Sometimes the answer comes from an unexpected place, and only after we stop looking.
I don’t know how many times I saw her for her recurrent atypical vaginitis, or how many times my long list of questions, an exam, and lab testing failed to reveal the cause. She saw two gynecologists for extra opinions, as well as a half dozen therapists with ‘alternative’ perspectives. They were no more successful than I at finding the cause. Her major symptom was intense itching, which suggested yeast, but we never found yeast and yeast treatments never worked. The only pattern we ever identified was that she never had episodes during the true winter months of December through March. We ultimately found a non-specific vaginal cream that seemed to help control the itch while her symptoms resolved gradually over a period of 7 - 10 days.
Then at her routine annual visit, I noticed that an entire year had gone by and she hadn’t called for a refill of her vaginal cream. Curious, I asked about this. And she told me how the mystery had been solved.
She had had a sudden flare of her symptoms and had gone to her local small town pharmacy to see if she had refills or if she needed to call me for a new prescription. When she got to the counter, the pharmacist told her he had been expecting her and handed her the prescription.
“How did you know I needed it?” she asked the pharmacist. “I didn’t call.”
“Well, you always come pick it up a couple days after I fill your husband’s Bactrim.”
She told me husband had recurrent prostatitis and had a refillable prescription for Bactrim from his urologist for his flares, which happened every several months during biking season - but not in the winter when he swam. And then she smiled.
“And, of course, I’m allergic to Bactrim. So now that my husband’s doctor has changed him to Cipro for his infections. I don’t seem to be allergic to him - or his Cipro.”