications: As for finding a medication similar to the one you were using that can be safely applied to the inner labia, it is crucial to choose products specifically designed for sensitive areas. Over-the-counter antifungal creams that are labeled for use in the vaginal area may be appropriate, but again, it is best to consult with your healthcare provider for recommendations tailored to your specific situation. They may prescribe a different antifungal cream or suggest a more suitable treatment that can address both the fungal infection and any irritation caused by previous medications.

In addition to medication, consider the following preventive measures to help manage and reduce the risk of future infections:
- Maintain Hygiene: Keep the genital area clean and dry. After exercising or sweating, change out of wet clothes promptly.

- Wear Breathable Fabrics: Opt for cotton underwear and loose-fitting clothing to allow for better airflow.

- Avoid Irritants: Be cautious with personal care products, including soaps, lotions, and feminine hygiene products, as they can sometimes irritate the sensitive vulvar area.

- Diet and Lifestyle: A balanced diet and adequate hydration can support your immune system, which is vital in preventing infections.

Lastly, if symptoms persist despite treatment, or if you experience recurrent infections, it may be beneficial to seek a second opinion or consult a specialist in gynecology or infectious diseases. They can provide further evaluation and may conduct tests to identify any underlying conditions that could be contributing to your symptoms.

In conclusion, managing fungal infections and related symptoms requires a comprehensive approach that includes appropriate medical treatment, lifestyle adjustments, and ongoing communication with healthcare providers. Your health and comfort are paramount, and addressing these issues with your doctor will help you find the most effective solutions.

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