What Happens When It’s Chronic?

What is chronic vaginitis?

Vaginitis is often what we call a yeast infection, or bacterial vaginosis (BV). We diagnose someone with “chronic” vaginitis when you have been diagnosed four times in twelve months. It is common for women to develop these types of infection, so having a diagnosis of yeast or bacteria once or twice in a year would not warrant a “chronic” label. Yeast and bacteria like to grow where it is warm, wet, and dark, so our vaginas are a perfect place.

How do we treat chronic vaginitis?

Our treatment options are very clearly lined out by the CDC (or Centers for Disease Control). But, please remember, these are treatments for people who have failed treatment multiple times. Yes, the body is resilient and can heal itself in many ways, there are lifestyle factors, etc., but some people will simply require pharmaceutical intervention.

CDC approved treatments for:

BV – Metronidazole vaginal gel twice weekly for at least three months

Yeast – Fluconazole by mouth weekly for 6 months, or intermittent topical medication

If you’re thinking to yourself, “Wow! That’s a lot!” you’re not wrong. And that is why we do not start chronic treatment lightly. It requires diligent adherence to a regimen that only works if you are also doing everything else right. So let’s talk about the “everything else.”

Everything Else To Consider

Boric acid. Boric acid suppositories can be utilized to maintain an acidic pH balance that promotes the growth of good bacteria in the vagina, like lactobacilli. Boric acid is over the counter, simple to use, and could help prevent future infections. Many people will utilize boric acid after intercourse, after a menstrual cycle, after treatment for vaginitis, or at the first sign of an infection. But boric acid is not for everyone. If it causes bleeding, discomfort, etc., then you should discontinue use of the product. And of course, always reach out to your healthcare provider.

Consistent Condom Use. Lack of condom use is a contributing factor to BV. If a male partner uses highly fragranced soaps, body oils, lotion, etc., that could disrupt the vaginal flora. So if a partner is not willing to switch soap, then it’s time to use a condom.

Utilizing Douching products is another risk factor for BV, so save your money and don’t purchase those products.

No Thongs. Thongs are a little tight rope that let all the bacteria from your back side crawl up to your front side. . . so not great. The introduction of this bacteria can cause BV, yeast, and urinary tract infections. Go with boring full coverage underwear that are fully cotton. Welcome to the Granny Panty Club.

No Fragrance. About 5 % of people will develop a sensitivity to fragrance over time. Maybe you could tolerate fragranced soaps, detergent, fabric softener, etc., before, but not now. Experimenting with reduction or elimination of fragrances is an easy change that could make a big difference.

Switch Menstrual Products. Again, you might have tolerated one product before, but maybe not now. Especially if you’re that person that feels like, “my period gives me BV.” It’s not your period, it’s the product. Consider a cup, disc, period underwear, reusable pad options, or my favorite brands at the moment (Cora and August).

Leggings/Bike Shorts. If you are constantly in tight, non-breathable fabrics that promote a warm, wet, dark environment, you might need to take a break. I love leggings as much as the next gal, but if you are getting recurrent infections, it’s time to favor joggers, sweats, and running shorts for your workout attire. It can be a big change, but if it prevents more infections then it’s worth it.

**Chronic yeast infections can be the canary in the coal mine for a diagnosis of prediabetes or insulin resistance. If you are getting recurrent yeast infections, your healthcare provider may recommend testing for insulin resistance before starting any new treatments.

I know that was a lot of information and a lot of things to think about/change. But chronic vaginal infections are complicated problem that require us to attack from all sides. So make the easy changes, talk to your healthcare provider about all your options, and don’t forget that there is no such thing as an awkward question.