[37F] With vaginal itching and menstrual irregularities

Patient Description

A 37-year-old female has been experiencing vaginal itching for the past two days, coinciding with the onset of her menstrual cycle. The itching is rated as 6 out of 10 in severity. The patient reports that her period blood is more like spotting and darker than usual, appearing brown. She has not used any new products that could be causing irritation but had recent unprotected sexual activity. There is no unusual odor, pain during urination or intercourse, pelvic or lower abdominal pain, fever, or chills. The patient has a history of trichomoniasis and has been using the NuvaRing for over a month without any irritation or discomfort. She also has Long Covid, diagnosed in November 2023, which has caused her periods to become inconsistent. The patient is allergic to penicillin and sulfur drugs and is currently taking Prozac (80 mg), Adderall (60 mg), and Clonazepam (2 mg) daily.

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Arora's Assessment

What might be happening

Based on the information you have provided, here are some possible explanations for your symptoms:

  • Yeast Infection (Candidiasis): Vaginal itching, especially around the time of your menstrual cycle, can often be due to a yeast infection. This is a common condition caused by an overgrowth of yeast in the vagina. Symptoms can include itching, irritation, and unusual discharge, which can sometimes be brownish if mixed with menstrual blood.

    • Treatment: Over-the-counter antifungal creams or suppositories can be effective. If symptoms persist, a doctor may prescribe oral antifungal medication.
  • Bacterial Vaginosis (BV): This condition is caused by an imbalance of the natural bacteria in the vagina. It can cause itching and unusual discharge, which may be more noticeable during your period.

    • Treatment: BV is typically treated with antibiotics prescribed by a doctor.
  • Sexually Transmitted Infections (STIs): Given your recent unprotected sexual activity, STIs such as trichomoniasis, chlamydia, or gonorrhea could be a cause. These infections can cause itching, irritation, and changes in discharge.

    • Treatment: STIs require specific antibiotics or antiviral medications prescribed by a healthcare provider.
  • Hormonal Changes: Long Covid and the medications you are taking (Prozac, Adderall, Clonazepam) can affect your menstrual cycle and vaginal health, potentially leading to symptoms like itching and spotting.

    • Treatment: Managing underlying conditions and discussing medication side effects with your doctor can help.

What you can do

While it's important to consult a healthcare provider for a formal diagnosis and treatment, here are some steps you can take to alleviate your symptoms:

  1. Maintain Good Hygiene: Keep the vaginal area clean and dry. Avoid using scented soaps, douches, or feminine hygiene sprays that can cause irritation.
  2. Wear Breathable Clothing: Opt for cotton underwear and avoid tight-fitting clothes to reduce moisture and irritation.
  3. Over-the-Counter Treatments: Consider using over-the-counter antifungal creams or suppositories if you suspect a yeast infection.
  4. Stay Hydrated and Eat a Balanced Diet: Proper hydration and nutrition can support overall health and help manage symptoms.
  5. Track Your Symptoms: Use MDandMe to journal your symptoms, track progress, and share longitudinal medical notes with your healthcare provider. This can help in identifying patterns and triggers.

What you should look out for

Seek medical attention if you experience any of the following:

  • Worsening Symptoms: If the itching becomes more severe or is accompanied by significant pain or discomfort.
  • Unusual Discharge: If you notice a strong odor, green or yellow discharge, or any other unusual changes.
  • Fever or Chills: These could indicate an infection that requires prompt medical attention.
  • Persistent Symptoms: If your symptoms do not improve with over-the-counter treatments or if they recur frequently.

Remember, while I can provide information and suggestions, it's crucial to consult a healthcare professional for a formal diagnosis and appropriate treatment.

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2 mo ago


People Also Ask


What are common symptoms of a yeast infection and how can it be treated?

Common symptoms of a yeast infection include vaginal itching, irritation, and sometimes a thick, white discharge. It can be treated with over-the-counter antifungal creams or suppositories, and if symptoms persist, a doctor may prescribe oral antifungal medication.


How can bacterial vaginosis be distinguished from other vaginal infections?

Bacterial vaginosis often causes a fishy odor and a thin, grayish discharge, which can be more noticeable after intercourse. It is typically treated with antibiotics prescribed by a doctor, and a healthcare provider can help distinguish it from other infections through examination and testing.


What are the risks of unprotected sexual activity in relation to STIs?

Unprotected sexual activity increases the risk of sexually transmitted infections (STIs) such as trichomoniasis, chlamydia, and gonorrhea. These infections can cause symptoms like itching, irritation, and changes in discharge, and require specific antibiotics or antiviral medications prescribed by a healthcare provider.


Can hormonal changes due to Long Covid or medications affect menstrual cycles?

Yes, hormonal changes due to Long Covid or medications like Prozac, Adderall, and Clonazepam can affect menstrual cycles, leading to symptoms such as irregular periods, spotting, and vaginal itching. Managing underlying conditions and discussing medication side effects with a doctor can help address these issues.


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