When I first met Salome*, she was 39 and was adjusting to having lost her husband the previous year after nursing him through a horrific experience with stomach cancer, watching him waste away day after day and knowing that there was nothing she could do to stop it. When she laid him to rest, a large part of her went with him.
A year after her husband’s death, Salome went to see her gynaecologist. She had a progesterone contraceptive implant that had lasted five years and it was due for removal. When she got to his office, he had just left to attend to an emergency and Salome did not want to wait. She wandered around the doctors’ plaza and walked into our office.
She had the implant removed and did not take up any contraceptive method as she felt she did not need to, now that she was a widow.
The procedure took less than 10 minutes, but we chatted for an hour. Salome’s heart was still bleeding and she needed to talk about her pain. I did not see Salome again for many years. Therefore, it was quite a surprise when she walked into my new office, having traced me to my new premises, seven years later.
This visit was the absolute opposite of the last one. Salome was now 46 years old, full of life and bursting with the excitement of the news she could barely wait to share with me.
After six years of loneliness, she had finally met someone who made her heart flutter. It took a long while to accept him into her life as she worried about her sons’ opinion of her new relationship, but now young men, they were ecstatic to see their mother smile and encouraged her to grab the opportunity to love again.
She had been intimate with her new partner for six months, and was using contraceptive pills. However, they were causing her adverse effects. Every time she was on her menses, she developed vaginal candidiasis, which made her vulva itchy. She also had thick white vaginal discharge. However, she never sought medical attention until that day when she came to see me.
When I examined Salome, it was obvious that the vaginal candidiasis she was suffering from was a chronic problem. The repeated irritation, soreness and itching had left the skin on her vulva thickened, peeling and completely discoloured, from brown to pink. It was sad that she had suffered so much from a problem that had an easy solution.
A swab test to ascertain the diagnosis was done and Salome was put on treatment. Within a week, she was fully relieved of the discomfort. The skin discolouration would take a bit more time to resolve, but she was on the path to full recovery.
She would take a monthly prophylactic medication to prevent relapses for the next six months. She got non-hormonal contraceptive option that suited her better and allowed her to experience a wholesome life.
Vulvo-vaginal candidiasis, commonly known as yeast infection, is the commonest cause of vulval irritation. This is not an acquired infection. The yeast is naturally found in the vaginal canal, where it co-exists peacefully with a number of bacteria. Any external or internal factor that messes up this balance will result in an overgrowth of yeast, leading to the uncomfortable symptoms.
The bacteria-yeast balance is highly dependent on the body’s oestrogen hormone balance. The yeast thrives when oestrogen level is low, which is the period around the menses. This explains why the symptoms are at their worst in the period around the menses.
Different women respond differently to hormones. For this reason, some will develop yeast while using hormonal contraceptives while for others, these hormones actually minimise the symptoms. Others will suffer candidiasis throughout pregnancy while for others, pregnancy may provide respite.
A good number of women will get yeast following a course of antibiotics which kill all bacteria, including the good ones that are protective. For others, conditions that create a warm, moist environment in the vulval area, such as tight clothing, poor choice of fabric for underwear, obesity or poor menstrual hygiene, could foster the growth of yeast.
For some women, repeated candidiasis may be the trigger that leads to eventual diagnosis of more complex health problems such as diabetes, HIV and other immunosuppressive illnesses. Allergy to sanitary towels is also a cause of vulval irritation, more commonly in women who are more likely to have multiple allergies.
Long-standing vulval irritation must be taken seriously and proper medical assistance sought. It is important to establish the correct diagnosis and treat it appropriately.