Diabetes & The Body

Vaginal Problems In Diabetes

Introduction:

Diabetes is a disease in which the complex biochemical changes bring about such a change in the internal environment of the body that it is prone for infections always. One such infection is the vaginal candidiasis.

Candidal Vaginosis is a vaginal infection caused most commonly by the fungal organism, Candida albicans. This is called by alternative names such as yeast infection-vagina; vaginal candidiasis; and monilial vaginitis.

Candida albicans is an organism with worldwide distribution. It is normally found in small amounts in the vagina, the mouth, the digestive tract, and on the skin without causing disease or symptoms. Approximately 25% of women without disease symptoms have this organism present.

Causes & Risks

Symptoms of this disease appear when the balance between the normal microorganisms of the vagina is lost, and the Candidal population becomes larger in relation to the other microorganism populations.

This happens when the environment (the vagina) has certain favorable conditions that allow growth and nourishment of Candida. An environment that makes it difficult for the other microorganisms to survive may also cause an imbalance and lead to a yeast infection.

Antibiotics

Yeast infection may follow a course of antibiotics, particularly tetracycline that were prescribed for another purpose. The antibiotics change the normal "balance" between organisms in the vagina by suppressing the growth of protective bacteria that normally have an antifungal effect. These are the bacteria called the lactobacilli, which utilize the glucose of the shed vaginal cells and produce the lactic acid, which helps keep the vaginal environment acidic, inhibitory for the harmful ones. These are killed by the broad-spectrum antibiotic paving way for fungal infection.

Hormonal use

Infection is common among women who use estrogen-containing birth control pills and among women who are pregnant. This is due to the increased level of estrogen in the body. The increased hormone level causes changes in the vaginal environment that make it perfect for fungal growth and nourishment. This is done by decreasing the level of glucose in the vaginal cells and consequently less acidic environment in the vagina.

Immuno deficiency

Yeast infections may also occur in association with diabetes or problems that affect the immune system (such as AIDS or the HIV virus). Close attention should be paid to episodes of vaginal candidiasis. Repeat infections that occur immediately following therapy, or a persistent yeast infection that does not respond to therapy, may be the first or, at least, an early sign that an individual is infected with HIV.

Both males and females with HIV infection who have developed AIDS may be subject to disseminated infection with Candida, including oral candidiasis (in the mouth), esophageal candidiasis (in the esophagus), and cutaneous candidiasis (on the skin).

Transmission

Vaginal candidiasis is not considered a sexually transmitted disease. However, 12% to 15% of men will develop symptoms such as itching and penile rash following sexual contact with an infected partner.

Symptoms

Symptoms for Candidal Vaginosis include

• Abnormal vaginal discharge : Here the vaginal discharge ranges from a slightly watery white discharge to a thick, white, chunky discharge, which resembles the one like a cottage cheese.
• Vaginal and labial itching, burning
• Redness and/or inflammation of the vulvar skin
• Pain with intercourse (dysperunia)
• Pain during urination.

Signs

The diagnostic signs are often visible only on doing a pelvic or per vaginal examination only.

• The presence of white curdy patches on the vaginal wall
• The white patches are on an inflamed, fissured background
• There may be signs of scratching due to the intense itchy sensation

Confirmation

Though confirmative tests are there, the diagnosis of candidal infection is usually clinically and is sufficient for starting presumptive treatment. Confirmation is by

1. Microscopy where the yeast cells are seen clearly on a wet mount or when stained by suitable stains
2. Culture when grown on appropriate culture medium, the characteristic branching structure of the candida is seen together with their budding yeast cells.
3. sugar fermenting tests these biochemical test are done to identify the albicans from other harmless candida yeasts which are normally present in the vagina, but are not done routinely.

Prevention

Preventive measures can help preventing the disorder from occuring, which is always the best way since prevention is better than cure.

• Avoid persistent and excessive moisture in the genital area.
• Wearing underwear or pantyhose with cotton crotches can do this, and also loose fitting slacks can be used.
• Wet bathing suits or exercise clothing should not be worn for long periods of time, and also they should be washed after use every time.

Treatment

Generally when the yeast infection first occurs in people their health care provider should treat it. Antifungals like the clotrimazole, fluconazole are to be used both locally and orally. In case of persons engaging in sexual activity, the partner must also take the treatment, to prevent reinfection after the treatment.

After the first yeast infection is treated, if the infection occurs for a second time and if it undoubtfully again a yeast infection, then a self-treatment may be initiated with over-the-counter vaginal creams such as miconazole or clotimazole. Your gynecologist or a primary health care provider should evaluate the persistent symptoms of this yeast infection.

The occurrence of yeast infection again and again can be prevented by two healthy foods, cranberry juice and yogurt. These foods can also be useful as a aid in the treatment of yeast infection.

Medications for vaginal yeast infections are available in either vaginal cream/suppositories or oral preparations. The use oral preparation should be avoided during pregnancy.

The symptoms of yeast infection usually disappear completely with adequate treatment.

Complications

The complications for yeast infection may be:

• Chronic or recurrent infections may occur. This may be from inadequate treatment or self-reinfection.
• Secondary infection may also occur.
• Intense or prolonged scratching may cause the skin of the vulva to become cracked and raw, making it more susceptible to infection.

Calling your health care provider:

Call for an appointment with your health care provider if this is the first time that vaginal yeast infection symptoms have occurred, or if you are unsure if you have a yeast infection. If you are sure that you have a yeast infection, you can treat the disorder with over-the-counter medications.

Call your health care provider if symptoms are unresponsive to self-treatment with recommended vaginal creams, or if other symptoms are present.