There is a very common vaginitis in Guangdong, which is characterized by unbearable vulvovaginal itching and bean curd-like leucorrhea. In severe cases, the vulva is swollen, the skin of the vulva is cracked and scratched, and there is a large amount of bean curd-like leucorrhea in the vagina, and the mucous membrane under the leucorrhea is congested and eroded when the leucorrhea is removed. On examination of the leukorrhea, interepithelial fungus and mycelium can be seen. It is called pseudomycosis vulvovaginalis. According to a survey, about 75% of women have had this type of vaginitis. A high percentage of these patients are seen in general gynecology clinics. In most cases, the itching is relieved soon after antifungal treatment and the leucorrhea is reduced. However, there are many patients with recurrent attacks. Some of them have several attacks during a year, and some of them don’t even have vaginal itching during every menstrual period. It seriously affects work and life. Some patients say that they are very nervous psychologically when their menstruation is approaching because the vulvovaginal itching will come on time. What can be done to cure it? Comprehensive literature reports that about 30% to 40% of women with vulvovaginal pseudomonal yeast disease experience recurrent episodes after treatment. A similar situation has been observed in my gynecological outpatient cases. Why are there recurrent episodes of this vaginitis? 1. It is related to the patient’s systemic or local resistance. Pregnant women, those with diabetes or those on immunosuppressive drugs are prone to develop you Candida vaginitis. The vagina itself is a non-sterile environment and there are many kinds of bacteria in the vagina. Among these flora, Lactobacillus predominates, and this bacterium converts the sugars secreted by the vaginal epithelium into lactic acid, which inhibits the growth of pathogenic bacteria. The vaginal epithelium secretes mucus, which, together with local immunity, allows the vagina to contain bacteria without any problems. When this environment is disrupted, pathogenic bacteria may take advantage of the situation. People with decreased immune function may have a local immune response disorder, which may easily lead to Candida infestation. 2. Taking broad-spectrum antibiotics can easily trigger dysbiosis in the vaginal flora. When Lactobacillus decreases and the side that inhibits Candida decreases, it is easy to develop vulvovaginal pseudomonal yeast disease. Many people have the habit of applying antibiotics without moving. For example, if you have a sore throat for a short time and gastrointestinal discomfort, you take antibiotics. Inappropriate application of broad-spectrum antibiotics can cause dysbiosis in the vaginal flora. This leads to Candida vaginitis. Clinically, there are patients who had a major surgery and applied antibiotics for a period of time and later got into this vaginitis. 3. It is related to the humid and muggy weather in Guangdong. In Guangdong women, the proportion of vulvovaginal pseudomonal yeast disease is high, while this disease is uncommon in women outside the province. 4. It is related to tight and airless underwear. Imagine wearing tight and non-ventilated clothes and pants, plus pads and sanitary napkins, under the weather in Guangdong, plus vaginal secretions and sweat, the vulva perineum area is such a humid and stuffy environment! The skin of the vulva is prone to stain-like changes and white surface erosion, making it extremely susceptible to fungal infections. Why is it easy to have recurrent attacks? In addition to the above factors, it is also related to fungal drug resistance and incomplete treatment. 20 years ago, mycophenolate was very effective, but now many patients are ineffective. Drug sensitivity tests also confirm this. Incomplete treatment is related to the course of treatment set by the doctor and the patient’s compliance. Fungal infections of the skin and mucous membranes are different from other bacteria in that they have less severe systemic symptoms but are more difficult to clear locally. Skin `symptoms are fungal infections as is vulvovaginal pseudomycosis. Topical medications for skin`s often need to be applied topically for a longer period of time, otherwise they tend to recur. Likewise, this vulvovaginitis requires longer topical application. Many patients take it back, use it for one or two nights, don’t itch anymore, and stop taking it. In a short time, it comes back. For patients with recurrent vulvovaginal pseudomelanosis, we use a comprehensive set of treatments that work well. First, we need to check for diabetes and immunocompromised conditions. If there is, treatment is required accordingly. Next, health promotion and education is used to understand the factors that trigger the disease and to avoid it. Encourage wearing loose and breathable clothing and pants to keep the vulva area dry. The vulva area should be cleaned, preferably with cold water. For medication, topical medication is given to both the vagina and vulva, with clotrimazole and ketoconazole preparations as suppositories to the vagina and creams or pastes to the vulva perineum. The duration is at least one week. Some patients are treated with intensive oral fluconazole for one week followed by one capsule per week for 3-6 months. The goal is to drive out the causative bacteria and allow enough time for the vaginal epithelium to repair. Many patients with recurrent candidiasis for many years are cured by this method.