Patient's question:
I have a fungal vaginal infection. During treatment, I still have sexual intercourse with my husband. Is there any adverse effect on the treatment? Medical history: First episode of fungal vaginal infectionDoctor's answer:
Hello, it is best to avoid sexual activity during treatment and before recovery. During the treatment of candidal vulvovaginitis, sexual activity can easily transmit the disease to the partner, which is not conducive to the recovery of the patient's own disease and the health of the partner.How to prevent candidal vulvovaginitis
The normal human body is a carrier of Candida. As a symbiotic bacterium in the human body, Candida can only cause disease under certain conditions. Therefore, as long as the conditions that may cause candidal vulvovaginitis are eliminated, the prevention goal can be achieved.
(1) Exercise regularly, maintain a balanced diet, and avoid excessive consumption of high-sugar foods.
(2) Develop good hygiene habits: Wash your hands before using the toilet; do not use unclean toilet paper; wipe the external genitalia from front to back after defecation; clean the external genitalia daily, change and wash underwear, and dry them in a ventilated place; use your own basins and towels; wash underwear and socks separately.
(3) Dress reasonably: Do not wear synthetic underwear, and do not borrow others' underwear, pants, or swimsuits.
(4) When using public restrooms, avoid sitting toilets as much as possible; advocate showering instead of tub baths; do not sit on bathroom chairs immediately after bathing; do not swim in poorly disinfected swimming pools.
(5) Do not overemphasize hygiene: Some patients claim to pay great attention to hygiene during their visit, washing the external genitalia 2–3 times a day, using a or hands to clean the vagina each time. In fact, this practice is incorrect. The vaginal environment is weakly acidic and contains many microbial communities that mutually restrain each other, inhibiting the excessive growth of certain bacteria and causing disease. This is the body's natural defense system. Washing the vagina will undoubtedly disrupt the weakly acidic environment and the mutual restraint between microbial communities, reducing the resistance of the vaginal epithelium to disease and causing candidal or other bacterial vaginitis.
(6) Do not overuse antibiotics: Long-term and excessive use of antibiotics can disrupt the mutual restraint between vaginal bacteria, allowing Candida to grow excessively and cause disease.
(7) Actively treat diabetes: Diabetic patients can use baking soda to clean the external genitalia, increasing the vaginal pH value and inhibiting the growth of Candida.
(8) Women using oral contraceptives who repeatedly suffer from candidal vulvovaginitis should stop taking the contraceptives and switch to other methods of contraception.
Why does candidal vulvovaginitis not heal despite treatment
Candidal vulvovaginitis is a vaginal infection caused by the fungus Candida albicans. It has a high incidence rate and is prone to recurrence, making it a common gynecological disease. Candida thrives in acidic environments and often inhabits the vagina, mouth, and intestines, causing mutual infection. The risk factors for candidal vulvovaginitis include:
1. Transmission through sexual intercourse.
2. Recent use of broad-spectrum antibiotics, leading to vaginal microbial imbalance and favoring Candida growth.
3. Use of corticosteroids, immunosuppressants, or patients with autoimmune diseases are prone to Candida infections.
4. During pregnancy, the vaginal carriage rate and infection rate of Candida increase significantly.
5. Diabetes.
6. Oral contraceptives.
7. Wearing tight nylon pants, etc.
The clinical manifestations of candidal vulvovaginitis are primarily itching of the external genitalia and changes in the amount and characteristics of vaginal discharge. Diagnosis relies on medical history, physical examination, and laboratory tests, and should be differentiated from trichomoniasis, non-specific vaginitis, and mycoplasma and chlamydia infections.
Treatment commonly uses Jieshu liquid, 2% sodium bicarbonate to clean the external genitalia and vagina, and local antifungal medications such as Daxin and Daqin. In recent years, incomplete treatment or deep tissue infections of the vagina have led to recurrence. For recurrent vaginitis, oral medication is effective for prevention. Common antifungal medications include fluconazole and Spironolactone, taken every 2–4 weeks for 3–6 months, which can completely control symptoms. Monthly premenstrual follow-ups are recommended, and three consecutive negative results indicate cure. Sexual activity should be avoided during treatment, and both partners should be treated simultaneously.
If candidal vulvovaginitis recurs, how should it be treated
To treat recurrent candidal vulvovaginitis, the underlying causes of recurrent Candida infection in the vagina must be eliminated, the treatment period should be extended, and multiple treatment methods should be used simultaneously. Local treatment can involve using traditional Chinese herbal medicine to steam and bathe the external genitalia, followed by applying medication to the vagina and topical antifungal creams. Local treatment can be performed throughout the menstrual cycle, with medication discontinued during menstruation but continuing after the period. Oral Spironolactone, 200 mg once daily after meals, for 3 days. This treatment should be maintained for 1–2 months.
