Recurrent vulvovaginal candidiasis

　　One, the cause of the disease

　　The causes of recurrence are as follows:

　　1. Incomplete treatment, presence of fungi in the vagina, use of antibiotics, sexual partners, environmental factors, etc.

　　2. Taking metronidazole orally for bacterial vaginosis or bacterial overgrowth syndrome can also trigger candidal vulvovaginitis.

　　3. It is closely related to intestinal host and sexually transmitted diseases. Women with recurrence have about 20% of men partners with Candida寄生 in the penis.

　　4. Factors such as uncontrolled diabetes, wearing tight synthetic underwear, etc., are also susceptible and triggering factors for recurrent vulvovaginal candidiasis.

　　Second, pathogenesis

　　Pathogenesis of recurrent vulvovaginal candidiasis

　　1. The onset of recurrent vulvovaginal candidiasis is also related to immune mechanisms. The reason why T lymphocytes have a weakened reactivity to candidal antigens is due to the result of the patient's macrophages producing prostaglandin E2, which may inhibit the proliferation of lymphocytes by blocking the production of interleukin-2. Abnormal phagocytic function may be caused by local IgE anti-candidal antibodies or a serum factor.

　　All women may have the phenomenon of yeast translocation, and many patients may have translocation for several months to several years, but under the immune protection of the body, only a small amount of yeast is maintained in the symbiotic relationship. Immunoglobulin IgE and IgA play a less significant role in maintaining this symbiotic relationship, while cell-mediated immunity plays a greater role, that is, Th1 secretes IL-1, IL-2, and TNF, etc., as pro-inflammatory factors, while Th2 secretes IL-4, etc., to inhibit cell-mediated immunity. Th1 and Th2 mutually inhibit and antagonize each other to maintain balance.

　　In women with recurrent vulvovaginal inflammation, there are changes in cytokines, and they secrete IL-4, IL-5, and IL-10. IL-4 has the potential to attract eosinophils, so it is easy to find eosinophils in the vaginal secretions of women with recurrent vulvovaginal candidiasis, and also to find IgE produced by mast cells. This indicates that the host of recurrent vulvovaginal candidiasis has an immediate allergic reaction in terms of immunity, where the host is allergic to its own yeasts, that is, the host changes from a Th1-mediated normal preventive response to a Th2 response. There are also reports that white Candida soaked in a skin test solution, most of which have an immediate positive skin test reaction, and a few have an immediate negative skin reaction, but a delayed positive skin reaction appears after 6 to 8 hours, which also indicates abnormal host immunity (Rigg D, 1990).

　　The onset of recurrent vulvovaginal candidiasis is related to immune mechanisms as well as microbial factors. It is known that the main fungus causing vulvovaginal candidiasis is Candida albicans, accounting for about 80%, and there are also non-white Candida, such as smooth Candida infection without hyphae but only germinating yeasts. These budding spores are difficult to identify under a microscope and are easy to confuse with diagnosis. Smooth Candida has higher tolerance to alkaline environmental pH than Candida albicans and is not sensitive to imidazole drugs, making it difficult to treat thoroughly and prone to recurrence.

　　When there is a candidal infection, it is prone to mixed infections with other pathogens and concurrent other sexually transmitted diseases, such as AIDS, condyloma acuminata, gonorrhea, and non-gonococcal vaginitis, etc.

　　Complications often occur simultaneously with gynecological cervical inflammation and pelvic inflammation, and are also commonly associated with trichomonas vaginitis. Reports show that 86% of women with trichomonas positive cultures have this condition.

　　In addition, candidal vaginitis during pregnancy can often lead to adverse perinatal outcomes such as chorioamnionitis, amniotic fluid infection, premature rupture of membranes, preterm birth, and endometritis after cesarean section or vaginal delivery.

　　Candidal vulvovaginitis is mainly manifested as vulvar itching, burning pain, and in severe cases, restlessness and abnormal pain. It is often accompanied by frequent urination, urgency, and dyspareunia.

　　After treatment for recurrent vulvar and vaginal candidiasis, symptoms, signs, and fungi all disappear, but they reappear and occur ≥4 times within a year.

　　During the acute stage, leukorrhea increases, and the characteristic of leukorrhea is white, thick, and curd-like. If vulvitis is present, clear erythema can be seen on the vulva, and small satellite lesions can be seen around large erythema. Sometimes, scratches or fissures on the vulvar skin can be seen, and the discharge may be odorless and yellowish. Symptoms may worsen in a warm environment, such as on a bed or when air circulation is restricted, or when the patient wears tight clothing or synthetic fabrics.

