Patient's question:
After the drainage of a Bartholin's gland abscess, how effective is a potassium permanganate bath?Doctor's answer:
Specifically, what are the clinical manifestations and diagnosis of candidal vulvovaginitis? The most common symptoms of candidal vulvovaginitis are external genital itching and a significant increase in vaginal discharge. The itching may vary in intensity and occur intermittently. The itching caused by candidal vulvovaginitis is generally more pronounced than that caused by trichomoniasis. Severe itching may cause restlessness and sleep disturbances. Patients may also experience vaginal burning sensation, especially during urination. In more severe cases, frequent urination, dysuria, and pain during intercourse may occur.An increased amount of vaginal discharge is another major symptom of this condition. The discharge is usually viscous and may be white or yellow, or sometimes thin. A typical candidal vulvovaginitis discharge appears like cottage cheese or creamy clumps. During gynecological examination, the following may be observed: depending on the severity of the condition, the labia minora and vaginal mucosa may show varying degrees of congestion and edema of the labia minora. The vagina may contain a significant amount of viscous discharge or be covered with a white membrane. If the membrane is wiped away, the exposed mucosa may appear red, swollen, eroded, or have superficial ulcers.
If the symptoms are typical, diagnosis is not difficult, but laboratory tests are still required for confirmation. The common method is the wet mount test: place a drop of physiological saline or 10% potassium hydroxide solution on a microscope slide, add a small amount of discharge, and examine under a microscope. If pseudohyphae and blastospores are found, it indicates that the Candida is in a pathogenic state, confirming the diagnosis of candidal vulvovaginitis. If the symptoms are suspicious but pseudohyphae are not found on multiple microscopic examinations, bacterial culture should be performed.
How is candidal vulvovaginitis treated? Treatment can be administered using pure Western medicine or a combination of traditional Chinese and Western medicine.
(1) General treatment: Actively treat other conditions that may cause candidal vulvovaginitis and eliminate predisposing factors. Maintain cleanliness and dryness of the external genitalia, avoiding scratching. Abstain from sexual activity during treatment. Avoid spicy and irritating foods.
(2) Changing the vaginal pH: The optimal pH for Candida growth is 5.5. Using alkaline solutions to rinse the external genitalia and vagina can alter the vaginal pH and inhibit 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 external genitalia to maintain dryness and inhibit Candida growth.
(3) Vaginal medication: Using imidazole suppositories for vaginal medication is highly effective for candidal vulvovaginitis. Clotrimazole suppositories: one suppository nightly, inserted into the vagina after rinsing, for 10–14 days. Terconazole suppositories: one suppository nightly, inserted after rinsing, for 7 days.
(4) External ointments: Applying clotrimazole ointment or terconazole ointment externally can treat external genital inflammation caused by Candida and alleviate 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 good anti-itch effects and is particularly suitable for those with severe itching from candidal vulvovaginitis. 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 partners. Oral medication can also inhibit intestinal Candida. Fluconazole oral: 150 mg once daily. Sporanox oral: For first-time candidal vulvovaginitis infection, take 200 mg once in the morning and evening for 1 day. For recurrent candidal vulvovaginitis, increase the dose to 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 external genitalia, can alleviate symptoms and inhibit or eliminate Candida. Due to the significant reduction in itching and burning after rinsing, this method is more suitable for women with acute candidal vulvovaginitis and can reduce patient discomfort. Additionally, herbs can be made into powders or suppositories for vaginal medication.
Prescription ①:
- 30g of bai xian pi (root of white peony)
- 30g of huang bo (cinnamon bark)
- 30g of ku shen (root of barberry)
- 30g of she chong zi (fruit of common pepper)
- 3g of bing pian (mastic)
Wrap the herbs in white cloth, decoct to obtain 2000 ml of liquid, and use the warm decoction to steam the external genitalia. After the liquid cools slightly, sit in the bath for 20 minutes, once or twice daily. Before steaming, remove the herb bundle and let it dry for reuse. One course consists of 7 days. After bathing, insert one clotrimazole or terconazole suppository into the vagina and apply the ointment externally.
Prescription ② (from Selected Practical Formulas for Dermatological and Venereal Diseases):
- 12g of ding xiang (clove)
- 30g of xiao xiang (patchouli)
- 15g of huang lian (coptis rhizome)
- 30g of da huang (rhubarb)
- 20g of long dan cao (gentian root)
- 15g of ku fa (tartar)
- 15g of bo he (mint)
- 1g of bing pian (mastic)
This formula clears heat, dries dampness, and kills insects to relieve itching. It has strong inhibitory effects on Candida albicans, other superficial skin fungi, and Neisseria gonorrhoeae.
Usage: decoct 1 dose daily, rinse and soak the external genitalia 1–2 times, each time for 30 minutes. It can also be made into an external rinse solution or ointment for external use. Married women can also rinse the vagina daily with the liquid. One course consists of 12 days.
Prescription ③ (from Latest Therapies for Venereal Diseases):
- 30g of ku shen (root of barberry)
- 30g of she chong zi (fruit of common pepper)
- 20g of long dan cao (gentian root)
- 15g of sheng bai bu (root of Chinese bugleweed)
- 15g of tu jin pi (bark of turmeric)
- 15g of huang bo (cinnamon bark)
- 15g of di fu zi (fruit of plantain)
Add 2000–3000 ml of water, decoct for 30–40 minutes, strain, and use for steaming and bathing. Use once nightly for 20–30 minutes.
Prescription ④ (from Selected Practical Formulas for Dermatological and Venereal Diseases):
- 30g of ku shen (root of barberry)
- 30g of she chong zi (fruit of common pepper)
- 30g of huang lian (coptis rhizome)
- 30g of huang bo (cinnamon bark)
- 10g of chuan jiao (sichuan pepper)
- 10g of ku fa (tartar)
- 3g of bing pian (mastic)
Grind into a fine powder, sterilize, and store. Before use, rinse the external genitalia and vagina with 3% soda water, then apply an appropriate amount of the powder to the vagina and external genitalia, once or twice daily. One course consists of 5 applications.
After treatment with the above methods, clinical symptoms will improve quickly. However, this does not guarantee that candidal vulvovaginitis has been cured. Patients must complete the full course of treatment and return to the hospital for symptom review, gynecological examination, and vaginal discharge testing. If all tests are normal, it indicates recent recovery. Monthly postmenstrual follow-up examinations should be conducted for 3 months. If all tests remain negative, the condition is fully cured.