Do you need doctor's care Gerri Kobren


May 14, 1991|By Gerri Kobren

The thing about vaginal yeast infections is that they itch.

And burn.

And make you so miserable you don't even want to put on your underwear.

"They're not life-threatening, but they certainly interfere with the activities of daily living," says gynecologist Gay Guzinski.

common infection in women, medically known as "monilia vaginalis," vaginal yeast has traditionally been treated with prescription medications that are inserted into the vagina.

In the past few months, two of those prescription medicines -- "Gyne-Lotrimin" and "Monistat 7" -- have become available without a prescription, selling for $15 to $19 depending on where you buy them.

Now you can diagnose and treat yourself for less than the cost of an office visit.

The question is: Should you?

"Most women who have had the infection know the signs," says Dr. Guzinski, chief of the section of benign gynecology at the University of Maryland Medical Center. "The thought behind making it an over-the-counter medication is that it doesn't have many side effects, it isn't toxic, and it's available for people who have irritating symptoms and might not reach the doctor for a couple of days."

"If a woman has had yeast in the past and knows the symptoms, and checks with the doctor first by phone, I'd say, 'Go ahead and get the stuff,' " says Dr. Theodore Baramki, head of the division of reproductive endocrinology at Greater Baltimore Medical Center.

However, he warns, a variety of other conditions can cause vaginal discharge and genital itch; a woman who's treating herself for monilia is wasting time and money if what she's got is an allergic reaction to laundry products, for instance, or an infection by a different kind of organism.

nTC Even when you've really got monilia, non-prescription medicine can be unnecessarily costly compared to buying it through your health insurance prescription plan: "There are still a couple of [anti-yeast medications] that are only released by prescription," says Dr. Allen Rubin, an obstetrician-gynecologist. "From a financial standpoint, I recommend that women call their doctor and get a phoned-in prescription. Most doctors will do it for you if the symptoms are correct."

The symptoms, as anyone who's had it can tell you, are pretty distinctive: "If the patient says, 'I'm itching, I'm going crazy, I'm climbing the walls,' that's monilia," Dr. Baramki says.

On examination, the patient will have a cottage cheese-like discharge and an inflamed vagina. The itch itself is most intense in the external genital region, which may also be inflamed and swollen. That's why Dr. Baramki recommends anti-monilia creams rather than suppositories; you can smear it around better.

That's also why women have sometimes sought relief by cutting the crotch out of their pantyhose: Sweating into nylon causes release of formaldehyde, which further irritates the already sore flesh, Dr. Guzinski explains. Besides, she adds, "Pantyhose keep a layer of water up against the skin, and these organisms like it wet."

For women in the throes of a yeast attack, tight jeans are also inadvisable, she adds: "The presence of any clothing on any part of the body that moves can break down the skin and allow secondary infection."

Awful as a yeast infection is, the organism causing it is a fairly benign fungus that usually co-exists quite peacefully with the other organisms inhabiting the body's warm, wet, dark places. Most often of the "candida albicans" type, it's also found in the gastro-intestinal tract and the mouth (where it's known as thrush.)

"When it's just there, it isn't an infection," Dr. Guzinski says. "When it's there in overwhelming numbers, to the exclusion of other things, then it's an infection."

That disproportion can occur for several reasons:

An antibiotic -- like penicillin, erythromicin, tetracycline, or any of the cephalosporins or sulfa drugs -- that might have been prescribed for an infection elsewhere in the body can also kill the bacteria that keep candida in check. "If a woman has discharge and itch after taking an antibiotic, it's almost a given that it's a yeast infection," Dr. Rubin says.

* Hormonal changes alter the vaginal environment and make it more hospitable to yeast: Women are susceptible to outbreaks during pregnancy and while taking birth control pills, the doctors say.

* Excess sugar in the body's tissues also encourages the growtof yeast. "It lives on carbohydrates," Dr. Guzinski says. "When someone has persistent or recurrent yeast infections, the question is, 'Do you have diabetes?' "

Although candida has been found in the male partners of infected women, it is not considered a sexually transmitted disease. "The organism is pretty ubiquitous," Dr. Guzinski points out. "But treating the consort [of a woman with recurrent monilia] does not decrease the rate of re-infection in the woman. This is not to say men don't have yeast; they have it, but they don't have a vagina, so they don't have that warm, dark, moist place where it can multiply."

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