　　The vaginal mucosa can be seen with varying degrees of edema and erythema. The erythema can extend to the external os of the cervix. The vaginal discharge is often in the form of clumps adhering to the vaginal wall. After wiping off the clumps of discharge, the red and swollen mucosal surface is exposed. In the acute stage, white clumps can also be seen under which there are damaged erosion surfaces and superficial ulcers.

　　Sometimes the edges of the inflammation also have small nodules and blisters. If a large area of tissue around is involved, the infected area can appear scaly and dry, with clear edges (eczematous change), and scratches are often seen at the sites of laceration and ulceration.

　　The severity of symptoms depends on the type and strain of the infecting bacteria, as well as the susceptibility of the patient. Mild symptoms may only include mild itching without other clinical symptoms. Vulvovaginal candidiasis is different from other bacterial infections; yeast does not ascend along the cervical canal, so it does not cause secondary diseases related to candidiasis migration. Candidiasis infection often occurs in the late luteal phase of the ovulatory cycle, that is, within one week before the onset of menstruation.

　　The clinical characteristics of vulvovaginal candidiasis during pregnancy are particularly abundant vaginal discharge, almost all cases have severe vulvar itching, and there is often a burning sensation in the vulva, even pain and irritation in the vagina, the typical secretion is cheesy, the labia minora are often edematous, erythematous, and the vaginal congestion is obvious and often accompanied by a white membrane-like covering. After peeling off the white membrane, the red and swollen mucosal surface can be exposed. In the acute stage, erosion or superficial ulcers can be seen.

　　The symptoms and signs of vulvovaginal candidiasis in children are no different from those in adults, but white spots or patterns on the vulva are often seen.

　　1. Prevention of vulvar and vaginal candidiasis

　　1. Thorough treatment should be given to patients with initial Candida infection:Candida albicans can grow on the mucosal surface and can also invade the deep layer. If the dose of medication is insufficient and the duration is too short during infection, it is not easy to completely kill the hyphae and spores, and it is easy to produce drug resistance, thus causing recurrent vulvovaginal candidiasis. Therefore, it is very important to thoroughly treat initial patients, which can take local treatment or combined systemic treatment, and can also adopt consolidation treatment, that is, repeat treatment 10 days after the initial treatment.

　　The standard for the thorough treatment of initial patients is that the自觉 symptoms disappear and the signs return to normal after the initial treatment, the Candida microscopic examination is negative, and the above-mentioned tests are negative after 3 consecutive menstrual periods. It is also proposed that for recurrent vulvovaginal candidiasis, prophylactic use of antifungal drugs once a month for 6 consecutive months, or antifungal drugs used vaginally once a week for 6 consecutive months can also effectively prevent recurrence.

　　2. Check for systemic diseases, detect and treat them in a timely manner:Candida albicans grows best in a vaginal pH environment of 4 to 5. When various factors increase the acidity of vaginal glycogen, it is most suitable for the proliferation of Candida, causing inflammation. In diabetes, the increase in blood glucose content leads to an increase in local vaginal glycogen content, thereby changing the normal vaginal pH value to create an internal environment favorable for the growth of Candida, causing infection. On the other hand, diabetic patients have multiple defects in white blood cell function, are prone to bacterial infections, and the use of antibiotics is also likely to trigger vulvovaginal candidiasis. Therefore, for patients with recurrent vulvovaginal candidiasis, blood glucose should be checked; for diabetic patients, blood glucose monitoring should be strengthened to control blood glucose levels between 6.11 and 7.77 mmol/L. If dietary treatment cannot achieve ideal blood glucose levels, medication for diabetes should be used. Through systemic treatment, the local vaginal environment should be restored to a normal state, which is not conducive to the growth and reproduction of Candida.

　　3、改善阴道局部环境：致病性白念珠菌生长的最适宜温度是37℃局部环境温度增高更有利于念珠菌生长。月经期除了全身免疫功能低下外，阴道局部pH的变化、潮湿温度增高更易继发念珠菌感染为此从预防感染角度出发劝告妇女应穿较宽松的透气和吸湿性好的内裤保持局部干燥，注意外阴清洁。

　　4、提高机体免疫力：念珠菌外阴阴道炎既是一种局限性疾病，又是一种全身性疾病，也就是说念珠菌是一种条件致病菌，即在宿主抵抗力及免疫力低下时使宿主致病。γ干扰素可抑制巨噬细胞产生PGE2，从而抑制真菌形成芽孢发芽生长因此，对某些疾病使机体免疫力低下者，如长期使用免疫抑制剂等，可使用γ干扰素以预防念珠菌性炎症月经期机体的免疫功能也会发生变化，易发生念珠菌感染因此应多注意休息。

