Q. I have recurring vaginal yeast infections. Is there something I can use to treat them without having to see my doctor each time? He'll only give me a non-refillable prescription. A. Vaginal yeast infections, also known as monilia or candida infections, can be annoyingly difficult to clear up. If you've had several typical bouts, with no unusual features, I think it's reasonable to ask your doctor for a refillable prescription.
Some conditions make you more likely to suffer from recurrent yeast infections. Diabetes is the most notable, and it's probably worth getting a blood sugar test to check for this. Others are pregnancy, use of birth control pills, and use of antibiotics, particularly tetracycline- and penicillin-type medications.
Feminine hygiene sprays and frequent douching also may change the normal vaginal environment and lead to yeast infections.
Yeast grows better in moist environments, so panty hose and noncotton underwear may make you more likely to have recurring vaginal yeast infections.
Medicated douches containing the antiseptic substance povidone-iodine are sometimes effective remedies for vaginal yeast infections. Two brands, available without a prescription, are Betadine douche and Massengill Medicated douche. If you have a severe yeast infection, these douches may be irritating. Also, you shouldn't use these products during pregnancy unless prescribed by your doctor.
Another approach used in treating troublesome yeast infections is taking an antiyeast medicine called nystatin by mouth. Sometimes this is also prescribed for the male sexual partner, the idea being that he can be a carrier of yeast. This type of therapy is not used very often because the standard treatment using medicated creams or vaginal suppositories is very effective.
The Washington Women's Self-Help Group recommends inserting yogurt into the vagina to combat yeast infections. The active cultures supposedly create an environment hostile to the yeast. As yet, few scientific studies support the effectiveness of this strategy. Q. I never hear anything about the hazards of cigar or pipe smoking. Are they dangerous? A. Cigarette smoking is associated with more than 300,000 deaths each year. Understandably, the surgeon general has proclaimed cigarette smoking the nation's largest preventable health problem.
As some people have given up cigarettes for other forms of tobacco, doctors are seeing increasing dangers with cigarette substitutes, such as cigar or pipe smoking, snuff and chewing tobacco. Most significantly, doctors have linked these tobacco products to oral cancer, a potentially fatal disease. The risks of other cancers and heart disease is greater in cigarette smokers compared with pipe and cigar smokers, but for cigar and pipe smokers who inhale -- a common practice among former cigarette smokers -- the risks are greatly increased. I think it's wise to consider tobacco harmful in any form, and recommend avoiding it entirely. Q. I have a small, bean-shaped lump on my anus. It's not painful, only a little itchy. What could this be? A. Only an exam by your doctor could tell for sure. In most cases, what you describe turns out to be an external hemorrhoid, also known as a pile.
Hemorrhoids are swellings in the veins that are normally present just inside the anal opening. However, an unusual lump or swelling is one of the seven warning signs of cancer, so it's best to have your doctor check any unexpected lump. The American Cancer Society also recommends yearly rectal examinations and stool tests to check for rectal and colon cancer in all adults over 40.