Brief Answer: FOLLOW THE GUIDELINE. Detailed Answer: Hello, Thanks for writing to us. I am trying to solve your problem. From your given history, I can assume that above clinical features may be due to protozoa or parasite infestation as bacterial infection and vaginal thrush are ruled out by repeated vaginal swab test. Vaginal dryness is quite common among breast feeding mother. Other least possible causes could be allergic reaction to soap/ perfume or other bath products, inserting foreign objects, urinary tract infection, improper genital hygiene etc. TREATMENT: With above condition, I treat my patient by following regimens: 1) Single dose ALBENDAZOLE (400 mg) tablet orally. In severe case, it is given for next 3 days. 2) METRONIDAZOLE Vaginal Gel (0.75%) 2-3 times daily or Vaginal suppository at bed time. If itching or swelling still persists, CORTISONE 1% cream can be given to reduce local inflammation. 3) Local hot compression and maintain genital hygiene properly. You can use water based lubricant (like KY gel) to reduce vaginal dryness. In addition, SITZ bath with olive oil can be continued. Kindly, consult with your local doctor for complete prescription. PREVENTIVE MEASURES: 1) Take anti oxidant (Vitamin-E, C, selenium, zinc etc) supplements with diet. 2) Do not touch or wipe out genital area too much. Also avoid inserting objects or tampons. Don't wear wet cloths for long time. 3) Wear only clean & cotton underwear. Don't wear any tight fitting cloths or pants to avoid repeated friction/ irritation. Remove underwear at bedtime. 4) Don't use chemical cosmetics or detergent powder/ soap or perfume around genital area. Also avoid chemical subs or lubricant gel during sex. 5) Avoid sexual relationship till the problem is resolved and practice protected sex in future. Hope, above said information is very much helpful to you. Let me know, if you need any clarification. Wish your good health and take care yourself. Regards, Dr Soumen For future query, you can directly approach me through WWW.WWWW.WW

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Brief Answer: DETAILS ARE GIVEN BELOW. Detailed Answer: Hello, Thanks for follow up query. Followings are my comments: 1) If your baby is more than 6 months old, then you can take single dose (400 mg) ALBENDAZOLE tab. It is not harmful in regular dose after 6 months. If your baby is less than 6 month old, you shouldn't take that. 2) There is no contraindication or harmful effect on applying METRONIDAZOLE VAGINAL GEL (0.75%). It is quite safe during lactation period. You can use it. 3) Parasites or protozoa are very small and usually can't be seen on naked eye during examination. However, one stool test and wet preparation test of vaginal discharge under microscope could be worthwhile to identify the causative agent. You can consult with your doctor regarding this and for pelvic examination. 4) In the mean time, you must follow the preventive measures and apply vaginal lubricant (KY Jelly) to reduce dryness and maintain moisture. Do not scratch the area which can aggravate the condition. 5) KY Jelly & METRONIDAZOLE VAGINAL GEL (0.75%) both are available over the counter without prescription. You can use those safely until you go for next visit to your doctor. Hope, above information is quite helpful for you. If you don't have any other query, you can close the discussion. All the best. Good luck. Regards, Dr Soumen

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Brief Answer: DETAILS ARE GIVEN BELOW. Detailed Answer: Hello, Thanks for additional query. 1) I have already mentioned the underlying causes (beside protozoa or parasite) in my earlier text like allergic reaction in contact with soap/ detergent/ perfume or other bath products, imbalance of vaginal pH and low estrogen level during lactation period, vaginal dryness, urinary tract infection (UTI) etc. 2) If Wet preparation test comes normal, then one Culture Sensitivity test of vaginal discharge, one stool test and urine examination (routine & culture) are quite helpful to narrow down the causative agents and pinpoint the diagnosis. 3) In addition to previous treatment strategy, Vaginal pH should be corrected during lactation period with VAGISIL Cream or RepHresh Gel. You must follow the preventive measures to get effective result. Hope, it helps for you. Take care yourself. Regards, Dr Soumen

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Brief Answer: FOLLOW THE GUIDELINE. Detailed Answer: Hello, Thanks for response and giving additional information. 1) In this context, low estrogen level with vaginal dryness and imbalance of Vaginal pH during lactation period are the most important cause of itching and mild swelling if other causative agents are ruled out by previously mentioned lab tests. 2) To correct hormonal imbalance, you must avoid mental stress or emotional upset by regular meditation or yoga (15 to 30 min) and control body weight by regular mild to moderate exercise. In addition, you can take estrogen containing food stuffs like beans, peas, rye, lentils, whole grains, millet etc. No estrogen pill is recommended during breast feeding. Drink more water or juice for better systemic circulation. 3) Ovarian cyst can cause hormonal imbalance which indirectly can cause dry vagina to some extent. However, improper function of vaginal or cervical gland are the main reason of vaginal dryness and itching. Here, you can use WATER based lubricant (KY Jelly or Astroglide) or moisturizer (like Replens, Luvena) to increase function and lubrication of vaginal gland and reduce vaginal dryness. Hope, I have answered your all queries. Kindly, close the discussion if you don't have any other query. Regards, Dr Soumen

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