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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor
Category: OB GYN
Satisfied Customers: 50097
Experience:  MBBS, MS. Deal with women related all surgical problems including genito-urinary and breast surgery.
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I've been suffering from recurrent yeast infection for over

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Hi I've been suffering from recurrent yeast infection for over a year now and bv, Dr did prescribe me different course of antibiotics and antifungals which reduced my yeast infection issue but left me with non stopping white discharge that seems doesn't go away and I feel my vaginal canal is swallon most of the time and make deep penetration painful, it seems every doctor that I am going to can't detect the problem and my test results are negative for any std or yeast infection
I don't use anything that would trigger these issues idk what it is please help me

I am writing the answer for you and will get back to you in 5 minutes. If you get a phone call request, you may ignore it as that is an automated site trigger. Thank you.

Your doctor may consider Cytolytic vaginosis as the diagnosis.

So this may be a possibility which entirely cannot be ruled out. Also, a recurrent or resistant yeast infection too is a differential diagnosis in your case. Signs and symptoms of cytolytic vaginosis mimic vulvovaginal candidiasis, thus it is important to exclude vulvovaginal candidiasis by investigations.

Following diagnostic criteria have been suggested for cytolytic vaginosis:

The absence of Trichomonas, Gardnerella or Candida on the wet smear.

An increase in the number of Lactobacilli.

A paucity of white blood cells.

Evidence of cytolysis.

pH between 3.5-4.5.

As discussed, this is also likely to be a chronic yeast infection. Some women experience chronic recurrent vulvovaginitis, which often requires long-term or prophylactic oral azole therapy for control. So for that, the recommended regimen is fluconazole 150 mg every other day for 3 doses, followed by weekly fluconazole 150-200 mg for 6 months. This regimen abates the symptoms and prevents further recurrence in the majority of women.

Boric acid wash for the vagina can be used in resistant cases, as an alternative measure with the consultation of your physician. A specific culture; Nickerson or Sabouraud mediums should be performed in refractory or recurrent cases of vaginal candidiasis to confirm the infection. So you can talk to your doctor to get this culture before you start the treatment.

Women who do not improve with the above can use, clotrimazole 500 mg vaginal suppositories administered once per week for six months which is also effective.

Also, avoid (if you do) following;

1) panty liners,

2) pantyhose,

3) sexual lubricants

The other possibility to consider would be "desquamative vaginitis" (cytologic vaginitis) which is not due to infection. It is due to chemical hypersensitivity to the repeated vaginal medicines, which, after all, are chemicals. Following treatment would help you;

1) Get a refillable script for Acigel vaginal cream with an applicator. Begin with 1/2 applicator at bedtime every other night for two weeks.

2) Then increase to a full applicator every other night for two weeks.

3) Then, use one applicator every night for seven days before the next period.

4) You can help restore the normal bowel flora by eating live bacterial culture yogurt every day for a few weeks and take acidophilus tablets three times a day for one month.

5) You do not have to use the Acigel while menstruating. Do not use tampons until the end of the treatment.

6) Wear loose, all-cotton underwear as they absorb body moisture.

7) Wipe front to back when you urinate or have a bowel movement. Bowel bacteria can infect the vagina.

8) Do not shave the vulvar area as the pubic hair protects against chemicals making contact with the skin.

9) Avoid all chemicals in the Vulvovaginal area.
10) Avoid pantyhose and tight pants such as jeans which trap moisture near in the perineum
11) After exercise or any sweat-producing activity, bathing or swimming, make sure the perineum is air-dried., Moist surfaces that rub against each other break down and provide an area for yeast secondary growth,

12) Follow a low carbohydrate diet. Take steroids, antibiotics and oral contraceptives only if very necessary.

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Customer: replied 4 months ago.
Thank you so much for your help Dr.Arun, very helpful I never heard of desquamative vaginitis or cytolytic vagnosis! My guess was maybe all of those antifungal medications thrown off my PH, I will let my Dr know about these possible issues
Many thanks again

You are very welcome.

Wishing you a speedy resolution and all the very best in life.

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Stay blessed.

Dr. Arun Phophalia and other OB GYN Specialists are ready to help you
Customer: replied 4 months ago.
Dr do I still need to take probiotic capsules if I have Cytolytic Vagnosis? And what can I do for this issue can I use baking soda douching?
Many thanks

Just take a Probiotic capsule for a while and see the response. The ideal is to get a diagnosis before using a vaginal medication which may augment the problem.

Customer: replied 4 months ago.
I see thank you for your response Dr

Very welcome.