My four-year-old daughter has type 1 diabetes. She has been having trouble with chronic yeast infections. Her vulva is always white and red with little blisters. It smells bad and is very itchy and burns when she voids. She has been having this trouble for a year and a half. I have been to a gynecologist and her specialist and they are unable to help me.

First of all I’d make sure she has had a culture to confirm that she has a yeast infection and not a bacterial infection that might need to be treated with antibiotics.

If you confirm that she has a yeast infection, there are a few things to discuss with your doctor. Since she is so young, she can’t use any of the medications that are inserted directly into the vagina, so she may benefit from an oral medication like fluconazole. If you do succeed in at least temporarily clearing up the infection, she may be susceptible to recurrent infections because of the sugar in the urine that promotes the growth of yeast. If you can get her to take oral nystatin either as a tablet or the liquid suspension, you might decrease the chance of recurrence. Often yeast starts growing in the GI tract and yeast in the stool can reinfect the vaginal area. The oral nystatin will help prevent this. Also, you can apply an antifungal cream or powder to the vaginal area several times a day even if there is no sign of infection to prevent reinfection. You can use these topical antifungal creams and oral nystatin indefinitely with no side effects if necessary.

TGL