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Q: I've been to several doctors over the past year for a very embarrassing problem, but it keeps coming back and I need your advice.

It all started with itching and a small amount of frothy discharge from my vagina. Over a few weeks it got worse, and intercourse started to be painful. I treated it with a couple of over-the-counter creams for candida without any success. And when I douche, it seems to flare back worse than before.

Each doctor I've been too has given me a prescription for a vaginal suppository. It seems to work, but then the problem returns a month later. Is menopause the reason for my problem?

-- A.L., North Hollywood, Calif.
A: It would be a lot easier to offer advice if I knew what the doctors said your problem was, and how they arrived at their diagnosis. But I think I can provide enough information to help.

When any skin or mucous membrane, such as the vagina, itches, it's almost always due to the release of histamine or similar chemicals under the skin. And this is almost always caused by inflammation of the area.

The medical challenge is to identify the underlying cause of the inflammation. It's also very important to determine if the mucous membrane lining the vagina is less healthy and therefore more likely to become inflamed by anything.

Vulvovaginitis is the medical term given to inflammation or infection of the vagina and surrounding tissue. A common symptom is abnormal vaginal discharge. Discharge is defined as abnormal if it occurs in large amounts, has an offensive odor, or is accompanied by vaginal itch or pain. The characteristics of the discharge depend on the cause.

Inflammation can be caused by many agents and conditions. They include infections, physical irritation, allergic reactions, tumors, drugs, radiation, hormonal changes, and the friction of sexual intercourse.

Vaginal infections can be due to bacteria, fungi, protozoa and viruses. Some chronic diseases, such as diabetes, can contribute to the growth of bacteria and fungi, as can decreased personal hygiene. And the decrease in estrogen around menopause makes the vaginal lining more susceptible to insult from any cause.

The most common vaginal infection is due to the fungus called candida. It typically causes a white, curd-like discharge with little to no odor. Diagnosis is often made by the woman herself and treated at home. But resistant cases need to be examined and the discharge looked at under a microscope.

Bacterial vaginitis, also called vaginosis, tends to produce a grayish, frothy or cloudy discharge with a foul or fishy odor. The odor may become stronger after intercourse or washing with soap, both of which reduces vaginal acidity and encourages bacterial growth. If your frothy discharge also had a strong odor, it's most likely that this is your problem -- in which case I hope that the suppositories you were prescribed contained antibiotics.

A very common underlying problem for women after menopause is the aging of tissue covering the vagina, including the outer parts called the labia. This condition is called vaginal atrophy. I suggest that you seek advice either from a gynecologist or a geriatric physician to determine if vaginal atrophy is the cause of your recurring bacterial infections.

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