Lady Trouble

August 3, 2011 9:07 PM

My fiance is concerned that her vaginal infection has been misdiagnosed/mistreated. She gives a thorough description and snowflake details inside. Please help!

Symptoms: Beginning 2.5 months ago, yeast infection type pain/discomfort/itching/sensitivity/discharge. It has changed a bit over this time, but those are the general symptoms.

Home care: I occasionally get yeast infections and felt one beginning, so purchased a one-day over the counter suppository (which has always worked until now). Two days later i did not feel better, so I took another one. Two days later still no good.

Doctor #1: I go to my lady doctor and she confirms that it is a yeast infection (by looking under a microscope). I take a course of oral anti-yeast antibiotic. Finish that, still no good and I find a new doctor.

Doctor #2: New doctor prescribes three rounds of suppositories (two different kinds over two months), orders two lab testings (also tested for gonorrhea, chlamydia, etc). She recommended I take some time off of meds and is now prescribing boric acid suppositories.

More specific: She looks under microscope and says it looks bacterial, which is why the meds have not been working. Ido a round of evening suppositories (7-10 days) and still don't feel right. I do another round, and still not right! She prescribes an alternate anti-bacterial suppository (perhaps the bacteria got wise to this one). At that time she also takes a swab for lab testing. I begin the 3rd round of anti bacterial meds, but a few days later she calls to tell me to that the recent lab tests don't show bacteria, yeast. She says I still need to finish the meds.

I finish them, confused and kind of worried about what the heck is going on (not in horrible pain, but uncomfortable). I go back to see her. She looks, says it looks a little irritated and to take a while without meds (as the lab shows nothing to treat) and let it try to re-balance itself. She swabs me again, sends to the lab and it again shows nothing. One week goes by, and I am still a bit irritated deep in there and slightly itchy on the exterior.

Today she prescribed boric acid suppositories to balance things out (14 days, 2x a day, then 7 days a month for 6 months!). I will see her tomorrow and am going to ask her what else could be possibly going on and if there is someone else I should see for a second opinion?

So: Was the early mis-diagnosis of yeast infection the issue (delaying the proper care for bacterial infection and intensifying it)? Are my lady parts just out of sorts with all this crazy medical attention and therefore needing time to settle back to normal? Is there something else entirely going on that I should get tested for?

posted by palacewalls to health & fitness (27 answers total)

IANAD, but I have lady parts. And one time I had what felt like a 6 month long UTI (it was fab, let me tell you!) that got everything I had down there all irritated and angry. Turns out it was interstitial cystitis...in other words, random irritation. Fun.

Has your diet changed any? Sugar consumption up or down? With my issue, I noticed that aspartame made things way worse, so I had to cut out the Sweet N Low in my tea. Random, but it made a difference. Pay attention to your diet and see if there is something you can eliminate. It may change things.

Also, has your soap, body wash, detergent, underwear, or condoms changed any? Some people are sensitive to different spermicides, so that may not be helping. Neither is the heat wave were having in the US (if you are in a heat wave) so do what you can to let things air out when you can.

It sounds like everything is still irritated with all the different meds in addition to the previous infections. I know nothing about boric acid, but I'd eat a lot of yogurt, pay attention to diet, and try to not throw too many things in there to see if things calm down.
posted by MultiFaceted at 9:20 PM on August 3, 2011

My doc used to prescribe two courses of the anti yeast oral meds since sometimes one didn't work. She also favored oral meds to suppositories to try and avoid irritation. Can you seek someone with experience treating vaginal pain (they might be able to help with less irritating treatments while you figure things out. Also depending exactly what it is there is a chance that your partner could have it and re-expose you to it.
posted by oneear at 9:29 PM on August 3, 2011

Try yogurt. I know, it sounds crazy, but it did the trick for me years ago when I was plagued by a series of recurring yeast / bacterial infections that just seemed to bounce back and forth between each other. And what the hell, it's cheap and it can't really hurt. Just go and get some plain yogurt (not the store brand, the good stuff and do not use cappuccino flavor, although I did in desperation and suffered no ill effects aside from a lengthy series of jokes from my partner) and put a couple of fingerfuls up in there. It feels good, soothing but slightly creepy - also, do not wear your favorite undies during this process - and then do it again a couple of times a day for a few days. See how you feel. It seemed to kick my balance back to where it needed to be.
posted by mygothlaundry at 9:40 PM on August 3, 2011 [2 favorites]

Probably a really good idea to use plain yogurt, with no sugar added.
posted by KokuRyu at 9:51 PM on August 3, 2011 [1 favorite]

"Also, has your soap, body wash, detergent, underwear, or condoms changed any?"