The reasons for recurrent candidal vulvovaginitis
The reasons for recurrent candidal vulvovaginitis may include:
1. Inadequate medication adherence after diagnosis, leading to incomplete treatment, which is a major cause of recurrence. After treatment, patients should undergo gynecological examinations and vaginal discharge tests every month after their periods for three consecutive times. If Candida infection is detected during this period, it is considered a recurrence or reinfection, requiring continued treatment.
2. Failure of both partners to receive simultaneous treatment: If a woman has candidal vulvovaginitis, sexual activity can transmit the pathogen to her partner, making him a carrier. About 10% of men may develop balanoposthitis. If only the woman is treated while the man is not, even if the woman is cured, she will be reinfected by her partner, leading to repeated transmission of Candida between the couple and recurrent candidal vulvovaginitis in women.
3. Failure to properly change and disinfect underwear and towels during treatment can also lead to reinfection.
4. The human body can naturally carry Candida, which can cause candidal vulvovaginitis when it infects the vagina. For example, poor hygiene habits, such as wiping the external genitalia from the anus to the urethra after defecation, may introduce intestinal Candida into the vagina, leading to recurrent candidal vulvovaginitis. Therefore, during treatment, oral medication should be used to eliminate intestinal Candida, and patients should improve their hygiene habits.
5. Frequent or long-term use of antibiotics can repeatedly disrupt the mutual restraint between vaginal microbial communities, allowing Candida to thrive. For such patients, antifungal medication should be given concurrently with or after antibiotic treatment to prevent recurrence.
6. Recurrent candidal vulvovaginitis in diabetic patients is due to increased vaginal acidity and long-term urinary sugar, which provide favorable conditions for Candida growth. Therefore, treating diabetes is key to reducing recurrence.
7. Poor hygiene, such as washing underwear and socks together, can rarely cause candidal vulvovaginitis through tinea pedis, but it is not impossible. If the bacteria causing tinea pedis are Candida albicans, this practice can lead to self-infection. Additionally, using unhygienic sanitary pads or toilet paper, or having the habit of tub baths, may also lead to recurrent candidal vulvovaginitis.
Is symptom disappearance a sign of cure
Currently, most medications used to treat fungal vulvovaginitis and vaginitis are imidazole drugs, which have excellent antifungal effects. Therefore, after oral and topical treatment, symptoms improve or disappear quickly, but this does not mean the candidal vulvovaginitis has been cured—it only temporarily suppresses Candida. Patients should never stop medication and should follow the doctor's advice to complete the treatment course ( during menstruation). After the period, they should undergo gynecological examinations and microscopic tests of vaginal discharge. If the results are negative, it indicates short-term cure. If further treatment is needed, it will be continued. Only if both gynecological examinations and microscopic tests of vaginal discharge are normal for three consecutive months can the disease be considered completely cured. Some patients do not follow medication rules, stopping treatment as soon as symptoms improve, only to see symptoms return shortly after. This cycle of stopping and starting treatment can lead to drug resistance in Candida, reducing medication efficacy and causing chronic candidal vulvovaginitis, which is difficult to treat and causes inconvenience and psychological stress. Therefore, to completely cure candidal vulvovaginitis, doctors should clearly explain medication methods and cure criteria, and patients should adhere to treatment and regular follow-ups without hesitation.
Can candidal vulvovaginitis be transmitted
Although 10%–20% of healthy women carry Candida in their vaginas, and certain life situations such as long-term antibiotic use or diabetes can trigger vaginal Candida infection, candidal vulvovaginitis can also be transmitted from the outside. When a woman has sexual contact with a man who has a positive Candida culture, her infection rate is 80%. About half of men with sexual contact with women who have candidal vulvovaginitis will also become infected. In other words, candidal vulvovaginitis can be transmitted through sexual activity, which is why both partners should be treated simultaneously when one is diagnosed with the condition. Additionally, indirect contact is another transmission route for candidal vulvovaginitis. Contact with contaminated public restrooms, bathtubs, shower seats, towels, or unclean toilet paper can cause transmission. When the number of Candida in the infected woman's external genitalia and vagina reaches a certain level, candidal vulvovaginitis may develop.
Treatment for candidal vulvovaginitis
Common medications for candidal vulvovaginitis include nystatin suppositories, one suppository (10,000 units) inserted deep into the vagina daily, with a 10-day course. Oral Nizoral tablets can also be taken for one week. After completing a course, patients should return to the hospital for a follow-up to determine if further treatment is needed. During treatment, maintain external genital hygiene, and ask the husband to clean the penis before sexual activity. Treatment can be administered using Western medicine alone or a combination of Western and traditional Chinese medicine.
(1) General treatment: Actively treat other diseases that may cause candidal vulvovaginitis and eliminate risk factors. Maintain clean and dry external genitalia, avoid scratching. Sexual activity should be avoided during treatment. Avoid spicy and irritating foods.
