Premenstrual yeast infections are fairly common. The timing has been attributed to either a slight blunting of immune function at this time in the cycle, or pH changes. (Menstrual flow is alkaline and the good vaginal bacterias prefer a more acidic environment.)
Yet in your specific case you mention using both an over the counter treatment (hopefully one with a truly active ingredient such as miconazole or clotrimazole) AND prescription Difulcan tablets. Frequent/recurrent yeast infections that do not respond to any of the prescribed treatments suggest a couple of POSSIBILITIES. First that yeast is not the culprit, or second that it is one of the atypical subtypes of yeast ("candida").
The easiest way to help unravel this question is to have the GYN do a yeast CULTURE the next time you have symptoms. If the culture is negative then yeast is not the cause. Some other conditions which can produce yeast type symptoms include:
1. Cytolytic vaginitis--this is an overgrowth of the beneficial, hydrogen peroxide producing lactobacili that help keep the vagina clear of undesirable bacteria. An overgrowth can produce an itchy, burning, irritating discharge.
2. Lichen sclerosus--this is a skin condition outside the vagina (usually between the vaginal opening and the anus) that can create intense itching and irritation.
3. Contact dermatitis--this would be from a change in tampons/pads, new bubble bath, etc.
If the yeast culture is positive, then the lab can identify which of the yeast subtypes may be the villain. Most yeast medications are developed for candida albicans --about 80% of yeast infections are due to this. The other 20% or so are uncommon subtypes (e.g. candid glabrata). To treat the less common subtypes clinicians may try boric acid vaginally or even painting with a gentian violet (very messy!).
If these are truly reoccurances of candida albicans you might need repeat or prolonged treatments. A blood sugar or hemoglobin A 1C test can be considered. If you have ever had someone give you oral sex (or you use saliva for masturbation) you may be getting exposure to yeast. Yeast is present in the gut from the mouth to the rectum.
You can certainly try the so called lifestyle treatments for yeast. Additional lifestyle methods, which have been advocated for "yeast infection prevention," include: a diet low in refined sugars and simple carbohydrates, avoidance of tight jeans, use of cotton underwear, eating natural lactobacillus yogurt, and others. There are few, if any, good research studies which demonstrate that these methods are helpful, but some women swear by them.
Bottom line, although it's more expensive, a yeast/candida culture may help find a diagnosis and direct treatment if this pattern persists.
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