INTIMATE (IN)BALANCES

On a Saturday morning, quite busy by the way, I am approached by a costumer who whispers something that I have difficulty hearing. Realizing that this is a sensitive subject, I direct her to the office where we can talk more freely.

– You can’t imagine what happened to me! A few days ago I tried some pants in a store and since yesterday I cannot stop scratching myself … I must have gotten one of those things from Candida, you know? I knew I should not have tried the pants, I knew it!

I try to put her at rest by explaining that if it is a candidiasis, it would hardly be transmitted in this way.

For many years candidiasis was exclusively associated to the sexual transmission or lack of hygiene, but nowadays, we know that this is not quite so.

The vaginal flora is made up of innumerable bacteria, some of them “good” and others “less good” but which remain in balance. In maintaining this balance, lactobacilli (“good” bacteria) play a very important role. In addition to not letting other microorganisms develop and cause disease, they are still responsible for producing lactic acid which maintains the acidic vaginal pH, which is unappetizing for the growth of fungi and other pathogenic bacteria.

Some pathologies, the taking of certain medicines, hormonal imbalances, or simply stress, can generate instability in this system and allow microorganisms like the fungus Candida Albicans to grow excessively and give rise to the characteristic symptoms of candidiasis.

In the course of the conversation she tells me that she just took an antibiotic for tonsillitis. And bingo! The cause of the vaginal discomfort is probably a yeast infection, not caused by the use of such pants, but by the antibiotic! Antibiotics “kill” the so-called “bad” bacteria but in the process end up destroying some “good”, hence women often develop candidiasis after taking this type of medication.

In spite of the confirmation of my suspicions, I still ask about some alteration of the vaginal discharge, which tells me that it is in greater quantity and of a milky aspect but without smell. All characteristics of a candidiasis.

As this is a one-time situation, I advise her to use a local action antifungal in the form of small eggs for three days before bedtime and an antifungal cream to apply externally morning and evening for six days. I also advise her to use an intimate wash product with soothing properties to help with the discomfort at this stage, and I suggest her another one for daily intimate hygiene, as I realize that she uses shower gel. The bath gels that we use for the skin are not always indicated for the intimate washing, either by the presence of some harmful substances in the vaginal flora or by the pH they often present.

Although not the most recurrent form of candidiasis, I also alert her to the risk of transmission to the sexual partner and advise her to use a barrier method not likely to be affected by the antifungal cream that she will use.

I end the conversation by advising her to be alert to the symptoms and if these have not improved or if she has any complaints of this type in the coming months, to see a doctor because there are women who have recurrent episodes of candidiasis that may have to resort to oral antifungals, and in these cases there must always be a medical follow-up.

She left the office much more at peace and much more enlightened. It is important that we, pharmacists, participate in the demystification of these situations and, without judgments, advise our costumers based on science and from the heart.

Text written by Paula.