So you think you have a yeast infection and you buy an over-the-counter (OTC) treatment, but four days later you are still very itchy/irritated/burning like crazy. First of all you need this background information: If you were right then there is a 85-90% chance that you should be better. The next step, for most women, is to call their GYNO and ask for fluconazole, known by many under the brand name Diflucan, or to retreat with a OTC topical. If you guessed correctly and aren’t better more of the same (i.e. trying fluconazole/Diflucan or another OTC medication) is not likely to be any better because the oral and topicals work in the same way. If you are not feeling better after treatment (which will happen 75% of the time just looking at the statistics) there are five possible scenarios: Put another way, if 100 women use OTC medication for vaginal yeast, 70 will have persistent symptoms because they never had yeast to begin with and 5 will still have persistent symptoms related to yeast. That means if you have persistent symptoms there is a 93% chance you never had yeast and a 7% chance that you did, but need further information to treat. The chance that more of the same will help is very slim. Other clinical pearls: A bad yeast infection can take seven days to feel a lot better, An antihistamine, like Zyrtec or Claritin, will help you feel better faster and a low dose topical steroid on the vulva (labia and vaginal opening) will also help if there is a lot of external irritation But the OTC always fails for me and the Diflucan always works! This is unlikely related to the type of medication (OTC vs prescription) and more a mechanical issue – some women place the vaginal medication too low in their vagina (if the tissues are really inflamed it can be harder to get high enough). Lately, I have been blogging on other websites, which I think is a delightful way of connecting. Kasalina Nabakooza is a photographer and a recent graduate in Comparative Literature from New York University. She lives in Brooklyn and began an exchange with me via email. Her website includes wonderful portraits of people on the street, in addition to this “interview” that we did. Today, in time for Hallowe’en, a blog post I wrote on Lady Gaga’s meat dress went live on the blog of University of Minnesota Press. 1987, is part of the Walker Art Collection in Minneapolis. It is called “Vanitas.” Thanks to Maggie Sattler for inviting me to blog for the Press. 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