　　5、严格掌握抗生素应用：白念珠菌是人体正常菌群之一约10％的妇女阴道内有此菌寄生而无明显症状抗生素的应用会影响阴道内和肠道内的菌群失调尤其是目前滥用抗生素的现象相当普遍，使微生物之间互相的制约关系失调，也易使念珠菌繁殖而致病抗生素使用时间越长患念珠菌感染的机会越多使用抗生素的人群较未使用者念珠菌性外阴阴道炎感染率高2倍，当使用广谱抗生素10～14天后则患念珠菌性外阴阴道炎的机会提高3倍而抗生素的种类与念珠菌感染无显著关系（Spini-lloA，1999）连续应用抗生素10天的患者患念珠菌性外阴阴道炎占20％，而一次性应用抗生素者未发现有念珠菌感染。

　　抗生素的使用是患念珠菌性外阴阴道炎的短期危险因素长期应用是念珠菌性外阴阴道炎流行增多的直接原因因此在各系统有感染时，应当严格掌握抗生素应用的适应证尤其是广谱抗生素的应用更为注意，适时停药，必要时口服抗真菌药以预防继发念珠菌性外阴阴道炎。

　　6、提倡患病妇女与性伴同时治疗：念珠菌外阴阴道炎是一种性传播性疾病，念珠菌外阴阴道炎患者的性伴其口腔精液及阴茎冠状沟内均有一定比例的念珠菌阳性率临床上对性伴也治疗者，其复发率明显低于性伴不治疗组，治疗组复发率也低（治疗组复发率为15.8％，未治疗组复发率为44.8％）。特别是对有口交者有必要对患者的性伴精液及口腔分泌物进行念珠菌培养及菌种鉴别单纯治疗女方男方也易交叉感染采用避孕套可减少性伴间的交叉感染。

　　7、生物制剂应用及含嗜酸乳酸菌的乳制品摄入：Biological preparations with therapeutic properties, such as lactic acid bacteria, can not only prevent infantile diarrhea and antibiotic diarrhea but also prevent candidal vulvovaginitis and intestinal infections, with no significant side effects, thereby reducing the dependence on antifungal drugs. Therefore, this biological preparation can be tried for patients susceptible to Candida infection, and its effect may be to restore the normal flora ratio.

　　Consuming dairy products containing lactic acid bacteria daily for 6 consecutive months reduces the incidence of intestinal and vaginal candidiasis by 3 times compared to non-consumers, and the colony count of Candida in the intestinal and vaginal tract of the consuming group is also significantly lower than that of the non-consuming group. Consuming a certain amount of lactic acid products daily can reduce the formation of Candida colonies and reduce infection (Hilton E, 1992).

　　In summary, the occurrence of candidal vulvovaginitis is multifactorial, and prevention should be individualized. Appropriate measures should be taken for each corresponding link to reduce recurrence or prevent infection.

　　1. Gynecological and family planning candidiasis infection issues, many operations are involved in the uterine cavity through the vagina, including the scope of gynecology and family planning work.

　　Common surgeries include various vaginal minor surgeries, such as physical therapy for cervical erosion commonly used in gynecology - laser electrocoagulation, cryotherapy, microwave, infrared, Ohm wave, etc., cervical dilation and uterine cavity measurement, various dilatation - diagnostic curettage, segmental curettage, resection of submucosal myoma of the uterus under hysteroscope, hysterosalpingography with uterine cornua iodine oil, endometrial electrosurgery, endometrial ablation, and various intrauterine operations. In family planning work, the curettage placement and removal of intrauterine devices after medical abortion and drug-induced abortion, the exploration of intrauterine devices, and artificial insemination in assisted reproductive technology, as well as transvaginal puncture for gynecological diseases such as ovarian puncture for oocyte retrieval through the posterior fornix into the abdominal cavity, reduction surgery, or transvaginal puncture for gynecological diseases, and the commonly used total hysterectomy in gynecology, etc., if there is a candidal infection in the vagina, it will affect the scheduled operation. After treatment, reoperation is often affected by missed surgery opportunities, so in order to reduce postoperative complications, strict control of surgical indications should be exercised, and routine vaginal secretion detection for the presence of Candida and/or mixed infection should be performed before gynecological surgery, family planning surgery, and assisted reproductive surgery, and rapid and effective antifungal treatment should be adopted before timely surgery is recommended.

　　1. Direct examination method:It is the most commonly used clinical test method, with a positive detection rate of 60%, and its advantages are simplicity and speed.

　　1. Saline method:A small amount of vulvar and vaginal secretion is taken, spread on a slide, and mixed with 1 to 2 drops of normal saline.

