DEAR DR. DONOHUE: I have battled a vaginal yeast infection without any success. I have used many different creams, but I haven’t made any progress. I am 66, and this is my first experience with such a problem. Can you offer any ideas? — B.W.

ANSWER: It might be that you don’t have a yeast infection.

For women who are past menopause, the No. 1 cause of vaginal discharge, itching or pain isn’t an infection; it’s atrophic vaginitis. The vaginal lining thins and dries because estrogen isn’t available to keep it healthy. This leads to irritation and inflammation, which produce painful intercourse, itching, burning and a bad-smelling, yellowish discharge. Estrogen products can reverse these changes. The ones I mention are applied directly to the irritated tissue. Estrace, an estrogen cream, is a popular choice. Vagifem, estrogen tablets, is inserted into the vagina for gradual dissolving. The estrogen ring, Estring, is another device that slowly releases estrogen after its insertion into the vagina. The dose of estrogen in these products is small. Only a tiny amount actually gets into the blood. The direct contact of estrogen with tissues is what brings relief. All of these products come with a warning about the possible consequences of estrogen, things like breast cancer. However, because of their low estrogen dose and because of the minimal amount of estrogen that makes its way into the blood, such side effects have not been a problem. A doctor has to determine if an individual woman is a candidate for this treatment.

Turning away from atrophic vaginitis to vaginal infections, we’re faced with the big three: candida yeast infection, trichomonas infection and bacterial vaginosis. A yeast infection produces a white discharge, often with clumps that look like milk curds. The irritated vaginal lining reddens and itches. Nystatin cream is one of the many products that end candida infection. The second infection trichomonas (TRICK-oh-MOAN-iss) gives rise to a yellowish-green discharge with an offensive odor. Metronidazole or tinidazole are its treatment. The third infection is bacterial vaginosis, a loss of the normal vaginal bacteria and the rise of unfriendly bacteria. It produces an odorless, white discharge. It, too, is treated with the same medicines used for trichomonas.

The booklet on vaginal infections treats these conditions in greater detail. To order a copy, write: Dr. Donohue — No. 1203, Box 536475, Orlando, FL 32853-6475. Enclose a check or money order (no cash) for $4.75 U.S./$6 Can. with the recipient’s printed name and address. Please allow four weeks for delivery.

DEAR DR. DONOHUE: For about three months, I had a sore on my forehead. Finally my wife insisted I see our doctor, who sent me to a dermatologist. He biopsied the sore, and the report came back as basal cell cancer. I can’t see any evidence of the sore now. The dermatologist wants to do more cutting. Is this necessary? — R.B.

ANSWER: Basal cell skin cancers arise from the basal skin layer, the deepest layer. They don’t usually spread, but they can dig deeply into underlying tissues and even bone, and produce a deformity.

The biopsy must have shown the doctor that the edges of the cancer were not taken in the biopsy. That’s often the case. Basal cancerous cells still remain in the skin. They’ll pop out again and again if they are not removed. Even though you see no evidence of cancer, more skin has to be taken.

DEAR DR. DONOHUE: Does douching prevent infections?

My mother insisted I regularly douche to stay healthy. Many years ago, I stopped the practice. None of my friends do this. I wonder if I am doing the right thing. Am I? — A.Y.

ANSWER: You are. Douching doesn’t prevent infections. It more likely to lead to an infection. The vagina cleanses itself.

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.

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