THE SIGNS & SYMPTOMS
Vaginitis refers to the inflammation of the vagina and the vulva. Among the different types of vaginitis, vaginal yeast infection is one of the most common causes which affects many women at some time during their life, and can recur regularly for some women. Vaginal yeast infection, also known as vaginal thrush, is associated with intense itching and burning of the vagina and the vulva. The infected woman may also notice a white, or yellowish thick curd-like discharge that resembles cottage cheese.
Image from: yeastinfectiondischarge.org
This image shows a typical discharge of vaginal yeast infection by the Candida fungus. Once infected, the vaginal discharge turns whitish or whitish-gray in colour and develops the thick consistency resembles cottage cheese.
An overgrowth of the fungus, Candida albicans, in the vagina is usually the culprit for this disorder. The candida fungus usually lives on the skin and mucous membranes without causing infection. It is part of the normal flora of the respiratory, gastrointestinal (guts) and female genital tract (vagina), but when given the opportunity, for example, when under stress or having reduced immunity, these microorganisms may develop into an overwhelming presence, and can cause symptoms to develop, we call this phenomenon an opportunistic infection.
RISK FACTORS OF CANDIDA INFECTION
Under normal circumstances, the immune system and the harmless bacteria in the vagina suppress the growth of candida fungus and help to maintain a healthy balance of the vagina flora.
Medications. Some medications, such as oral antibiotics, steroids and iron tablets kill or reduce the healthy bacteria in the vagina and weaken the immune system, leading to rapid growth of candida fungus, which may cause symptoms of infection.
Hormones. Women who are constantly taking birth control pills, or who are pregnant, have higher levels of oestrogen that may create an environment conducive for yeast to grow faster and stick more easily to the walls of vagina.
Diabetes. The risk of developing vaginal yeast infection is also increased in diabetic patients who do not have good control over their blood sugar,
Poor Immunity. and in women with poor immune system, such as those with HIV or receiving chemotherapy, as the body’s immune system cannot effectively control the growth of candida fungus in the vagina.
Lifestyle. Other factors such as stress, deprived from sleep, personal hygiene, tight clothing, diet high in refined sugars or carbohydrates are risks factors that may predispose a woman to developing candida fungus.
Summary: Conditions that predispose women to developing candida yeast infection
Diet: High in sugar or refined carbohydrates
Medication: Antibiotics, steroids, birth control pills, immune suppressants and iron supplements
Underlying illnesses: Diabetes, HIV, iron deficiency (low in lactoferrin)
Treatment: Receiving chemotherapy, oestrogen therapy
Vulnerable time frame: Before menstrual period, during pregnancy, during or after stressful life event
CONFIRM YOUR DIAGNOSIS
Although it is possible to diagnose vaginal yeast infection clinically without lab confirmation, and most of the time over-the-counter medication eliminates the symptoms quickly, it is advisable that you see your family doctor or gynaecologist for a proper diagnosis if this is the first time you are experiencing vaginal discomfort with abnormal discharge, or you recognise the infection in a more severe and persistent way.
Your doctor will do a pH test and a swab for examination under a microscope. It is important to establish the cause of your infection as different types of vaginitis, such as bacterial vaginosis and trichomonas (parasite) infection, requires different treatments. This is more so if you have had more than one sex partner or a recent new sex partner as the signs and symptoms of some sexually transmitted disease resembles that of a yeast infection.
Image from: microbiologyinpictures.com
This image shows pure colony appearance of Candida albicans cultivated on Sabouraud agar in Petri dish. Cultivation 48 hours at 37°C and additional cultivation 24 hours at room temperature.
While vaginal yeast infection is rarely serious, it can cause severe discomfort and extreme inconvenience, not to mention the feeling of embarrassment, agitation, anger and frustration experienced by the infected women. Moreover, for pregnant women, it may be a sign of gestational diabetes and the infection may also be transmitted to the baby during vaginal birth.
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ANTIFUNGAL MEDICATION VS TCM HOLISTIC TREATMENT
Conventionally, treatment of vaginal thrush involves the use of antifungal medications, which include vaginal creams, pessaries and tablets, and oral tablets. Steroids are sometimes prescribed to treat severe cases. The treatment is usually successful. However, the infection tends to recur regularly for some women. There may also be some side effects, such as headaches and stomach upset from the use of conventional medication, TCM can be a good complementary treatment when conventional regimen has lost its effectiveness, or when the condition recurs regularly.
From a Traditional Chinese Medicine’s perspective, vaginal itching with an abnormal discharge is usually a manifestation of damp-heat in the Liver Channel or dampness in the lower jiao with Spleen Qi deficiency. Classically, dampness describes a condition of viscosity and stagnation. It is one of the yin pathogenic factors in the TCM concept, and all its related diseases tend to be persistent and recurrent.
