THE STRUGGLE WITH CANDIDIASIS

The past few days have seen social media run amok with the hashtag #MyAlwaysExperience. The sanitary towel brand has been hit hard with many consumers telling of their negative experiences with the product. The general feeling was that the product sold in the Kenyan market was substandard and that our watchdog, the Kenya Bureau of Standards (KEBS) had failed in its mandate.

But away from the controversy, one of the messages that came through for us as reproductive health specialists is that a large number of women are silently suffering with issues that involve the vulval region.

Salome* is a 46-year old lady whom I had last seen about seven years ago. When I first met her, she was not in a good space. She was 39 and had lost her husband the year before, to stomach cancer. It was a trying moment for her as she was adjusting to having lost her best friend in such a harrowing ordeal. She had nursed her husband through a horrific experience, watching him waste away day after day and there is nothing she could do to stop it. When she laid him to rest, a large part of her went with him.

A year later, Salome left home to see her gynaecologist. She had a progesterone contraceptive implant that had lasted five years and it was due for removal. When she got to his office, he had just left to attend to an emergency. Salome did not want to wait. She wandered around the doctors’ plaza and walked into our office. She had the implant removed and did not take up any contraceptive method as she felt she did not need to, having lost her husband.

The procedure took less than ten minutes but we chatted for an hour. Salome’s heart was still bleeding and she needed to talk about her pain. I did not see Salome again for many years. Therefore it was quite a surprise when she walked into my new office, having traced me to my new premises.

This visit was the absolute opposite of the last one. Salome was full of life and she could not wait to tell me the good news. After six years of loneliness, she had finally met someone who made her heart flutter. It took a long while to accept him into her life as she worried about her sons’ opinion of her new relationship. The now young men were ecstatic to see their mother smile, they encouraged her to grab the opportunity to live again.

At 46, Salome needed contraceptive advice. In the last six months that she had been intimate with her new partner, she had chosen to use the contraceptive pills. This was an easy option for her as she did not need a doctor’s expertise to insert a device in her body. What she had not bargained for, was the adverse effects the pills would cause her.

Though she maintained regular menses, she noted that every time she had her menses, she developed vaginal candidiasis, which caused her to itch severely in the vulval region with thick whitish vaginal discharge. What was surprising was that she had never sought medical help for it for months.

When I examined Salome, it was obvious that the vaginal candidiasis she was suffering from was a chronic problem. The repeated irritation, soreness and itching had left the skin on her vulval region thickened, peeling and completely discoloured, from brown to pink. It was sad that she had suffered so much from a problem that had such an easy solution.

A swab test to ascertain the diagnosis was done and Salome was put on treatment. Within a week, she was fully relieved of the discomfort. The skin discolouration would take a bit more time to resolve but she was on the path to full recovery. She would take a monthly prophylactic medication to prevent relapses for the next six months. She was also able to get a non-hormonal contraceptive option that suited her better and allowed her to experience a wholesome life.

Vulvo-vaginal candidiasis, commonly known as yeast infection, is the commonest cause of vulval irritation. This is not an acquired infection. The yeast is naturally found in the vaginal canal, where it peacefully co-exists with a number of bacteria. Any external or internal factor that messes up this balance will result in an overgrowth of yeast, leading to the uncomfortable symptoms.

The bacteria-yeast balance is highly dependent on the body estrogen hormone balance. Therefore in the course of the normal menstrual cycle of women, the yeast thrives well when the estrogen level is low, which is the period around the menses. This explains why the symptoms are at their worst in the period around the menses.

Different women respond differently to hormones. For this reason, some will develop yeast while using hormonal contraceptives while for others, these hormones actually minimize the symptoms. Others will suffer candidiasis throughout pregnancy while for others, pregnancy may provide respite.

A good number of women will get yeast following an antibiotic course as the antibiotics kill all bacteria, including the good ones that are protective. For others, conditions that create a warm, moist environment in the vulval area could foster the growth of yeast such as tight clothing, poor choice of fabric for underwear, obesity or poor menstrual hygiene.

For some women, repeated candidiasis may be the trigger that leads to eventual diagnosis of more complex health problems such as diabetes, HIV and other immunosuppressive illnesses. Allergy to sanitary towels is also a cause of vulval irritation, more commonly in women who are more likely to have multiple allergies.

Long-standing vulval irritation must be taken seriously and proper medical assistance sought. It is important to establish the correct diagnosis and treat it appropriately. The jury may still be out on the issues surrounding quality of sanitary towels but it does not stop us from sorting out all other easily manageable causes of this embarrassingly uncomfortable problem!