October 01, 2021

What can I do for a vaginal yeast infection that won't go away?

Q: I had burning and discharge that I thought was a vaginal yeast infection, so I treated it with an over-the-counter medication. However, it's been more than a week, and the symptoms haven't gone away. What else can I try?

A: Not every vaginal irritation or discharge needs to be looked at by a health care provider. However, since you've completed a course of anti-yeast medication with no improvement, it's important to get it checked out. Your provider can identify the cause of symptoms and recommend appropriate treatment.

Yeast infections are a form of inflammation of the vagina (vaginitis). In younger women, yeast infections generally present with itching, irritation and thick, curd-like white discharge. In postmenopausal women, common symptoms include burning, irritation and itching, while discharge may be absent. These infections are caused by various fungi, and most yeast infections respond to nonprescription treatment.

However, there are other forms of vaginitis that cause discomfort, which could explain why you didn't respond to treatment. One is bacterial vaginosis, which occurs when an overgrowth of certain types of bacteria changes your typical vaginal bacteria mix. This overgrowth typically produces a grayish-white, fishy-smelling discharge and is treated with an antibiotic.

Trichomoniasis, another infection, is caused by a parasite transmitted through sexual intercourse. You may notice a greenish-yellow, sometimes frothy discharge. With trichomoniasis infection, both partners require antibiotic treatment.

Reduced estrogen levels after menopause or ovary removal can cause thinning of the vaginal lining. This sometimes results in vaginal irritation, burning, dryness, painful sex and urinary symptoms. These symptoms can often be treated with low doses of vaginal estrogen creams, tablets or rings.

Sometimes, products such as vaginal sprays, perfumed soaps or new detergents can irritate sensitive vaginal tissues. You can test this by eliminating products one by one and seeing if...