THE itch was so bad she could not stand or sit without fidgeting.

After five days, Ms Cynthia Ang, 25, could not take it anymore and went to see a gynaecologist and obstetrician (O&G).

The diagnosis: vaginal infection, a condition which affects at least one in five women here.

Her doctor, Dr Lee Keen Whye, a consultant obstetrician and gynaecologist at Gleneagles Medical Centre, prescribed Neo-Penotran, a vaginal suppository.

The relief was immediate.

The O&G Society of Singapore (OGSS) noted that women here are largely unaware of vaginal infections - or vaginitis - until the infections become very severe.

Those who visit a gynaecologist with the condition will do so for abnormal vaginal discharge.

And the leading cause for the discharge is vaginitis (vaginal inflammation or infection), according to the OGSS.

Last month, the society launched the 'V(aginitis)-free' public education programme to raise awareness that a vaginal infection is a common, treatable female gynaecological condition.

The weapon of choice is Neo-Penotran, a broadest-spectrum drug that was launched in January by pharmaceutical company Bayer Schering.

There are several causes for a vaginal infection, which is why it usually takes some time to diagnose and may require different medications to treat.

But this insert can treat nearly all these causes, even if it is related to a sexually transmitted disease.

OFTEN, NO CLEAR CAUSE

Dr Beh Suan Tiong, the president of OGSS, said: 'The problem with vaginitis is that although it strikes many women regardless of their age, the cause may not be easily determined on the basis of symptoms or physical examination alone.'

Often, in order to make a diagnosis, a specimen of the vaginal fluid has to be examined under a microscope.

However, the sensitivity of tests vary and may not always be accurate.

Additionally, such tests take up time and increase costs to the patient.

In the meantime, the woman will continue to experience discomfort, which can sometimes be severe, as it was in Ms Ang's case.

Ms Ang, a private tutor, said: 'It was so bad that I had to keep going to the toilet to relieve myself.

'After five days, it was not getting better and it was getting a little painful in the lower abdominal area, so I panicked.'

Her mother suggested that she see a specialist, recommending her own O&G, Dr Lee.

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Dr Lee said: 'The most effective solution is to prescribe the broadest-spectrum treatment at once so that it can provide immediate and effective relief.

'Then the patient can undergo more tests if the doctor thinks it is necessary.'

Ms Ang said: 'Dr Lee told me I very likely had a yeast infection, but since I had pain as well, he decided to do a culture of the discharge as he suspected there was also bacterial infection.'

Her culture was positive for bacteria.

So she had to undergo a course of antibiotics as well as a seven-day course of Neo-Penotran, which is inserted vaginally to target the affected area directly.

The itch went away immediately.

TOO MUCH SUGAR

An interesting trend Dr Lee noted was that after festive periods such as Christmas and the mid-autumn festival where many cakes and other sweet food items are served, he will see a surge in the number of vaginitis cases in the next two to three weeks.

This is because high sugar content in the urine encourages fungal growth.

Dr Lee said: 'You don't have to be diabetic to have sugar in the urine. Eating too many sweet things can also lead to sugar in the urine.'

This is something Ms Ang can identify with because she got her infection after the Christmas season last year.

'I have a very sweet tooth,' she said.

Another group of women Dr Lee sees are those who over-indulged during their holidays, for example, those who visited chocolate factories and ate lots of chocolate and ice cream.

Three in four women will experience at least one symptomatic yeast infection during their lifetime.

The most frequent symptoms are itching, burning and irritation of the vagina.

Painful urination and/or painful intercourse are also common symptoms.

Vaginal discharge is not always present and may be minimal.

The three main contributing causes of vaginitis:

BACTERIA

Most common cause of vaginitis symptoms among women of childbearing age. Untreated, it can develop into pelvic inflammatory disease, which can cause infertility and tubal (ectopic) pregnancy.

TRICHOMONIASIS

Sexually-transmitted disease that can cause adverse outcomes in pregnancy such as premature delivery and infants with low birth weight.

VAGINAL YEAST (CANDIDIASIS)

Common cause of vaginal irritation. Hint: It causes intense itchiness

This story was first published in The New Paper on Apr 10, 2008.