(2) Change vaginal pH: The optimal pH for Candida growth is 5.5. Using alkaline solutions to rinse the external genitalia and vagina can inhibit Candida growth and reproduction. A 2%–4% sodium bicarbonate solution can be used to rinse the vagina once or twice daily, with a 2-week course. After rinsing, dry the external genitalia to maintain dryness and inhibit Candida growth.
(3) Vaginal medication: Imidazole suppositories can be used for vaginal medication, which is effective for candidal vulvovaginitis. Clotrimazole suppositories, one suppository nightly after rinsing, for 10–14 days, or Daktarin suppositories, one suppository nightly after rinsing, for 7 days.
(4) Topical creams: Clotrimazole cream or Daktarin cream applied externally can treat external genital inflammation caused by Candida and relieve itching and pain. Apply several times daily for 2 weeks. Efuqing cream, containing econazole as the main ingredient and a small amount of topical steroid, has good anti-itch effects and is more suitable for patients with severe itching from candidal vulvovaginitis. Apply externally twice daily.
(5) Oral medication: Since Candida infection can be transmitted through sexual activity between partners, oral medication can be used to treat both partners and also inhibit intestinal Candida. Fluconazole oral: 150 mg once daily. Spironolactone oral: For first-time Candida vulvovaginitis, 200 mg once daily after breakfast and dinner for one day; for recurrent candidal vulvovaginitis, the dose of Spironolactone should be increased to 200 mg once daily for 3 days, or 100 mg twice daily for 3 days. All medications should be taken after meals.
(6) Traditional Chinese medicine treatment: Boil traditional Chinese herbal medicine with detoxifying, antiparasitic, and anti-itch properties, and use the decoction to steam and bathe the external genitalia. This can alleviate symptoms and inhibit or eliminate Candida. Due to the significant reduction in itching and burning symptoms after steaming and bathing, this method is more suitable for acute candidal vulvovaginitis and can reduce patient discomfort. Additionally, traditional Chinese herbal medicine can be made into powders or suppositories for vaginal medication.
Prescription ①:
- 30g White peony root
- 30g Coptis chinensis
- 30g Sophora flavescens
- 30g Cnidium monnieri
- 3g Benzoin
Pack the herbs in white cloth, decoct to obtain 2,000 ml of liquid, and steam the external genitalia while the liquid is hot. After the liquid cools slightly, sit in the bath for 20 minutes, once daily or twice daily. Before steaming, remove the herb pack and dry it for reuse once. A 7-day course is recommended. After bathing, insert one Clotrimazole or Daktarin suppository into the vagina and apply the above cream externally.
Prescription ② (from Selected Practical Formulas for Dermatological and Venereal Diseases):
- 12g Clove
- 30g Patchouli
- 15g Coptis chinensis
- 30g Rheum palmatum
- 20g Gentiana scabra
- 15g Ammonium sulfate
- 15g Mint
- 1g Benzoin
This formula has strong detoxifying, moisturizing, antiparasitic, and anti-itch effects, as well as potent inhibitory and killing effects on Candida albicans, other superficial skin fungi, and Neisseria gonorrhoeae.
Usage: decoct once daily and bathe the external genitalia 1–2 times, each for 30 minutes. It can also be made into an external wash solution and topical cream for use. Married women can also use the liquid to rinse the vagina once daily. A 12-day course is recommended.
Prescription ③ (from Latest Therapies for Sexually Transmitted Diseases):
- 30g Sophora flavescens
- 30g Cnidium monnieri
- 20g Gentiana scabra
- 15g Stemona japonica
- 15g Lindera aggregata
- 15g Coptis chinensis
- 15g Trichosanthes kirilowii
Add 2,000–3,000 ml of water, decoct for 30–40 minutes, remove the residue, and steam or bathe. Once nightly, for 20–30 minutes.
Prescription ④ (from Selected Practical Formulas for Dermatological and Venereal Diseases):
- 30g Sophora flavescens
- 30g Cnidium monnieri
- 30g Coptis chinensis
- 30g Coptis chinensis
- 10g Sichuan pepper
- 10g Ammonium sulfate
- 3g Benzoin
Grind into a fine powder and sterilize. Rinse the external genitalia and vagina with 3% sodium bicarbonate, then apply an appropriate amount of the powder to the vagina and external genitalia once or twice daily. A 5-day course is recommended.
After treatment with the above methods, clinical symptoms will improve quickly, but this does not guarantee that candidal vulvovaginitis has been cured. Patients should complete the treatment course and return to the hospital for symptom evaluation, gynecological examinations, and vaginal discharge tests. If all results are normal, it indicates short-term cure. Monthly follow-ups after menstruation are still required for the above tests for three consecutive months. If all results remain negative, it is considered complete cure.