Or menstrual pads, pantiliners, or tampons? Sometimes they change materials or manufacturing processes without notice. You may be one of the three lucky people who happen to react to slight change X.

(Also, if you're not already -- plain cotton underwear for a while.)
posted by Eyebrows McGee at 10:07 PM on August 3, 2011

I've had something similar before after successfully treating a yeast infection. I called it...angry vagina. It went away on its own after a week or so of no sex (sorry), loose cotton underwear, and frequent washing with water only.
posted by the young rope-rider at 10:21 PM on August 3, 2011 [3 favorites]

(Oh, and I talked to a doctor who basically diagnosed it as something fancy but I couldn't remember the term, hence "angry vagina". She prescribed a steroid cream to reduce the inflammation but I thought my poor vagina had been through enough and let it work through its emotions.)
posted by the young rope-rider at 10:23 PM on August 3, 2011 [3 favorites]

Boric acid is what modern doctors use with vaginal infections when they have no idea what to do. Which is sad, because it's pretty awesome and having used it myself I'd make it the first line of defense before I tried any anti-fungals. I would look for a second opinion from someone rated highly among your female friends since your doctor seems terrifically lost. But give the boric acid a shot.
posted by schroedinger at 10:26 PM on August 3, 2011

I had a serious irritation for quite awhile, and yes I went through a couple different doctors and treatments for yeast infection etc. which didn't work. Doctor #3 finally got me on boric acid suppositories twice a day or something and warm baths at night (just warm water for 15 minutes, no soap). That treatment did take awhile it's true, but it calmed everything down and I felt normal again after. Boric acid supps worked wonders for me -- they were not irritating at all -- seemed like they brought everything back into balance.

By the way, 100% cotton underwear all the time are words to live by.

Good luck -- hope the boric acid helps you like it helped me.
posted by minx at 10:28 PM on August 3, 2011

Oh and are you using condoms or diaphragms? I have a friend who had random vaginal nastiness until she started sleeping with someone who was allergic to latex and switched to polyurethane condoms. BAM! Happy vagina again!

Something to think about.
posted by the young rope-rider at 10:43 PM on August 3, 2011

IAAD (NYD, and not a GYN) and I also have lady parts, and I've also had difficult to treat yeast infections.

It is not really that unusual to have a yeast infection that is not fully treated by the over the counter yeast treatments, or to have one that is not cured by oral antifungal. Unfortunately, yeast infection treatments just aren't always that effective, seems to me we must have a pretty delicate balance going on there. This is also a good reminder that a lot of people self-diagnose yeast infections inaccurately and that a look under the microscope is the best way to see for sure what's going on. As people here are pointing out, there are a lot of other reasons for vaginitis.

It sounds like you had a really rough time of things and I hope things look up for you from here. There are some good suggestions from other posters.

Remember that after an antibiotic treatment, you're much more susceptible to yeast infections because the antibiotics kill off some of the 'good bacteria' that's normally keeping the yeast in check. So although I can certainly understand why you're feeling like you're at the end of your rope with this whole process and questioning your diagnoses, I think it does sound like a realistic course of events, and it sounds like your current doc is doing the right things to treat you. It seems unclear whether you were ever mis-diagnosed... could you have initially had yeast, then a bacterial vaginosis, then now back to yeast again? It would be difficult to confuse yeast and bacteria under a microscope. They look quite different.
posted by treehorn+bunny at 10:57 PM on August 3, 2011 [4 favorites]

I have been through the wringer of Vaginal Situations in the last year (so, NOTHING BUT SYMPATHY HERE) and just in the past few weeks my doctor and I finally figured out what was wrong. I still feel the occasional twinge in my vag but right now I'm chalking it up to "I had recurring yeast infections for 10 months, I can't even remember what it's like to feel normal in there." So best case, maybe that's what's going on.

Antibiotics always give me yeast infections, and that's very common, so the fact that you have another infection is not surprising, and it's really weird that your doctor is opting not to medicate. Basically think of this as a war between several factions of vaginal flora. There are good bacteria (which kill yeast, essentially - as I understand it they lower the pH in your vag by producing hydrogen peroxide or somesuch, which makes it too acidic for yeast to thrive), bad bacteria, and fungi (yeast). Your first round of medicine was meant to kill yeast. It didn't help. Your second round of medicine was meant to wipe out bad bacteria; this has the unfortunate side effect of wiping out the good bacteria too, which means yeast can run rampant up in there with no good bacteria to destroy it with acid. So it makes total sense that you're in a yeasty state now.

