IT is a problem few women like to talk openly about. Characterised by a persistent itch or irritation 'down under', vaginitis is a common gynaecological condition that plagues a good many women here each year.

Yet despite it being widespread - about three out of every four women will experience at least one episode of vaginitis in their lifetime - patients and even doctors here are still somewhat befuddled by the condition.

'Vaginitis is an inflammation of the vagina that can result in discharge, itching and pain. It can be caused by bacteria, or parasites, or fungus. The symptoms for all three types of infection can be quite similar,' says Christopher Chong, secretary of the Obstetrical & Gynaecological Society of Singapore (OGSS).

This can pose a problem for doctors, since the cause may not be easily determined on the basis of symptoms or physical examination alone. Not infrequently, making an accurate diagnosis will involve sending a specimen of vaginal fluid for laboratory testing under a microscope.

'The problem is that diagnosis takes time. Such tests could take a few days. But in the meantime, the woman will be in great distress. So the question is: Should the doctor offer treatment even before confirming the actual cause of vaginitis?' asks Dr Chong.

In his opinion, the answer is a qualified yes.

The OGSS recently outlined the correct treatment approach to vaginitis at a recent KK Hospital Combined Annual Scientific Meeting.

'Without prompt treatment, you run the risk of the condition worsening. We don't want to under-treat because this could lead to greater tolerance for the infection in future. But we don't want to overtreat, too,' says Dr Chong.

The best thing to do immediately will be to thoroughly clean up the discharge, followed by the prescription of a broad-spectrum medication that will take care of everything - bacteria, parasites and fungus.

'Many doctors prescribe oral medication but neglect to clean out the vaginal tract. This doesn't get rid of the problem. They should do a good cleaning, before offering the patient medication,' says Dr Chong, who uses a drug called Neo-Penotran. This medicine, in the form of a tablet, is inserted deep inside the vagina twice a day for a week and works as a 'cover all' for the various kinds of vaginitis. A complete dose costs about $40.

Treatment aside, Dr Chong feels women here lack awareness of the condition. He explains that the vagina, being exposed, can become easily infected.

'The most common vaginal infections are bacterial vaginosis and vaginal yeast infection,' says Dr Chong.

Bacterial vaginosis results from an overgrowth of one of several organisms normally present in the vagina. Usually, 'good' bacteria outnumber 'bad' bacteria in the vagina. But if the latter become too numerous, it could upset the balance. This form of vaginitis is usually spread during sexual intercourse, although it can occur in people who aren't sexually active.

Yeast infections, on the other hand, occur when certain factors change the normal environment of the vagina, triggering an overgrowth of fungus.

Symptoms for both forms of vaginitis could include intense itch, pain and also changes in the colour, odour or amount of discharge from the vagina.

Left untreated, a vaginal infection could spread upwards, to the womb and ovaries. This could lead to severe pain in the lower abdomen which may require hospital intervention. In the worst case, vaginitis could cause infertility.

'If left alone, vaginitis can spread and block the fallopian tubes causing sub-fertility. Also, the infection can kill sperm, making it difficult to conceive,' warns Dr Chong.

It need not get to that stage, though, if women keep several tips in mind.

'Three things encourage the proliferation of germs - blood, urine and sweat. Therefore, women who are menstruating should be especially careful about hygiene, because it presents a good environment for bacteria to grow,' says Dr Chong, who adds that pregnant women are especially susceptible to vaginitis.

'Pregnancy is a time when one's resistance is lowered. If this pregnant woman has had vaginal infections before, the resistance in the genital may be further lowered during pregnancy, making infection easier,' he explains.

According to Dr Chong, a good dose of certain foods may help prevent vaginitis.

'Eat yoghurt that contains active lactobacillus cultures. This sometimes helps reduce recurrent vaginal yeast infections. Lactobacillus is a type of good bacteria that is common in the vagina. Cranberry juice is also good as it prevents urinary tract infections,' advises Dr Chong.

Last but not least, women should douche with care.

'Douche only if you know the proper technique. Whatever you do, please do not wash the vagina out with soap, or worse, dettol! Just plain water will do, or if you must, use a feminine wash.'

KK Hospital will be launching a GP survey on vaginitis diagnosis and treatment approaches, the results of which will be announced in late August.

This article was first published in The Business Times on Aug 9, 2008.