Womens Health

Question 1

Vaginal dryness

How is it caused?

What happens if left untreated?

Answer 1

Vaginal dryness is usually caused by a reduction in oestrogen levels, and is common following menopause

however it can alspo be caused by childbirth, oral contraceptives, stress, vaginal deodorants or perfumed bubble baths

If left untreated, atrophy (a thinning) of the vaginal tissues may occur causing a loss of elasticity

in addition, the environment inside the vagina can become less acidic, increasing the risk of infection

Damage can more easily occur leading to pain during sex, itchiness, or blood spotting

Question 2

Vaginal thrush

What is vaginal thrush

What are the symptoms?

If itching is the main symptom and there is no discharge, what should you consider?

What symptom would suggest bacterial vaginosis

What are the treatments?

Who to refer?

Answer 2

Vaginal thrush (vaginal candidiasis) is a common fungal infection caused by overgrowth of the yeast, candida albicans.

Vaginal thrush is uncommon in girls before their first menstrual cycle and in women after menopause

Although not considered a sexually transmitted infection, ocasionally the yeast can be transferred to a masle partner causing redness, itching, and soreness around head of the penis. treat males with symptoms with an antifungal cream

symptoms of vaginal thrush in woman include itching, irritation, soreness, or a burning sensation in the vaginal area. there is often a thick white, or creamy vaginal discharge.

If itching is the main symptom and there is no thick discharge, consider other reasons for the symptoms such as cystitis (bladder infection), vaginal dryness, or an allergy to toiletries or synthetic underwear.

If a “fishy” or malodorous smell is present, consider bacterial vaginosis (refer to doctor)

Occasional episodes of vaginal thrush may be treated with otc vaginal antifungal agents
Vaginal creams and pessaries come in one, three, and six day courses

Usually 1 day treatments will cure most bouts of thrush but consider longer courses for women still taking antibiotics or prone to recurrent thrush

A single, oral dose of fluconazole 150mg provides rapid relief and may be more convenient

refer customers who have not responded to pom

some medical conditions, such as diabetes or autoimmune conditions make women prone to recurrent thrush

Sometimes thrush can be caused by other yeasts (eg candida glabrata) or it is actually bacterial vaginosis, a sexually transmitted infection, or rarely, cancer

Question 3

What are some imidazole antifungal vaginal products?

Answer 3

• clotrimazole
• miconazole

Vaginal antifungal products are available as creams, pessaries or ovules for intravaginal use in single-dose, three and six-day treatment

Single-dose treatments are more convenient; However, longer therapy may be required in some circumstances (eg, if the woman is still on antibiotics)

Disposable applicators are supplied in the packet and treatment is best used at night

Question 4

What are some triazole antifungal vaginal products?

When to avoid?

Answer 4

• fluconazole

Only one capsule needs to be taken, once. Similar in efficacy to imidazole vaginal antifungals

Avoid use if the patient has previously had liver disease with fluconazole (rare)

Note possible drug interactions

Pharmacist is not able to sell OTC in females aged under 18 or in pregnancy or breastfeeding

Question 5

What are some combination antifungal vaginal products?

Answer 5

Clotrimazole cream + oral fluconazole capsule

Question 6

What are some vaginal lubricants and gels?

How do they help?

Answer 6

Aci-Jel, anime lubricant, kolorex, replens

vaginal gels, creams, and ovules restore moisture levels in the vagina helping to maintain a healthy vaginal pH which reduces the risk of vaginal infections.

Some may help suppress bacterial vaginosis-associated bacteria

Question 7

What are some natural / herbal products / supplements?

Answer 7

• Horopito extract
• Lactobacillus acidophilus
• Echniacea

Horopito is an effective antifungal agent

Several probiotics are effective at returning gut yeast populationsback to normal

Echinacea stimulates the immune system and the body’s ability to overcome Candida overgrowth

Question 8

Advice for customers

Answer 8

• Be sexually responsible. Always wear condoms unless you are in a mutually monogamous relationship with a partner who is free from STIs
• Pelvic exercises
• Women prone to recurring episodes of thrush should consider using a water-based lubricant during intercourse and when inserting tampons if the vagina is dry, using a vaginal gel to regulate vaginal pH which can alter during the menstrual cycle, and showering straight after exercise
• Oral probiotics may be useful to recolonise bacterial flora within the vagina