Vulvovaginal candidiasis (Vaginal yeast infection)

Vulvovaginal candidiasis is an infection of the vagina caused by a yeast-like fungus (usually Candida albicans). It is one of the commonest causes of vaginitis (inflammation of the vagina). An estimated 75 percent of all women will develop a yeast infection during their lifetime. Vaginal candidiasis infections are very common in pregnancy due to the increased levels of circulating oestrogen in the bloodstream.

CAUSES

The fungus Candida lives in small numbers in a healthy vagina, rectum and mouth without causing problems. When the vagina’s hormone and pH balance is disturbed, the organisms multiply and cause infections.

SYMPTOMS AND SIGNS

  • White, “curdy” vaginal discharge, (resembles lumps of cottage cheese). The odor may be unpleasant, but usually not foul-smelling.
  • Swollen, red, tender, itching vaginal lips (labia) and surrounding skin.
  • Burning sensation on urination.
  • Change in vaginal and skin color from pale pink to red (sign of inflammation).
  • Pain during sexual intercourse (dyspareunia).

RISK FACTORS

  • Pregnancy.
  • Combined oral contraceptive pills user.
  • Diabetes mellitus.
  • Frequent or prolonged antibiotic treatment.
  • Reduced immunity from drugs or disease.

POSSIBLE COMPLICATIONS

Without treatment, symptoms may persist and can be extremely uncomfortable. Other infections may co-exist, especially bacterial. About 5 percent of women with vulvovaginal candidiasis may develop recurrent vulvovaginal candidiasis (RVVC), which is defined as four or more episodes of vulvovaginal candidiasis in the previous year. Recurrent or persistent infection is usually due to the non-albicans species. During pregnancy, vaginal candidiasis has no impact on the pregnancy outcome or the fetus.

INVESTIGATION

Diagnostic tests may include laboratory studies of vaginal discharge, cervical cytology smear (Thin Prep) and pelvic examination.

DIAGNOSIS

Diagnosis is often made clinically, from the presenting complaints and the typical appearance of the discharge seen during speculum (internal) examination of the vagina. The smear of the discharge for laboratory identification is sent if the diagnosis is uncertain or if the symptoms persist despite the completion of therapy. The identification of the candida is sometimes seen in the Thin Prep or Pap smear report.

TREATMENT

  • Drug therapy with antifungal drugs, either in vaginal creams or suppositories or in oral form, is usually recommended. During pregnancy, vaginal cream or tablet suppositories are preferred.
  • If vaginal creams or suppositories are prescribed, use a panty liner during the treatment period to avoid the discharge from staining the undergarment.
  • It is best not to do self-treatment for the disorder until the specific cause of your vaginal infection is determined. Studies have shown that as many as two-thirds of all non-prescription drugs sold to treat vulvovaginal candidiasis were used by women without the disease.
  • Do not douche unless prescribed for you.
  • For severe infections, repeated doses may be given, or the duration of treatment may be longer.
  • Recurrent vulvovaginal candidiasis treatment usually involves one to two weeks of intensive anti-fungal medication, followed by up to six months of a lower “maintenance” dose.
  • There is no evidence to show that treatment of sexual partner will reduce the recurrence of the infection. Therefore, routine treatment of male partner is not required unless the partner has symptoms attributed to candida infection.
  • It is advisable to avoid sexual intercourse until symptoms cease.

PREVENTIVE MEASURES (for those with recurrent infections)

  • Keep the genital area clean. Use an unscented, dermatologically approved, soap-free skin cleanser. Use it once or twice a day during shower. Do not wash too frequently with normal bath soaps or shower foams.
  • Consider other family planning methods if you have recurrent candida infection and currently on the combined oral contraceptive pills.
  • Take showers rather than tub baths.
  • Wear cotton underpants or pantyhose with a cotton crotch. Do not wear underwear at night.
  • Do not sit around in wet clothing, especially a wet bathing suit.
  • Limit your intake of sweets and alcohol.
  • After urination or bowel movements, cleanse by wiping or washing from front to back only in one direction (vagina to anus).
  • Lose weight if you are overweight.
  • If you have diabetes, ensure good sugar control.
  • Avoid unnecessary use of antibiotics unless prescribed by the doctor.
  • There are many feminine hygiene products in the market, many of which can irritate the vulva and vagina: such as special sanitary pads, feminine spray, douches and deodorants, scented oils, bubble baths, bath oils, talcum powder etc. These should be avoided.
  • There is no strong evidence to support the routine advice of eating yogurt or a low sugar diet in those with recurrent or persistent yeast infection. However, some women may find it beneficial and there is no harm in trying it out if you are keen. It is a healthy practice anyway. The benefits of taking probiotics in recurrent or persistent yeast infection is also uncertain but there is probably no harm if you are keen to start on it.