1. Damp-Heat in the Liver Channel
Damp-Heat in the Liver Channel is usually the root cause of vaginal yeast infection. Liver and Spleen are the two main internal organs that are closely related to the condition. Liver which is associated with emotional wellness can be affected by stress, resulting in the stagnation of the Liver Qi. The stagnated Liver Qi can turn into Liver Fire. The Liver Excess can cross over to attack the Spleen, leading to a deficiency of the Spleen. At the same time, the Spleen may also be weakened by having an unhealthy diet. When the function of the Spleen declines, the ability of the Spleen to transform and transport food and fluids also reduces. The waste products gather and transform into Dampness Evil. When Dampness Evil accumulates in the Liver Channel and turns into Damp-Heat, vaginal thrush may occur.
Typical manifestations of this pattern differentiation include:
Intense vulvovaginal itching
Yellowish curd-like vaginal discharge
A red tongue body with yellow greasy coating
A slippery (滑) or wiry (弦) pulse
Image from: designua / 123RF Stock Photo
This image shows the Five Element cycle and its ability to "generate" and “attack” each element.
2. Dampness in the lower jiao with Spleen Qi deficieny
Typical manifestations of this pattern differentiation include:
Whitish curd-like vaginal discharge
Tiredness and sluggishness of the body
A pale or pinkish tongue body with milky white coating and teeth marks on the sides
A weak (弱) or slippery (滑) pulse
3. Linkage between Diabetes and Vaginal Yeast Infection: A Deficiency in Liver and Kidney Yin
Diabetic patients and patients with poor immune system often have a Liver and Kidney Yin deficiency body constitution. This type of body constitution often fails to nourish the Liver Channel that circulates the genital area, thereby predisposing the women to vaginal yeast infection.
During an acute attack, TCM aims to remove any Damp-Heat Evil, so that the symptoms can be quickly relieved. Once the infection is under control, the next step is to prevent the infection from recurring. The approach of TCM is more comprehensive during remission period. The goal is to nourish the Liver and Kidney Yin and tonify the Spleen to restore the imbalances caused by diabetes. The combined use of acupuncture and Chinese medicine often creates an environment that is not favourable to the growth of C.albicans.
TREATMENT MODALITIES AND PRINCIPLE
Acupuncture, the use of oral Chinese Medicine, and Chinese herbal lotion for douching (of the vagina) and cleansing (of the vulva) are treatment methods commonly used for treating vaginal yeast infection.
Acute Phase / First Attack
A TCM physician who is experienced in treating vaginal yeast infection will prescribe oral Chinese medicine, and Chinese herbal lotion for a one-time (or weekly) douching and daily cleansing according to disharmony patterns based on TCM syndrome differentiation. For a woman suffering from acute symptoms, the focus is on purging the Liver Fire, clearing Heat and expelling Dampness Evil. Sometimes, an acupuncture session for alleviating itchiness may be prescribed if the symptoms are too irritating. Certain empirical acupoints such as LIV-5 (蠡沟), HT-8 (少府) and SP-9 (阴陵泉), have been clinically proven to be useful. Many experienced a marked improvement following the initial treatment. A weekly follow-up is usually necessary.
Follow-up / Recovery after Acute Phase
Symptoms of acute vaginal yeast infection most often clear up after one week if this is the first time you are having a vaginal yeast infection. During the follow-up, Chinese medicine prescription will be adjusted to strengthen the immune system and improve gut and vaginal flora. The emphasis is on tonifying the Spleen Qi, or nourishing the Liver and Kidney Yin. Some herbs from the earlier prescription may be included, but in smaller dosage, to clear up any remaining infection. Douching and daily cleansing for one more round may also be prescribed.
For women who have frequent recurring infection, TCM treatments during remission period aims at correcting the underlying disharmony and offers good preventive effects. A weekly acupuncture session is usually recommended for this phase. Empirical points such as LIV-3 (太冲), LIV-4 (中封) clear stagnation and heat in the Liver Channel; SP-9 (阴陵泉) diminishes dampness in the genitals, both from external pathogenic factors and chronic internally generated conditions; ST-36 (足三里) fortifies the Spleen and resolves dampness. ST-36 is also called the “Immune booster point” as it has been scientifically proven to improve overall immune system function, restore intestinal flora and increase resistance to bacterial and viral infections.
TCM preventive treatments also take into consideration patients’ existing illness and the usual time of outbreaks. For example, points will be added to nourish Liver & Kidney Yin for diabetic patients; for women who are prone to develop thrush when under stress, points will be added to ensure a smooth flow of Liver Qi ; for women who are prone to get thrush before every menstrual period, she will be advised to receive treatment just before menstruation starts.