Healthy Dose: All That Itches Is Not Yeast

July 14, 2008— -- Many medical students are taught simple sayings to help them make the most accurate diagnosis possible. One such saying that comes to mind is: "All that wheezes is not asthma."

This statement means that just because a patient is wheezing when you listen to the lungs with a stethoscope, it does not mean they have asthma. There are many other conditions that cause wheezing: everything from heart failure (probably the most common cause of wheezing) to aspirating a foreign substance, such as a toy part or even a tumor.

The saying is important because it reminds doctors to be thorough in their evaluation and not to conclude quickly without a complete evaluation of the problem.

Another saying that I suggest should be heeded by women: "All that itches is not yeast." Most women will have at least one vaginal yeast infection at some point in their lives and will remember all too well the severe itching and thick white discharge that came with it.

Often the yeast infection followed a course of antibiotics allowing the yeast to overgrow and "set up house," so to speak, or started while on birth control pills or following too many trips to a pool or hot tub. Occasionally however a yeast infection can signal something more serious. A yeast infection that doesn't go away can be the first clue to an elevated blood sugar level and type 2 diabetes.

However itching outside the vagina (an area called the vulva) is more commonly caused by problems other than a yeast infection — everything from allergies, to dry genital tissues from lack of estrogen and often from other infections.

According to Susan Hoffstetter of the Saint Louis University School of Medicine, who analyzed the records of more than 150 new patients last year who thought they had yeast infections, only 26 percent actually did have yeast. She warns that women should not be so quick to pick up the over-the-counter yeast treatment but rather get appointments with their health-care practitioners to be evaluated first.

The good news for women who think they may have a yeast infection is that there are simple things you can do to help you decide whether to pick up the phone and make an appointment with your doctor or whether to purchase one of the readily available yeast creams or tablets sold in supermarkets and pharmacies.

If you are experiencing vaginal symptoms such as itching and a discharge, you can buy a simple self-test kit at your pharmacy to help you determine whether the infection may be yeast or possibly something else.

Yeast infections typically don't affect the usually low or acidic pH of the vagina fluids. Yeast grows in the vagina when the typical acid producing vaginal bacteria called lactobacillus is overtaken by other bacteria, either from antibiotics, from douching, or even in women who have less estrogen after menopause. (Probiotics — which are products that contain acidophilus, a bacteria similar to the normal healthy bacteria — are sometimes taken to minimize vaginal or bowel symptoms while on antibiotics.)

The pH or acidity of the vaginal fluid with other infections such as bacterial vaginosis (also called BV) and trichomoniasis (commonly referred to as trich) typically is much higher or is what we call "more basic." Diagnosis and treatment of BV and trichomoniasis can be important for pregnant women to prevent pregnancy complications.

A simple and reliable home test of the vaginal pH — similar to what doctors will typically use during an office visit — can help you decide whether you need to call the doctor.

If your pH is low and therefore normal, you could safely try one of the many effective yeast medications that can be purchased without a prescription. If your pH test result is abnormal and high, you may have an infection or other cause that needs your doctor's expert diagnosis and advice. An appointment with your doctor in this case is important so that you get the correct diagnosis and best treatment.

The bottom line for all women, however, is that if your symptoms don't go away with over-the-counter treatment for yeast infection, it is well worth your time to make an appointment to find out exactly what is wrong. Post-menopausal women with low estrogen may benefit from a vaginal hormone cream; some women may find they are allergic to something they are using and would be helped by avoiding all perfumed hygiene products and switch to hypoallergenic baby wipes rather than toilet paper. Other women may need to be treated for specific infections such as bacterial vaginosis and trichomoniasis.

Have you recently been diagnosed with a vaginal infection? Have you tried the pH test at home or did you try over-the-counter yeast creams before calling your doctor?

As always, I welcome your questions and comments.

Dr. Marie Savard is an ABC News medical contributor. Dr. Savard's book, How to Save Your Own Life, and her entire system is available on her Web site at www.DrSavard.com.