Did you know that cyclic vulvovaginitis, also known as candida hypersensitivity syndrome, is the most common cause of vulvodynia? Vulvodynia affects up to 15 percent of the female population at some stage in their lives and for some of these women, the symptoms last months or even years. Despite this, some women have not heard of vulvodynia and even less have heard of cyclic vulvovaginitis.
What is Cyclic Vulvovaginitis?
Cyclic vulvovaginitis is when a woman suffers from recurrent or persistent thrush that worsens just before or during a menstrual period every month. It was once thought that women were becoming re-infected with candida, but doctors now suspect that it is a chronic, long standing infection that does not respond to treatment.
It can lead to vulvodynia--nerve damage of the vulva, causing a constant or near constant burning pain that worsens during or after intercourse.
Most women have a small amount of candida in their vagina that lives there harmlessly and doesn’t cause any symptoms but some women are hypersensitive to it and will have thrush symptoms even when there is only a tiny amount present. This hypersensitivity to candida is thought to be the main cause of cyclic vulvovaginitis. Five percent of women have reoccurring thrush and 1 percent have thrush constantly.
Changes in hormones and the pH level of the vagina are why the thrush worsens before or during a menstrual period.
Diagnosis
If a woman has thrush four times a year or more and there is a regular pattern to it, she may have cyclic vulvovaginitis. A gynecologist can confirm this by taking a series of swabs whenever she has symptoms. If some or all of them test positive for candida, then he can make the diagnosis.
How is Cyclic Vulvovaginitis Treated?
Normal over-the-counter anti-thrush creams will not work and may even make vulvodynia worse by increasing vulval burning. Oral anti-thrush medication given on a long-term basis could help. Gynecologists vary in how long they prescribe them for but it’s usually anything from three months to a year, depending on the severity of the case. Drugs used are fluconazole, ketoconazole or itraconazole. Some women are advised to take the medication five days before each period to prevent a flare up.
A low oxalate diet or calcium citrate tablets to reduce the oxalates in the urine may be offered. Oxalates make the urine more acidic which is irritating to the vulva.
Topical steroids can be given for a limited amount of time to calm genital irritation, but these creams should only be used briefly as they can thin the skin and make the problem worse if used longer term.
If the doctor thinks the problem is being caused by immune system hypersensitivity to candida, he may also prescribe anti-histamines to suppress the immune response.
Sources:
Family Practice Notebook, Cyclic Vulvovaginitis - http://www.fpnotebook.com/gyn/vulva/CyclcVlvgnts.htm
DermNet NZ, Cyclic Vulvovaginitis - http://dermnetnz.org/site-age-specific/cyclic-vulvitis.html
NHS Choices, Thrush: Vaginal - http://www.nhs.uk/Conditions/Thrush/Pages/Introduction.aspx
Reviewed May 30, 2011
Edited by Alison Stanton
Joanna is a freelance health writer for The Mother magazine and Suite 101 with a column on infertility, http://infertility.suite101.com/. She is author of the book, 'Breast Milk: A Natural Immunisation,' and co-author of an educational resource on disabled parenting, in addition to running a charity for people damaged by vaccines or medical mistakes.