If you’ve had vulvar itching for the last two months (especially at night) and had a small amount of white discharge that was clumpy, what would you do? After you tried the Monostat or the Vagisil and it wasn’t getting better (or even getting worse) what would be your next step?

There are many women who will self-medicate for yeast infections. Some are correct and the problem goes away, but the statistics say the 70% of women who self-medicate are treating the wrong condition, and the discharge doesn’t go away. All itching is not yeast.

We take a history and review past cultures and biopsies if available. Next we do a physical exam, take our own culture and do wet mounts (make slides of the discharge). Using these findings, we can make a plan and determine if it is chronic vaginitis or one of the vulvar dermatologic conditions.

Vaginitis can be a chronic yeast infection that requires regular long term treatment. It may be bacterial vaginosis, trichomoniasis, desquamative vaginitis, or it may be an allergic reaction or response to one’s birth control, or, if a woman is postmenopausal, to lack of estrogen. Depending on the cause, various treatments will be started.

Vulvar dermalogic conditions are various skin conditions which one sees on the vulva. These may include psoriasis, eczema, chronic dermatitis, lichen sclerosis, lichen planus, veneral warts, etc. Depending on the findings and/or biopsy results, the appropriate treatment will be started.