Clive Anderson - AT THE DERMATOLOGISTTHIS QUERY from a reader introduces a subject that may interest some women. The question from C.P. 'Shopping for sanitary napkins, I've noticed a new type on the market which is very thin and comfortable but scented. Is it safe to wear as it relates to yeast infection?'
Yeasts or candida are found in the vagina of up to 20 - 25 per cent of all women, increasing to 40 per cent in pregnancy. It appears to be a normal part of the vaginal ecosystem, occupying a small niche in competition with other microorganisms.
Usually the yeast causes no symptoms, but any changes in environmental conditions may result in the yeasts becoming pathogenic and causing itching, redness and a curd-like discharge. These changes may be increased warmth or moisture, pregnancy or a reduction in the numbers of the other microorganisms caused by taking a course of a broad-spectrum antibiotic.
Not all that itches is yeast however. In a recent study of 1,000 women, chronic itching and burning were associated with fungal infections in only four per cent of cases. In another study of 111 women who were surveyed regarding their symptoms during an office visit, 43 insisted they had a yeast infection but only one-third actually did, 45 said they were sure they did not have yeast and one-half of them actually did.
In a number of women the symptoms of a Candidal or yeast infection return even after adequate treatment. Furthermore, there are no obvious predisposing factors such as antibiotic or steroid therapy, pregnancy or diabetes. In some of these ladies it may well be that a local allergic or irritant reaction may be the trigger for Candida infection.
Distinguishing between an irritant and an allergic reaction on the genitals is often difficult. The irritant substance will cause a reaction that occurs soon after contact whereas the allergic reaction takes some time to develop. Common vulval irritants include body fluids such as sweat, vaginal secretions, urine and in some cases semen.
Products used to cleanse such as perfumed soaps and gels, bath oils, bubble baths, douches, deodorants, perfumes, hair-removal products and sanitary pads and toilet paper may also be the irritating factors. Medicaments like disinfectants, antifungal creams, topical antibacterial agents and preservatives in creams may result in an irritant or an allergic dermatitis. The lubricants in some condoms may cause an allergic or an irritant reaction and some ladies are allergic to latex condoms.
So, to answer the question posed by the reader. Yes, it is possible that perfumed sanitary napkins could be the cause of an irritation to the genitals and are best avoided in persons with a history of itching and discharge. The napkin may however be the cause of an irritant or an allergic condition rather than cause a yeast infection.
As we have noted above, it is often difficult to determine whether the cause of the itching and discharge is a yeast infection or an irritant or allergic dermatitis. Persons who suffer from chronic vaginal irritation should see their health-care provider. A careful history along with microscopic evaluation of the discharge will often provide the answer as to the cause of the irritation.
Avoid all products to the genitals, including soap, and especially those with perfume. Cetaphil cleanser or Neutrogena extra-gentle skin cleanser may be used. Dry the area well - use a blow drier on low heat or blow only. Your health-care provider may sometimes prescribe a
low-potency steroid to treat
the irritation.
Dr. Clive Anderson is a Dermatologist and Venereologist.
