April 26, 2000 -- Think you know when you have a yeast infection? Maybe not. According to a recent study in the current issue of the journal Family Practice, women often self-diagnose vaginal infections incorrectly and then use over-the-counter vaginal medicines inappropriately or against recommendations.
The results of the study raise concerns about women's ability to self-diagnose correctly, according to the study's lead author Sinikka Sihvo, of the University of Helsinki, in Finland.
Vaginal yeast infections, which are caused by an organism called Candida, are common in women, affecting as many as 75% of all women during their lifetimes. Vaginal itching is the most common symptom of a yeast infection, but women may also have a thick, white discharge and pain when they urinate. Yeast infections can also be treated by applying antifungal medications to the vaginal area.
In the early 1990s, some vaginal antifungal medications like Monistat became available "over the counter" (without a prescription) to allow women to self-diagnose and self-treat this common infection. However, not all vaginal itching is caused by yeast infection.
Sihvo and colleagues used two questionnaires to assess women's use of medicines to treat vaginal infections and physicians' views about problems women have after treating themselves. The questionnaires were administered at random to almost 300 women who purchased antifungal medicines in Finnish pharmacies and to more than 300 gynecologists and general practice physicians in Finland. General practice physicians are known as primary care physicians in the U.S.
Results from the women's survey showed that 44% of the women could be classified as using vaginal antifungal drugs against recommendations. This included women who had never before been diagnosed by a physician as having a Candida infection, those who used the medicine two or more times in the previous year without consulting a physician, those who were pregnant and had not been advised to use the medicine by a health care professional, and those younger than 16 years old.
According to Sihvo, results of the physician survey found that side effects reported from women using antifungal medications were often due to unnecessary use and use of the medicine for the wrong reasons. In fact, 21% of physicians found that the side effects were serious.
"We do see a fair number of women who have self-diagnosed and used over-the-counter antifungals," says George Huggins, MD, director of obstetrics and gynecology at Johns Hopkins Bayview in Baltimore, in an interview with WebMD. He says that use of these medicines can 'muddy the waters' when trying to diagnose an infection that is not due to yeast.
The over-the-counter medicines are great for women who have had yeast infections previously diagnosed by a physician and who know the symptoms, he says. "For them, the availability of antifungals over-the-counter gives them immediate access to treatment and saves them a visit to a physician. "
But Huggins adds that there are a large number of women who waste money on these medicines treating infections that are not caused by yeast.
Huggins and the researchers agree that over-the-counter vaginal antifungal medicines are likely to remain in drugstores, so they recommend that physicians, pharmacists, and drug companies provide better information to women about yeast infections and these medicines.
"Women who use these products should be encouraged to see a physician if they try one of these products one time and do not get their desired result," says Carl Weiner, MD, professor of obstetrics and gynecology at the University of Maryland School of Medicine. "They are wasting both time and money if they continue to attempt to self-treat."