Some women are plagued with what are thought to be chronic yeast infections (caused by the yeast, candida albicans).
But no matter how many different treatments they try, from topical and oral antifungals to home remedies, the vulvar itching and irritation does not go away.
Is it possible there is something else going on here?
Yes. A frequently misdiagnosed, little known, yet apparently quite common condition, called cytolytic vaginosis (CV), is often confused with a true yeast infection.
However, the two actually share almost nothing in common, except for symptoms. Like a yeast infection, cytolytic vaginosis is characterized by itching and burning, painful intercourse and a slight discharge. It also tends to become more symptomatic premenstrually.
Since the symptoms are so similar, physicians often mistake cytolytic vaginosis for a yeast infection.
The Tell-Tale Differences: What You Must Know
To distinguish CV from other conditions, the physician must rule out other possible causes of symptoms, such as vulvodynia, bacterial vaginosis (an infection of the vagina caused by the bacterium gardnerella) and trichomonas.
This can be done with a high-powered microscopic examination of vaginal secretions. And herein lies the biggest clue to differentiate between a yeast infection and CV:
Under a microscope, candida has a distinctive appearance abundant yeast-like fungal growth, and a low number of lactobacilli (the so-called "good bacteria").
CV, on the other hand, presents with an overabundance of lactobacilli, few yeast-like growths, and few white cells. It is thought that CV is an overgrowth of normal vaginal bacteria (lactobacilli).
The vagina has both lactobacilli and candida (as well as many other organisms) as part of its normal, healthy flora. It is all a matter of keeping the proper balance between these....which involves pH.
The overgrowth of organisms that occurs with CV causes the vaginal environment to become too acidic (low pH). This damages the epithelial cells of the vagina, and can cause itching, burning and irritation.
Candida overgrowth tends to occur in an alkaline environment (high pH). This, too, can result in pain, itching and burning.
Management of CV consists of stopping all antifungal treatments (oral and intravaginal), using pads instead of tampons so that menstrual blood can flow unimpeded and re-balance the pH of the vagina, and taking baking soda sitz baths.
It may also be a good idea to stop taking any probiotic supplements that you may be using, such as lactobacillus acidophilus.
Yogurt has also been found to exacerbate CV.
In other words, everything you have been told to do to treat a yeast infection is the wrong approach for CV!
The vaginal flora is a complex ecosystem that requires checks and balances. Many different things, from birth control pills and antibiotics, to diet, can have an effect on the environment of the vagina.
If you think you may have CV, please consult a physician knowledgeable about this condition (as well as about IC) before undertaking any new course of therapy.
Suggested Reading about CV
·
Hutti MH, Hoffman C. Cytolytic vaginosis: an overlooked cause of cyclic vaginal itching and burning. J Am Acad Nurse Pract 2000 Feb;12(2):55-7
·Secor RM. Cytolytic vaginosis: a common cause of cyclic vulvo-vaginitis. Nurse Pract Forum 1992 Sep;3(3):145-8
·Cibley LJ, Cibley LJ. Cytolytic vaginosis. Am J Obstet Gynecol 1991 Oct;165(4 Pt 2):1245-9.
·Cytolytic Vaginosis: A Vaginitis You May Not Have Heard About by Tori Hudson, ND (naturopathic medicine practitioner) (http://vitanica.com/cytolytic_vaginosis.htm)