Who knows why your first course of yeast medicine didn't do the trick; maybe it was misdiagnosed, maybe you had a resistant strain, whatever. The good news is that boric acid suppositories have a great reputation for being highly effective. Another thing you should look into is a probiotic that's specifically formulated to help with vaginal flora. I don't know the details of why the bacteria are supposedly better, but the salient thing is that more of the helpful bacteria actually make it through your digestive system because the capsule is less flimsy. Worth looking at; I get mine from Whole Foods.

BTW, I tried the yogurt thing once and "can't hurt" was inaccurate. They were definitely yeasts I had, and it was definitely plain, non-sugared yogurt, but the yeasts loooved it. I seem to be the only person on the internet for whom this has been the case, but there it is. I had better luck with half-cloves of garlic, and with tea tree oil suppositories, but I think boric acid is likely to blow those guys out of the water.

Oh, and! In addition to the other changes mentioned, have you changed meds at all? It turned out my issues were somehow due to a drug interaction, and apparently some hormonal birth controls can turn on you suddenly and throw off your vaginal homeostasis. The more you know!
posted by troublesome at 12:47 AM on August 4, 2011 [1 favorite]

Memail me if you want more details on what was going on with me, BTW.
posted by troublesome at 12:50 AM on August 4, 2011

IANAD. I do have lady parts and in the past have suffered serious yeast infections. Yogurt is good, but garlic is better. Yes, garlic. Some sources recommend inserting the clove with a piece of string attached, or wrapped in a bit of gauze, but frankly it's very similar to inserting a tampon without an applicator, and the garlic will come out easily enough with the right kind of squeezing or a little help from your finger. Doesn't smell great, but it was the most effective thing I ever tried. Good luck!
posted by Paris Elk at 2:52 AM on August 4, 2011

Are you having unprotected sex? Perhaps your boyfriend is giving the yeast infection right back to you. Instead of seeking out a third doctor for the girlfriend, try seeking out out a first doctor for the boyfriend. [Mayo Clinic Cite]
posted by headspace at 5:15 AM on August 4, 2011 [1 favorite]

You could try a week-long prescription of systemic antifungals like they give to open heart surgery patients and whatnot. It will likely annihilate whatever is colonizing your lady parts, but in the long term is terrible for your liver and will make you wicked constipated. It's called Sporanox (usual dosage is 200mg/day for a week iirc) and should be used as a weapon of last resort, but it sounds like you've reached that point anyway.

ianad, &c.
posted by elizardbits at 5:26 AM on August 4, 2011

I was once on this roller coaster for a year-plus.

Things that didn't work: suppository goo of any sort, sugar-free plain yogurt, garlic, tea-tree oil body wash, a month-long course of oral Diflucan.

What finally did work: a prescription nystatin/triamcinolone cream that I'd apply externally for two to four days whenever I experienced a return of my symptoms. That, and making sure my nails were trimmed—I'd been inadvertently irritating the hell out of things when they weren't. And making sure to only use one of two kinds of gentle St. Ives body wash (Oatmeal & Shea Butter or Energizing Citrus) on that area all the time.

It still took months for things to completely stabilize down there, but those are the changes that really put me on the path to recovery.
posted by limeonaire at 5:32 AM on August 4, 2011

Some thoughts (not medical provider, but I am a woman):

Definitely send your boyfriend to the doctor to get checked if you're not using condoms. Even if you are, he should be checked for oral yeast (may be called oral thrush).
Are you using spermicidal condoms or spermicide? STOP if you are. Spermicide is terrible stuff and can be very irritating. Also, if you're using lube, it needs to be sugar-free--what you want to look for and avoid is glycerin. Yeast loves that stuff.
You need to deep clean your underwear. All of it--the yeast may be hanging out and reinfecting you (possibly the bacteria too? not sure about that one). You want to wash it on hot and dry on the highest setting (run it through twice) and then iron the crotch. Do that every time you wash your underwear until you've been cured for awhile. This may melt your underwear if it's not cotton, so you may want to buy some new stuff if you have a lot of nylon. Buying new wouldn't hurt, actually, but make sure you wash it before using! Try unscented detergent.
You may also want to consider dietary changes. Yeast feeds off sugars, so eliminating alcohol, sugar, simple carbs, etc, may help. You want to eat vegetables, meat/fish, plain yogurt, stuff like that, and avoid desserts, breads/pastas, fruit, etc. Google diets for systemic yeast for more info.
I would also look for a third gynecologist, someone highly rated and experienced.

