Itch and pain in the female GUS & ReproS

The female genitourinary system (GUS) and reproductive system (ReproS) are close together and  delicate. They are a woman's best friend. The female genitalia must be properly washed daily, each time after defecation or urination. Soaps and body wash gels and liquids used for personal hygiene matters for the female, not so much for males.

I'm bringing up this matter because this is a common problem in females, and many females end up coming to hospital or clinic for pain in the genitalia and/ ReproS. 

Young women and old women also get infections of the female genitalia. Mothers often have hematuria (blood in urine, bloody urine) and pain urinating following maternal delivery. Non pregnant women and menopausal women also get infections, but less frequent than mothers in their reproductive age.

Infections of the female genitalia can mean a lot of things. It can be just urinary tract infection (UTI). It can be just extreme itch due to Chlamydia trachomatis infection. It can be both UTI and Chlamydia. It can be other things. A good physical examination to locate the itch, pain and examination of the female genitalia becomes necessary. Itch with yellowish discharge indicate pus, coming from an infection. 

Sometimes doctors do not convey the condition clearly to their female patients, leaving the patients lost as to what conditions they actually have. This is bad enough as women tend to worry a lot when something goes wrong in the most private part.

Here is a scenario to let you see the scope a how a female patient got very worried. Text is edited.

SCENARIO

A 67-year old unmarried female Malay lady lives alone after retirement at 55. She had pain on urination and was admitted to hospital. She was diagnosed to have UTI and prescribed a course of antibiotics. Her condition did not heal after a week and she was again prescribed another course of antibiotics for a week. She was discharged home. 

At home, she was still sensing pain upon urination once in a while. She contacted some friends for help. Her friends tried to help and asked her questions too.

1. She wanted to know if she needed a third course of antibiotics to rid her pain. Her friends replied no, and to seek traditional alternatives.
2. She wanted to know if her blood test results was a sign of stone in the bladder. Her friends asked if the doctors had performed an ultrasound scan of the kidneys and bladder when they did her urine test. She replied no.
3. Her friends told her that renal stones hardly form in the urinary bladder unless she was a "teh tarik" person. They told her that if she was a teh tarik person, then she would have had renal stones by age mid-20s. She replied she did not like tea latte since young. Her friends said they did not think she had renal stones since she was not a teh tarik fan. She had to be a better consumer of teh tarik than the teh tarik man in order to get renal stones.
4. She asked if it was just infection? Her friends believed so it was an occasional infection.
5. She said her doctor first said it was UTI and she was given Zinnat.
6. She said she took 2 courses of antibiotics but her condition did not resolve as she had expected. So she was worried. Her friends tried to calm her down and said her condition would resolve, and was just taking a bit longer.
7. She wanted to know if the lab test results meant a dangerous condition. She was really worried and wanted some clear answers.
8. Her friends told her that even if she kept her personal hygiene super clean, she can still catch an infection. She wanted to know how and why? Why in the world would over-washing and being super clean give infection?
9. She wanted to know if her infection was the side effect of antibiotics, .... possibly a Candida?
10. Her friends told her if she had Candida, she would not and could not remain still as the itch is do severe and dreadful. She said she did not feel any itch, just the pain when urinating.
11. Her friends told her Candida was unlikely in elderly ladies her age. It was just one of those infections.
12. She wanted to know if she had to take MORE ANTIBIOTICS!
13. Her friends tried to calm her down and told her to treat her condition conservatively, ie, to drink warm water regularly, every hour and before bed.
14. She wanted to know if increasing water intake will resolve her condition. Will her infection clear up?
15. Her friends added, yes, conservative treatment is alright, ie, drink water, get some rest, eat boiled food, no spicy food, until her condition improves and clears up.
16. Her friends asked if her pain was increasing or otherwise. 
17. She wanted to know if she was ok, and not worry about her condition.
18. Her friends told her worrying would only add to her existing problem (ie make it worse).
19. She said sometimes there was no pain and at times, there was excruciating pain upon urinating.
20. Her friends told her not to worry too much. She said she was a worrier!
21. According to the lab test results, there was blood in her urine. Her friends explained why.
22. Her friends asked if her urine was cloudy (murky), clear or sandy? She replied it was clear.
23. Her friends responded she had no stones.
24. She furnished her lab test results:  pH 5.5, protein, glucose, ketone nil.
25. Her friends explained she did not drink sufficient water and that she was probably dehydrated, her urine was probably concentrated, with a highly acidic pH (lower limit of normal range). If she had eaten meat (chicken or beef), that too would make her urine highly acidic. Urine pH 5.5 is ok but pH 6.0 is better.
26. She furnished additional lab test results: Epithelial occasional, crystals and casts ... nil. Her friends explained why.
27. She asked if the amount of blood in the test results was not a lot. Her friends replied no.
28. She furnished additional lab test results: WBC up to 100 ... a lot! She was intimidated by the "big numbers".
29. She furnished yet additional lab test results: Leukocyte 3+. Her friends explain why, ie WBCs are raised in infections. They wanted to know if her doctors have found out what bacteria had invaded her.
30. She thanked her friends for alleviating much of her fears about her condition as it was uncomfortable. She wanted to know if she needed to next see a urologist or a gynae.
31. She said when she was admitted, her urine culture did not show which bacteria was significant.
32. She said her first urine test had no RBCs and had no blood in urine.
33. Her friends informed her of likely bacteria as causative agents of her painful episodes upon urination.
34. It has been a week after her discharge from hospital. She lived alone and that caused her a lot of worry.

In the end, her friends managed to counsel her and she was happy that her condition could be easily taken care of. She seemed much happier after getting all the answers she needed. Her doctors should have taken additional time to explain to her, her lab test results and the progress of her condition. It saves the patient a lot of useless worrying when they can be advised on the next course of action to take at home and therefore be in a position for self-help. They in turn can help other friends who face the same condition.

External links
https://en.wikipedia.org/wiki/Chlamydia_trachomatis
https://www.emedicinehealth.com/candidiasis_yeast_infection/article_em.htm