By Aisha Naava
Previously, I visited a secondary school to provide career guidance to a girl child and realized an important issue that is always taken for granted by both parents and teachers themselves. It was a long conversation about studies and health.
At the end of the conversation, I asked every student to write down one most challenging health problems that they experienced at school. To my surprise, 60% of the students were affected by itching of the private parts, vaginal discharge that looks like spoilt milk and sometimes a weird smell.
Some of them said that every time they told the matron, their issue was taken for granted since they didn’t look sick and ended up not receiving treatment for some good time. A few who received treatment said that this health problem reoccurred after some time.
Students reported that this health problem brings about discomfort during studies and other activities as it’s shameful to scratch your private parts in public. The question was; is this normal? Since even after treatment it reoccurs?
Normally, about 6 months to 1 year before a girl gets her first period, her body may start to make vaginal discharge due to changing hormone levels and this helps to keep the vagina healthy, it can have a texture that’s anywhere from thin and slightly sticky to thick.
However, vaginal candidiasis is commonly known as a yeast infection of the vulva and vagina which can cause inflammation, intense itchiness and a thick white discharge from the vagina. It’s transmitted through contact with contaminated objects or surfaces and direct contact with an infected individual during sex.
Traditionally candidiasis is known to be an opportunistic infection that exploits opportunities such as a weakened immune system by suppressive drugs (steroids) or other diseases like HIV and cancer, and altered microbiota; however, symptomatic candidiasis infections may also be a result of hypersensitivity reaction to commensal organism candida albicans with genetics and estrogen levels also alleged to play a role.
Generally, vaginal candidiasis is more common in women of reproductive age 25-34 years, but it can also occur in girls, especially during puberty due to rise in estrogen levels.
Globally, vulvovaginal candidiasis (VVC) is a public health problem that affects millions of women; at least 75% of all women are estimated to experience vaginal candida infection at least once in their lifetime. Additionally, 372 million women are affected by recurrent vulvovaginal candidiasis over their lifetime.
What are the likely causes of vaginal candidiasis?
Imbalance in vaginal flora; when the balance of bacteria and yeast is disrupted, it can lead to an overgrowth of yeast-candida albicans hence candidiasis.
Poor hygiene practices; a moist environment due to wet swimsuits or improper wiping which encourages yeast growth can lead to candidiasis.
Hormonal changes i.e. increased estrogen levels during puberty promote yeast growth.
Excessive antibiotic and corticosteroid use may disrupt the natural balance of bacteria which prompts overgrowth of yeast leading to candidiasis.
Wearing tight or non-breathable underwear or leggings can trap moisture and heat around the vaginal area, creating an environment conducive to yeast growth.
Girls or women with weakened immune systems either due to medical conditions or medications may be prone to developing vaginal candidiasis.
Sexual activity can introduce yeast into the vagina or disrupt the normal flora hence increasing the risk for yeast infections.
Using scented sanitary products and douching can upset the healthy balance of bacteria in the vagina and make yeast infections more likely
Other factors such as diabetes, pregnancy, /and the use of certain contraceptives for example hormonal birth control and underlying medical conditions can also contribute to the development of vaginal candidiasis.
How do you know that you could be having vaginal candidiasis?
- Vaginal itching in and around the vaginal area is the most common symptom of vaginal candidiasis that leads to discomfort and irritation among women and girls.
- Irritation of the urethra or inflammation of the surrounding tissues may be manifested by frequent urination, urgency or discomfort during urination
- An abnormal discharge that is typically thick, white and clumpy, resembling cottage cheese and may have a yeasty odour.
- The presence of yeast causes inflammation and irritation and this can lead to redness, swelling and soreness of the vaginal area which makes sitting and other activities uncomfortable.
- Burning sensations particularly during sexual intercourse or urination may exacerbate the discomfort associated with the infection.
- Dyspareunia, which is painful sexual intercourse due to inflammation and irritation of vaginal tissues hence making penetration uncomfortable.
NOTE:
Awareness of these clinical manifestations helps girls and women to seek medical attention for early detection and treatment hence preventing complications.
Management and Prevention
Managing vaginal candidiasis among school-going girls typically involves both self-care measures and medical treatment.
Encourage girls to practice proper hygiene, including regular washing of the genital area with mild soap and water. Emphasize the importance of wiping from front to back after using the toilet to prevent the spread of bacteria from the anus to the vagina.
Girls should be advised to wear cotton underwear and loose-fitting clothing to promote airflow and reduce moisture in the vaginal area. Avoid tight-fitting or non-breathable fabrics, which can create a conducive environment for yeast growth.
Avoid potential irritants like scented feminine hygiene products, douches, and perfumed soaps, as these can disrupt the natural balance of vaginal flora and exacerbate yeast infections.
Girls are encouraged to opt for a balanced diet with plenty of fruits, vegetables, and whole grain rather than sugary foods and beverages which promote yeast growth.
Girls can use over the counter anti-fungal creams, tablets or suppositories as they follow instructions on the product packaging or seek guidance from a pharmacist. In cases of severe or recurrent vaginal candidiasis, a healthcare provider may prescribe oral or vaginal antifungal medications, such as fluconazole or clotrimazole, for more aggressive treatment approach.
If symptoms persist or worsen despite self-care measures and over the counter treatments, girls should seek medical evaluation from a healthcare provider. A healthcare professional can confirm the diagnosis and prescribe appropriate antifungal medication if necessary.
Sexually active girls are advised to use condoms, to reduce sexually transmitted infections which may disrupt the normal flora hence prompting yeast infection. Futhurmore, sexually active women should inform their sexual partners about their yeast infection so that they can also receive treatment as this can help to prevent reinfection or transmission of the yeast infection.
Encourage girls to follow up with their healthcare provider if symptoms persist or recur after completing the prescribed treatment regimen as this is essential to ensure that the infection has been adequately treated and to address any underlying factors contributing to recurrent infections.
Provide education on preventing future episodes of vaginal candidiasis, including maintaining good hygiene practices, avoiding irritants and seeking prompt treatment for any symptoms of infections.
Encourage girls to schedule regular gynaecological checkups with healthcare providers even without experiencing symptoms.
REMINDER;
Untreated candidiasis in women can lead to various reproductive health issues. It can cause inflammation and irritation of the vagina and vulva, resulting in discomfort, itching and burning sensation. In severe cases, it may lead to vaginal discharge, pain during sexual intercourse and urinary discomfort.
Additionally, recurrent or chronic candidiasis may disrupt the natural balance of the vaginal microbiota, potentially increasing the risk of inflammation and other infections which affect the quality and quantity of cervical mucus, making it more difficult for the sperm to travel through the cervix and reach the egg for fertilization hence infertility. Similarly, chronic or recurrent candidiasis may cause inflammation in the reproductive organs, potentially leading to scarring or damage that can interfere with conception.
In conclusion, it is very important for women and girls to seek medical attention for proper diagnosis and treatment of vaginal candidiasis to prevent complications.
The author; Aisha Naava, is the General Secretary, Islamic Medical Association of Uganda – Womens Branch (IMAU-WB); and a Nursing officer working with Kawolo General Hospital- MUWRP.
