The female client who was thinking of divorce after getting itchy down there

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Agatha, a staunch religious adherent, had strong values on issues of sex and marriage. One of her beliefs was monogamy. She believed in the principle of one man one woman and could not tolerate a cheating husband. 

“My friends have warned me that I should leave room for some erring from my husband, Noah, to avoid a catastrophic heartbreak in the event that I catch him cheating but I have my own standards: you cheat, we part ways, it is that simple,” she declared when I first saw her at the Sexology Clinic. She came with Noah for the consultation for what she described as a decisive moment in their relationship.

Noah intimated that the previous night had been one of their worst in the marriage. His wife came home having done her investigations on how to file for divorce. He was not aware that she had taken such drastic steps. 

“Noah, we need to talk,” she said after the children had gone to bed.

Having been married for five years and with two children to show for it, Noah had learnt a lot about Agatha. Whenever she started her conversation with the “we need to talk” phrase, things were not to be rosy. His heart, therefore, sank for he didn’t know what would follow. And yes, Agatha hulled the bombshell.

“Who is this woman you are sleeping with?” She asked gearing up for a fight.

“I do not understand what you mean,” Noah answered.

The problem was that Agatha was having itchiness on her private parts. Initially, she thought she was reacting to her underwear. She got more worried when she started having a whitish discharge. In her life, she had vowed never to cheat on her husband and she expected the same from him. She was scared stiff of HIV and knew that a one-time mistake could change her life forever. She had repeatedly told her husband that she would rather stay single than live with an unfaithful man.

According to her, she did not expect this reality to dawn too soon, just five years into marriage. Even before discussing the problem with her husband, she talked to a lawyer and understood the process of divorce. She was prepared to walk out. Infidelity was a deal breaker. 

After a very difficult discussion at the night, Noah convinced Agatha to come with him to the clinic. According to him, he was innocent. He had no other relationship. He loved his wife and had no intention of getting another woman. He could not tell the cause of Agatha’s itching and discharge.

I examined Agatha and confirmed irritation of her vaginal area and the yoghurt-like discharge. I concluded that Agatha was suffering from vaginal Candidiasis, a common fungal infection. The disease is an overgrowth of the fungus in the vagina. In life, the fungus exists in low amounts in the vagina but changes in the body can make it overgrow and this causes itchiness and milk-like discharge. I informed Agatha that the disease was not sexually transmitted.

“But what makes the fungus over grow doctor if not infidelity,” she asked rather agitated, “why now? How come I have never had it since we got married?” 

Vaginal candidiasis is a common disease and I told Agatha as such. The disease is caused by a fungus called Candida albicanswhich is found in small amounts in the vagina and even in the mouth of healthy people. Immunity of the body keeps the amount of the fungus in check so that it does not overgrow. Changes in the body interfering with immunity could lead to the fungus multiplying. Some of these changes are caused by diseases while others are normal and physiological. 

Common among the physiological changes are fluctuations in body hormones. This happens from time to time and some fluctuations enhance fungal growth. Some fluctuations are a result of the reproductive cycle while others could be due to day-to-day stress. These fluctuations lower body immunity and cause the fungus to increase.  

Then there is the use of antibiotics. Antibiotics used to treat diseases such as throat infections and other common ailments are known to promote the growth of the fungus.

Diabetes, a disease that is increasingly becoming common, is another cause of the overgrowth of the fungus. This is because diabetes weakens the body’s immunity, creating an environment that makes the fungus thrive. 

Other diseases that depress body immunity such as HIV also exacerbate vaginal candidiasis. In this case, the disease is an opportunistic infection, taking advantage of the weakened body to thrive.

Then there are behavioural factors that promote the disease. A common practice among women – douching, is one such behavioural cause. Douching is washing or cleaning out the inside of the vagina with water or other mixtures of fluids. Most douches are sold in prepackaged mixes of water and vinegar, baking soda, or iodine. In the process, the protective layer on the surface of the vaginal wall is washed off exposing the vagina to candidiasis.

Given the many possible causes of this disease, it is important to have a thorough medical assessment to determine the cause. After assessing Agatha, I could not put a finger on any cause. Hers was idiopathic, a common finding in most cases of this disease. In such cases, all that is needed is to reduce factors that cause low body immunity such as stress and poor feeding and to provide antifungal medicines to curtail the fungal growth.

Agatha got her pack of medicines and the couple left the clinic. After a few days I got a call from Noah late in the afternoon:

“Doctor, I am at work, and imagine Agatha has called me and again said that we need to talk! We are meeting over coffee after work,” he said in a worried voice. We agreed that he would update me on whatever it was after their meeting. 

Instead of hearing from Noah, it was Agatha who called that evening:

“Doctor, I am healed,” she said, “we have met over coffee and I have apologised to my husband for falsely accusing him of infidelity, I have never loved him more,” she reported.    BY  DAILY NATION   

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