ABSTRACT

One-third of all women of childbearing age currently have one or more vulvovaginal infections. Despite the discovery of highly effective, specific therapeutic agents against most vulvovaginitis, the overall incidence has not been favorably affected, and patients are inadequately diagnosed and treated by many care-givers all over the world. Indeed, due to the specificity of some complaints, and the avoidance of offering the patient a potentially embarrassing examination, too often patients are not examined well or not at all, and given prescriptions for treatment of a disease that is often thought to be Candida. This is a cumbersome evolution, as wrongly or undiagnosed patients are often maltreated or undertreated, and they start complaining after long periods of time without improvement or give up hope that their odyssey of suffering and seeing different care-givers will eventually come to an end. Very often, the answer is hidden in the first clinical encounter, which happens usually during the acute symptomatic phase. Indeed, if one fails to diagnose the disease correctly at first, some patients will develop a long-lasting chronic condition, in which complaints fluctuate, but signs and symptoms, and even laboratory means, become less and less clear and less convincing, further complicating the search for the correct management of an increasingly depressing chronic illness.

It is remarkable how many physicians continue to disregard the effects on the general wellness and sexual function such chronic vulvovaginal illnesses can bring along. So every effort has to be put into obtaining a correct and complete diagnosis during the first attack of the disease, in order to make the treatment likely to be successful. In our 20 years of experience in taking care of long-term suffering, mostly desperate patients with long-lasting chronic recurrent vulvovaginal diseases, we discovered three main problems of diagnostic accuracy. The first is that some doctors fail to develop their knowledge and clinical expertise along with the evolving medical advancements.The second is that patients may not recognize that what started as a one disease, for instance Candida, may have evolved over time into another disease, let us say chronic vestibulitis posterior (vulvodynia).