Patient's question:
I was diagnosed with candidal vulvitis in May 2006. The doctor concluded that it was caused by improper use of anti-inflammatory medication because I was a virgin. The doctor prescribed Jieryin and Antifungal Cream for external use, which I applied for about two months. The itching subsided, and I cleaned my vulva with plain water daily. Occasionally, when I felt a slight itch, I used Jieryin twice to relieve it. However, the skin in my vulva no longer felt smooth as before, resembling tiny bumps.At the end of July this year, the itching in my vulva became severe, and my discharge turned yellow and cottage cheese-like. I followed the doctor's instructions from last year and applied medication externally for about a month, during which the symptoms improved, and the discharge disappeared. Ten days after my period, I noticed a small amount of transparent discharge, but the tiny bumps on my skin remained. Over the past two months, I have been using medication to restore my skin to its original condition. Recently, however, I found that the bumps on my inner vulva have been controlled, while the bumps on my outer vulva have spread toward my anus. There is no itching, but I feel a burning sensation.
Because of this, I avoid traveling with friends and swimming pools. I recently accepted my boyfriend's proposal, but this condition makes me feel guilty, even though it wasn't caused by any reckless behavior. I feel ashamed and dare not visit my boyfriend's home. What should I do! It has severely affected my life. I am still a virgin and refuse to use internal medication, unsure if external medication alone can eliminate the pathogen and prevent recurrence, allowing my skin to return to its healthy state. I am exhausted and desperately ask the doctor for help to relieve me from this embarrassing problem.
Doctor's answer:
Treatment for candidal vulvitis can be achieved through either purely Western medicine or a combination of Chinese and Western medicine.(1) General treatment: Actively treat other diseases that can cause candidal vaginitis, eliminate predisposing factors. Maintain vulvar cleanliness and dryness, avoid scratching. Abstain from sexual activity during treatment. Avoid spicy and irritating foods.
(2) Changing vaginal pH: The optimal pH for Candida growth is 5.5. Therefore, using alkaline solutions to rinse the vulva and vagina can alter the vaginal pH, inhibiting the growth and reproduction of Candida. A 2%–4% baking soda solution can be used to rinse the vagina once or twice daily, with 2 weeks constituting one course. After rinsing, dry the vulva to maintain dryness and inhibit Candida growth.
(3) Vaginal medication: Using imidazole suppositories for vaginal medication is highly effective for candidal vaginitis. Clotrimazole suppositories: 1 suppository per night, inserted into the vagina after rinsing, with 10–14 days constituting one course. Alternatively, Daktarin suppositories: 1 suppository per night, inserted into the vagina after rinsing, with 7 days constituting one course.
(4) Topical ointments: Applying clotrimazole ointment or Daktarin ointment externally can treat vulvitis caused by Candida infection and alleviate symptoms of vulvar itching and pain. Apply externally several times daily for 2 weeks. Eucerin ointment, which contains econazole as the active ingredient and a small amount of topical steroid, provides excellent anti-itch effects and is particularly suitable for those with severe vulvar itching and pain due to candidal vulvitis or vaginitis. Apply externally twice daily.
(5) Oral medication: Since Candida infection can be transmitted between partners through sexual activity, oral medication can be used to treat both individuals. Oral medication can also inhibit intestinal Candida. Fluconazole oral: 150 mg once daily. Alternatively, Sporanox oral: For primary Candida vaginitis, take 200 mg once daily after breakfast and dinner for 1 day. For recurrent candidal vaginitis, increase the dose of Sporanox. Take 200 mg once daily for 3 days, or 100 mg twice daily for 3 days. All medications should be taken after meals.
(6) Herbal treatment: Boiling herbs with (clearing heat and detoxifying) and (insecticidal and anti-itch properties) effects, then using the decoction to rinse the vulva, can alleviate symptoms and inhibit or eliminate Candida. Due to the significant reduction in vulvar itching and burning after rinsing, this method is more suitable for women with acute candidal vaginitis, reducing their discomfort. Additionally, herbs can be prepared as powders or suppositories for vaginal medication.
Guidance:
Dietary precautions:
(1) Avoid spicy foods. Excessive consumption of spicy foods can generate dry heat, leading to internal heat and toxicity, worsening symptoms such as vulvar itching and pain.
(2) Avoid seafood and other allergenic foods. Fish, shrimp, and crabs can exacerbate damp-heat, intensify vulvar itching, and hinder inflammation resolution, so they should be avoided.
(3) Avoid greasy and sweet foods. Fatty foods like lard, butter, and cream, as well as high-sugar foods like chocolate and sweet pastries, can increase vaginal discharge and affect treatment efficacy.
(4) Avoid alcohol and smoking. Nicotine in tobacco weakens the binding of oxygen to arterial blood, while alcohol promotes damp-heat. Both should be avoided, as should alcoholic beverages like fermented rice wine and medicinal wines.
(5) Consume more foods rich in vitamin B, such as wheat, sorghum, lotus seeds, honey, tofu, chicken, chives, and milk. Also, eat more fruits and fresh vegetables.