Good luck! You have my sympathies, I hope you feel better soon. Feel free to memail if you have any questions.
posted by min at 5:42 AM on August 4, 2011 [1 favorite]

I, too, have been on this particular roller coaster through hell. There are a lot of good suggestions in this thread. If I were your fiancee, I would try one at a time, to be sure to isolate what is and isn't working. She should also see a third, superfab gyno, as min suggests. I have a recommendation in the US Midwest, if that is helpful for you (memail me).

In the meantime: cotton underpants always, no fragrances in any detergent, soap, tampon, pad (etc), good diet and watch the sugar, as much exercise as is comfortable with a shower or bath afterwards.
posted by sideofwry at 5:48 AM on August 4, 2011

I've thought of a few more things...I wish I didn't know all this stuff but hopefully it will help you!

You should make sure your genitals are totally dry after bathing. The easiest way to do this is to wait awhile before getting dressed (robe is fine, but no underwear). If you're in a rush, blow dry your crotch with a hair dryer on the cool setting.
Wear underwear as little as possible--don't sleep in it, for example.
If you shave/wax, stop for awhile.
Your vaginal pH changes with your cycle. You may find you feel better after your period.
Do not wash your genitals with soap of any kind--just water (and avoid getting the soap/bodywash you use on the rest of your body in there). If you use a wash cloth, treat it the same as the underwear routine and change it daily. Actually, you may want to change your towels you dry off with daily for awhile, and wash and dry them on high heat.
Also, sorry, but you may want to hold off sex for awhile until you get things sorted out, if you aren't already. Sex can be irritating (aside from the possibility of passing infections back and forth) and you may be making things worse if you're still having sex regularly.
Have you been checked for diabetes? I think that diabetes can lead to frequent yeast infections. You may want to get a regular physical to check on things.
posted by min at 6:22 AM on August 4, 2011 [1 favorite]

You poor thing. I've been through this too. The thing that finally worked for me was boric acid, lots of "airing out" (no undies unless totally necessary), and time. After the boric acid, I just gave everything some time to rebalance. Don't be too eager to try something else. Also, I found that applying a thin coat of vaseline on the inflamed skin once or twice a day was a major help.
posted by jrichards at 6:44 AM on August 4, 2011

Have you tried taking lactobacillus acidophilus supplements ('good' bacteria)? My local sexual health clinic sells it and suggests two a day - one orally, one vaginally (not sure for how long). You can find it at the grocery store.
posted by ghost dance beat at 7:25 AM on August 4, 2011

I don't think I've seen any discussion of this being possibly bacterial vaginosis (BV)? Has your doc ruled that out with a lab test?

BV is treated with either clindamicyn or metronidazole (both antibiotics). Just to clarify, yeast treatments are anti-fungals, not antibiotics.
posted by tristeza at 9:16 AM on August 4, 2011

Definitely investigate the possibility that your boyfriend is passing the infection back to you. Guys generally don't show any symptoms.

Also, if you use wipes of any kind, stop. I started using those Cottonelle wipes after using the bathroom, and started to feel itchy and like I had an infection. It was only after I ran out of wipes and things got better within in a couple days that I realized the wipes must have been disrupting the natural balance of things.
posted by catatethebird at 9:22 AM on August 4, 2011

this is the fiance with "angry vagina"

thank you all for your thoughtful replies. i have gathered a lot of great ideas that seem to resonate with what might be appropriate for me including the following and more: reviewing diet/soaps/med changes, keeping clean and dry, no undies or 100% cotton, taking pro-biotic, garlic or boric acid, checking boyfriend out (though sex has pretty much been a non issue), sterilizing panties and "trying not to throw too many things in there to see if things calm down."

i will continue to check this for a few days if anyone desires to add to the conversation. much appreciated and cheers to happy lady parts all around!
posted by palacewalls at 9:25 AM on August 4, 2011

also, thank you for putting me at easy that, most likely, nothing else is going on. it will probably just take a bit more time to balance out...
posted by palacewalls at 9:27 AM on August 4, 2011

Another thing to avoid irritation: make sure your boyfriend (fiance) hasn't been eating things you're allergic to. I had an ex who tried some bee pollen as a health thing and it was *not good* for my lady parts.
posted by kitcat at 7:41 PM on August 4, 2011