VAGINITIS, MONILIAL

General Information

DEFINITION--Infection or inflammation of the vagina caused by a yeast-like fungus (Monilia or Candida albicans). Monilial vaginitis causes at least 50% of infections in the vagina.

BODY PARTS INVOLVED--Vagina and adjacent skin.

SEX OR AGE MOST AFFECTED--Females of all ages, especially after puberty.

SIGNS & SYMPTOMS--

Severity of the following symptoms varies between women and from time to time in the same woman:

• White, "curdy" vaginal discharge (resembles lumps of cottage cheese). The odor may be unpleasant, but not foul.
• Swollen, red, tender, itching vaginal lips (labia) and surrounding skin; burning on urination; change in vaginal color from pale pink to red.

CAUSES--

Monilia (or Candida) live in small numbers in a healthy vagina, rectum and mouth. When the vagina's hormone and pH balance is disturbed, the organisms multiply and cause infections. Monilial vaginitis tends to appear before menstrual periods and improves as soon as the period begins. Factors that may disturb the vagina's balance include:

• Pregnancy; diabetes mellitus; antibiotic treatment; oral contraceptives.
• High carbohydrate intake, especially sugars and alcohol.
• Hot weather or non-ventilating clothing, which increase moisture, warmth and darkness, fostering fungal growth.
• Immunosuppression from drugs or disease.

RISK INCREASES WITH--Factors listed under Causes.

HOW TO PREVENT

• Keep the genital area clean. Use unscented soap. Take showers rather than tub baths.
• Wear cotton underpants or pantyhose with a cotton crotch.
• Don't sit around in wet clothing, especially a wet bathing suit.
• Avoid douches, vaginal deodorants and bubble baths.
• Limit your intake of sweets and alcohol.
• After urination or bowel movements, cleanse by wiping or washing from front to back (vagina to anus).
• If you have diabetes, adhere to your treatment program; lose weight if you are obese.
• Avoid broad-spectrum antibiotics unless necessary. If they are necessary, eat yogurt with live cultures to help prevent a yeast infection.

What To Expect

DIAGNOSTIC MEASURES--

• Medical history and physical exam (including pelvic exam) by a doctor.
• Laboratory studies, such as a Pap smear (See Glossary), and culture and microscopic exam of the vaginal discharge.

APPROPRIATE HEALTH CARE

• Self-care after diagnosis.
• Doctor's treatment.
• Drug therapy will be directed to the specific organism. Your sexual partner may need treatment also. It is best not to do self-treatment for the disorder until the cause is determined.

POSSIBLE COMPLICATIONS--Secondary bacterial infections of the vagina and other pelvic organs.

PROBABLE OUTCOME--Usually curable with 2 weeks of treatment. Recurrence is common.

How To Treat

GENERAL MEASURES--

• Don't douche unless prescribed for you.
• If urinating causes burning, urinate through a tubular device, such as a toilet-paper roll or plastic cup with the end cut out, or pour a cup of warm water over genital area while you urinate.

MEDICATION--Your doctor may prescribe antifungal drugs, either in oral form or in vaginal creams or suppositories (usually). Keep creams or suppositories in the refrigerator. After treatment, you may keep a refill of the medication so you can begin treatment quickly if the infection recurs. Follow the directions carefully. Non-prescription treatments (Gyne-Lotrimin, Mycelex, etc.) are effective.

ACTIVITY--Avoid overexertion, heat and excessive sweating. Delay sexual relations until symptoms cease.

DIET--Increase consumption of yogurt, buttermilk or sour cream. Reduce alcohol and sugars.

Call Your Doctor If

• You have symptoms of monilial vaginitis.
• Despite treatment, symptoms worsen or persist longer than 1 week.
• Unusual vaginal bleeding or swelling develops.
• After treatment, symptoms recur.