DEAR DR. DONOHUE: I’ve never heard of getting a yeast infection without having taken an antibiotic, but I have one and never took antibiotics. It is agony, with terrible itching and burning. What caused it? Will I ever get rid of it, or is it something I have to live with? I have not had sex since my husband passed away 25 years ago. – L.D.

ANSWER: The vagina has many bacteria and some yeasts, but the largest population of organisms is a kind of bacterium called lactobacillus. These bacteria make lactic acid and hydrogen peroxide, which keep the other bacterial and yeast populations in check. When a woman has to take an antibiotic for an infection somewhere else in the body, the antibiotic can kill the lactobacillus bacteria, and then other bacteria and yeasts, such as the candida yeast, multiply and take over the territory vacated by lactobacillus.

However, the antibiotic-yeast link is not the sole cause of such infections. Tight, insulating underwear, diabetes and the female hormone estrogen give rise to vaginal infections. In fact, most women come down with these infections without ever finding a cause for them.

Candida yeast infections produce itching and, often, pain upon urinating. They can also give rise to a thick, white, odorless discharge.

You can get rid of a yeast infection with one of the many creams, ointments, suppositories and vaginal tablets that are available. Clotrimazole, Vagistat, Monistat, Mycelex and Gyne-Lotrimin are some examples. If these medicines prove ineffective, the oral medicine Diflucan can often bring success.

Keep in mind that candida yeast infections are not the only causes of vaginal itching and discharge. If your infection isn’t controlled with one of the above medicines, then a microscopic examination of vaginal secretions is a must to find out the true culprit. Or if it is candida but it doesn’t respond to medicine, it might be necessary to test its susceptibility to the medicines. It could have become resistant to them.

The booklet on vaginal infections discusses their common causes and treatments. Readers can order a copy by writing: Dr. Donohue – No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6.75 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: My husband thought he had hemorrhoids, but when he finally went to the doctor, he found out he had a fissure. The doctor recommended fiber and soaks in warm water. He continues to have recurrences. Can you tell us more about this? – E.M.

ANSWER: Fissures are painful tears in the anal skin. Frequently, constipation is the cause. Straining to eliminate hard stool tears the skin. Such tears not only are painful, but they can itch and bleed.

Squatting in a tub of warm water – sitz baths – promotes healing.

Your husband has to adopt a program that keeps his stool soft if he wants to prevent recurrence. Fiber usually can do the trick, but if it isn’t working, then he should go on a product like Metamucil or use a stool softener such as Colace.

He might need additional medicine. Part of the fissure problem comes about from a sphincter muscle that’s in spasm. The sphincter is a round muscle that encircles the anus to keep it closed. A sphincter in spasm puts tension on the anal skin and promotes fissure formation. Nitroglycerin ointment — the same ointment used for the chest pain of angina – relaxes the sphincter. He might try it.

When anal fissures refuse to heal or when they keep recurring in spite of maximum treatment, there are surgical procedures to remedy the situation.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.