Vulvovaginal candidiasis in young women with cystic fibrosisBMJ 1994; 308 doi: https://doi.org/10.1136/bmj.308.6944.1609 (Published 18 June 1994) Cite this as: BMJ 1994;308:1609
- S M Sawyer,
- G Bowes,
- P D Phelan
- Department of Thoracic Medicine and Paediatrics, Royal Children's Hospital, University of Melbourne, Parkville, Victoria 3052, Australia
- Correspondence to: Dr S M Sawyer, Respiratory Physiology Program 1-1302, Harvard School of Public Health, Boston MA 02116 USA.
- Accepted 7 February 1994
The great improvement in the survival of young people with cystic fibrosis over the past few decades means that most children with this disease now survive to face the challenges of adolescent and adult life.1 Little attention, however, has been paid to the reproductive health problems in these young people. In particular, women with cystic fibrosis may be at increased risk of vulvovaginal candidiasis because of frequent use of systemic antibiotics and a relatively high prevalence of diabetes mellitus. We report the rate of vulvovaginal candidiasis in young women with and without cystic fibrosis.
Subjects, methods, and results
Women aged 18 years and over who attended the cystic fibrosis service at our hospital or the Alfred Hospital, Melbourne, Australia, were invited to complete a self administered questionnaire on reproductive health. This covered a wide range of reproductive health concerns, but only the relevant results are reported here. Control subjects from two general practices were asked to complete a modified questionnaire omitting questions related to cystic fibrosis and asking about other illness and drugs. We obtained details of pulmonary function (for cystic fibrosis), antibiotic use, and diabetes from the patients' medical records.
Fifty five of 62 (89%) women with cystic fibrosis completed the questionnaire. The mean age was 23.7 years for women with cystic fibrosis and 23.9 years for controls. In women with cystic fibrosis the mean forced vital capacity (percentage of predicted) was 81 (SD 21) and the mean forced expiratory volume in one second (percentage of predicted) was 64 (24). Ten women with cystic fibrosis had diabetes mellitus, 39 took daily oral antibiotics, and 19 regularly took oral contraceptives. A similar proportion of respondents in each group were sexually active (41/54 with cystic fibrosis v 60/76 controls).
In response to the question, “Have you had vaginal thrush infections (candida infection)?” 13 women with cystic fibrosis reported suffering from vulvovaginal candidiasis either once a month or almost all the time compared with four controls (P=0.002; table). Thrush that was persistent or difficult to treat was reported by 25 (35%) women with cystic fibrosis and 10 (13%) controls (P=0.005). Twenty five of the 43 women with cystic fibrosis who had had vulvovaginal candidiasis recognised an association with oral antibiotics compared with 14 out of 45 controls (P=0.05). There was no significant association with diabetes (4/10 of those with diabetes versus 9/45 of those without diabetes had vulvovaginal candidiasis at least once a month; P=0.18).
Although vulvovaginal candidiasis is a common problem, we are unaware of longitudinal studies in all women or those with known risk factors such as regular antibiotics or diabetes mellitus. It has been estimated that 75% of women will have at least one episode of vaginal candidiasis, 50% will experience a second episode, and 5% will have severe, intractable symptoms.2
The health system, and health professionals generally, trivialise illnesses and diseases that are common, easily treated, and not life threatening.3 This is especially true in patients with severe chronic illness, when health professionals focus on disease stability and survival. This may explain why the problem has not been highlighted and suggests that ways of reducing the risk of candidiasis were not explored for many women.
Our results suggest that women with cystic fibrosis should be given advice about candidiasis. As the transition from paediatric to adult health services for people with chronic illness occurs mainly by default4 all people providing health care to young women, whether in a paediatric or adult setting, should be capable of meeting their reproductive health needs.
We thank Dr Trevor Williams and Ms Libby Francis from the department of respiratory medicine, Alfred Hospital, for their help.