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Benign ovarian cysts

The ovaries are the female reproductive organs that contain eggs and will release them on a regular basis (usually monthly in the majority of the women). It also produces female and male hormones. An ovarian cyst is abnor¬mal growth in the ovary and can be either solid or cystic. It can be divided into either a benign (non-cancerous) or malignant (cancerous) type. Benign or non-cancerous cysts do not invade neighboring tissue the way malignant cyst does. The exceptionally large ovarian cyst often turns out to be benign.

The term ovarian cyst refers to abnormal growth in the ovary that contains mainly fluid, although occasionally some solid component may be present as well.

Symptoms and signs

Read moreBenign ovarian cysts

Hysterosalpingogram (HSG)

Hysterosalpingogram (HSG) is an x-ray examination that is used to evaluate the uterine cavity and to check for patency of the fallopian tubes (whether the tubes are blocked).

INDICATIONS (REASONS FOR PROCEDURE)

  • Infertility (difficulty in conceiving).
  • Confirm tubal and uterine abnormalities.
  • Recurrent miscarriages.
  • Follow-up to some surgical procedures.

CONTRA-INDICATIONS TO THE PROCEDURE

  • Undiagnosed vaginal bleeding.
  • Pelvic inflammatory disease (PID).
  • Pregnancy.
  • Recent curettage or active genital tract infection.

Read moreHysterosalpingogram (HSG)

Polycystic Ovary Syndrome (PCOS)

Polycystic ovary syndrome (PCOS) refers to a spectrum of clinical problems due to hormonal and metabolic imbalance, which can affect the reproductive and endocrine systems.

 

 

How Common?

PCOS affects 5-10% of all women of childbearing age regardless of race or nationality. It may begin during puberty and become more severe with time.

Read morePolycystic Ovary Syndrome (PCOS)

Hysteroscopy (diagnostic and operative)

The hysteroscope is a small lighted telescope used for visual examination of the cervix and the uterus to help diagnose and treat abnormalities in the cervical canal or the uterine cavity. If it is used to look for the cause of the presenting problem, it is term as diagnostic hysteroscopy. If it involves some form of surgical procedures such as removal of growths (endometrial polyps or fibroids), removal of the lining or separation of adhesions, then it is called operative hysteroscopy. In many cases, both procedures are done concurrently – the so-called “see and treat” approach.

Reasons for the procedure

  • Evaluation and treatment of abnormal uterine bleeding.
  • To look for the displaced and removal of the intrauterine device (IUD).
  • Evaluation for infertility (difficulty in conceiving) or recurrent miscarriage.
  • Uterine polyps, fibroids or adhesions (which is called Ashermann’s syndrome).
  • Obstructed fallopian tubes.
  • Congenital malformations of the uterus

Read moreHysteroscopy (diagnostic and operative)

Anaesthesia and Analgesia in Obstetrics and Gynaecology

Dr. William Morton demonstrated the first public administration of ether anaesthesia in the operating theatre of the Massachusetts General Hospital on the 16th October 1846
That day is remembered as a milestone in anaesthesia and celebrated as World Anaesthesia Day.
From that date onward, many progresses have been made in the field of anaesthesia, and more so specifically for the practice of obstetrics and gynaecology.

On the 16th August 1897, a German surgeon by the name of Dr. August Bier administered the first spinal anaesthetic. Spinal anaesthesia becomes one of the most popular methods of administering a patient pain free from surgery of the lower limbs, lower abdomen and Caesarean sections and is still widely used.

Read moreAnaesthesia and Analgesia in Obstetrics and Gynaecology

Combined oral contraceptives (COC) pills

The reason for practicing contraception (or birth control) is to prevent an unplanned pregnancy. Most methods of contraception enable sexually active couples to temporarily avoid pregnancy. Permanent birth control is accomplished through sterilization. There are many types of birth control methods that are currently available. There is no perfect method at the moment. Each has its own advantages and disadvantages. Be sure you know and understand the different types of birth control available to you, the risks and benefits of each, and any side effects, so that you can make an informed choice.

Read moreCombined oral contraceptives (COC) pills

Cervical Intraepithelial Neoplasia (CIN)

Cervical intraepithelial neoplasia (or CIN) refers to the presence of abnormal cells seen on the cervical cytology smear. These abnormal cells are obtained from the lining of the outer cervix and can range from mild to severe changes. A diagnosis of CIN changes is not cancer. However, the severe form of dysplasia can be considered a precancerous condition and may eventually progress to cancer in several years if not treated.

The cervical cytology smear was previously referred to as Pap smear. Currently, the newer cervical cancer screening uses a liquid based cytology and the commonest one used are: Thin Prep or Sure-Path. These are better and more accurate compared to the conventional Pap smear test.

Classification of CIN 

Read moreCervical Intraepithelial Neoplasia (CIN)