Please continue repeating the stats about misdiagnosis of yeast infections! Itching is so commonly just chalked up as a yeast infection, folks treat at home – whether due to lack of access to care or mistrust – and they keep itching. And it could be something else entirely.
How do I know? I am dealing with a worst case scenario version now. Finally got access to care and treated for yeast, then excellent care which included actual testing but no yeast. Upon closer examination by one practitioner, it looked like textbook lichen sclerosis – okay, treated that way for a few years.
I’m now in the hands of even better providers who last November suggested we biopsy, just to be sure. Surprise! HSIL/VIN 2 aka pre-cancerous lesions on my vulva. Treatment option one (Aldara, a topical treatment also commonly used for skin cancers) attempted, but I did not tolerate it well.
Partial vulvectomy in August, which provided the bigger surprise: positive at all margins for Paget’s disease.
I have a rare cancer, and am extremely fortunate to have a phenomenal team helping me through it, including a gynecological oncologist who has dealt with it before.
But please, people – if at all possible, get those itches checked. I can promise you that you don’t want any of this. I will never know how much detecting this earlier would’ve changed this. I’ve never had an abnormal pap or any other sign, just the itching.
My cancer is rare, but everyone deserves proper treatment for what is actually ailing them and not the hand wave of a treatment that may not help and could set off a yeast/BV teeter totter.
Seriously. YOU are precious and deserve good care.
How very, very interesting. I suffered from resistant yeast for a decade. I could usually smell it myself, although I did get regularly tested. It disappeared once I stopped the pill, but I used Tretinoin over the years for cosmetic reasons as well. I guess I'll never know if one or the other or both might have been contibuting factors. Am I ever glad you are posing these questions, our dear Dr Gunter.
I'm interested to hear the rationale behind using estrogen to treat vaginal dryness caused by isotretinoin....the mechanism of dryness is not that isotretinoin lowers estrogen is it? So how does more estrogen help? thank you!
There isn't really a rational behind it. Mucosal dryness from isotretinoin isn't related to low estrogen. It wouldn't be necessarily wrong to try it, but biologically it doesn't make much sense. A vaginal moisturizer would likely be better. But there are no studies here.
Pleasssse discuss recurrent or resistant yeast! I'm struggling with patient care plans on this issue and I see it so frequently (cultured and confirmed). You rock!!
Very interesting article! Thank you for walking us through the process towards understanding what is going on, when symptoms are present.
As someone who is suffering from RVVC, now on year 3, and the treatment doesn't seem to keep things under control, it helps to see ways to go back to my doctor to discuss a new path.
Please continue repeating the stats about misdiagnosis of yeast infections! Itching is so commonly just chalked up as a yeast infection, folks treat at home – whether due to lack of access to care or mistrust – and they keep itching. And it could be something else entirely.
How do I know? I am dealing with a worst case scenario version now. Finally got access to care and treated for yeast, then excellent care which included actual testing but no yeast. Upon closer examination by one practitioner, it looked like textbook lichen sclerosis – okay, treated that way for a few years.
I’m now in the hands of even better providers who last November suggested we biopsy, just to be sure. Surprise! HSIL/VIN 2 aka pre-cancerous lesions on my vulva. Treatment option one (Aldara, a topical treatment also commonly used for skin cancers) attempted, but I did not tolerate it well.
Partial vulvectomy in August, which provided the bigger surprise: positive at all margins for Paget’s disease.
I have a rare cancer, and am extremely fortunate to have a phenomenal team helping me through it, including a gynecological oncologist who has dealt with it before.
But please, people – if at all possible, get those itches checked. I can promise you that you don’t want any of this. I will never know how much detecting this earlier would’ve changed this. I’ve never had an abnormal pap or any other sign, just the itching.
My cancer is rare, but everyone deserves proper treatment for what is actually ailing them and not the hand wave of a treatment that may not help and could set off a yeast/BV teeter totter.
Seriously. YOU are precious and deserve good care.
How very, very interesting. I suffered from resistant yeast for a decade. I could usually smell it myself, although I did get regularly tested. It disappeared once I stopped the pill, but I used Tretinoin over the years for cosmetic reasons as well. I guess I'll never know if one or the other or both might have been contibuting factors. Am I ever glad you are posing these questions, our dear Dr Gunter.
I’d love to read your take on resistant yeast. All the patients I want to try Brexafemme for can’t afford it. Interested to hear your experience!
Please try this article and it also links to at least one other. https://vajenda.substack.com/p/when-a-yeast-infection-wont-go-away
Thank you for your expert advice!
I'm interested to hear the rationale behind using estrogen to treat vaginal dryness caused by isotretinoin....the mechanism of dryness is not that isotretinoin lowers estrogen is it? So how does more estrogen help? thank you!
There isn't really a rational behind it. Mucosal dryness from isotretinoin isn't related to low estrogen. It wouldn't be necessarily wrong to try it, but biologically it doesn't make much sense. A vaginal moisturizer would likely be better. But there are no studies here.
Pleasssse discuss recurrent or resistant yeast! I'm struggling with patient care plans on this issue and I see it so frequently (cultured and confirmed). You rock!!
Very interesting article! Thank you for walking us through the process towards understanding what is going on, when symptoms are present.
As someone who is suffering from RVVC, now on year 3, and the treatment doesn't seem to keep things under control, it helps to see ways to go back to my doctor to discuss a new path.
Thank you so much, Dr. Gunter!