　　2, Potassium Hydroxide Method:Take a little curd-like secretion, place it on a glass slide containing 10% KOH or normal saline, mix it, and find the spores and pseudohyphae under the microscope. Since 10% KOH can dissolve other cell components, the detection rate of Candida is higher than that with normal saline. The positive rate of asymptomatic carriers is 10%, and the positive detection rate of symptomatic vaginitis is 70% to 80%.

　　Two, Gram Staining Method:The positive detection rate of this method is 80%. Take the secretion, make a smear, fix it, Gram stain it, and observe it under a microscope. A group of Gram-positive ovoid spores and pseudohyphae can be seen.

　　Three, Culture Method:If suspected to be candidal vaginitis, multiple checks are negative, fungal culture can be performed, and the specimen is inoculated onto Sabouraud's medium, placed in a 37℃ incubator, and observed after 24 to 28 hours. A large number of small and white colonies can be seen. They are taken for microscopic examination. The positive rate of culture is almost always 100%. The main purpose of Candida culture is to observe the morphology, color, smell, and microscopic appearance of the colonies. First, check the entire culture plate under a 10X magnification, which is enough to distinguish yeast cells, pseudohyphae, and primary cell wall spores. Further, biochemical methods can be used to detect the consumption of sugar, nitrogen-containing compounds, and vitamins to distinguish different species.

　　通常, if the patient has typical clinical manifestations and spores and pseudohyphae are seen under the microscope, a diagnosis can be made without the need for further culture to reduce unnecessary related costs. However, since microscopic examination is not a very sensitive method, fungal culture is often also needed to confirm the diagnosis.

　　Four, Species Identification Experiment:To determine the type of Candida, it is necessary to perform fermentation tests, assimilation tests, and differentiate based on the morphological characteristics of the colonies.

　　Five, pH Value Measurement:It has important differential diagnostic significance. If the pH value is 4.5 and there are a large number of white blood cells in the smear, there may be a mixed infection.

　　Six, For elderly, obese, or patients who have not been cured for a long time, urinalysis and blood glucose should be checked to find the cause of the disease.

　　One, Dietotherapy for Vulvovaginal Candidiasis

　　1, Mixed Fresh Lotus Root

　　20 grams of mung beans, 300 grams of fresh lotus root, 3 slices of fresh mint. Wash the fresh lotus root clean and peel it. Soak the mung beans in water until soft, then put them into the holes of the lotus root, steam and slice them, chop the fresh mint, sprinkle it on top, season it, and eat it cold.

　　2, Stewed Pig Intestine with Mung Beans

　　Pig intestines, mung beans, and an appropriate amount of Bài Ji Cao. Boil the mung beans for 20 minutes, then put them into the pig intestines (tied tightly at both ends) with the Bài Ji Cao and cook them together. Add seasonings for eating.

　　3, Other

　　30 grams of Di Fu Zi, 5 red dates. Take them in decoction, twice a day.

　　4, Kelp Mung Bean Soup

　　Kelp (chopped), mung beans, and an appropriate amount of sugar. Boil together with water to make a soup and eat it. Take once a day for 10 consecutive days.

　　5, Other

　　Yin Chen 30 grams, Jiangmi 50 grams, a little rock sugar.

　　First, boil Yin Chen with an appropriate amount of water to extract the juice, remove the dregs, and then cook it with粳米to make porridge. Add rock sugar for taste before serving. Take 2 to 3 times a day, and a course of treatment is 7 to 10 days. This formula has the effect of clearing heat and dampness in the liver and gallbladder.

　　What to eat for patients with vulvovaginal candidiasis

　　1. Choose a light diet, and eat foods rich in vitamin A, B2, C, etc.Such as animal liver, fish eggs, carrots, etc.; poultry eggs and fresh vegetables, such as tomatoes, spinach, amaranth, soybean sprouts, mung beans, lotus root, etc.; eat more fresh fruits, such as tangerines, oranges, pomelos, lemons, strawberries, hawthorn, hawthorn, etc.

　　2. People with vulvar itching should eat more nutritious foods:Such as chicken, milk, tofu, beans, etc.

　　3. Appropriately supplement vitamin A, vitamin B2, and folic acid:Such as fish liver oil, carrots, animal liver, fish, apricot, whole wheat, pumpkin, etc. They can alleviate the symptoms of itching, but should not be taken in excess

　　Third, what foods should vulvovaginal candidiasis patients avoid eating

　　1. Triggers:Such as sea fish, shrimp, crab, river fish, lake fish, etc., after eating, it will worsen the itching of the vulva, so it should be avoided.

　　2. Smoking and alcohol:Because it can aggravate inflammation and congestion, making vaginal itching worse, it should be禁忌.

　　3. Spicy and刺激性 food:Such as chili, pepper, fennel, Sichuan pepper, onion, etc., which can cause the inflammation to spread and make the vaginal itching worse, so they should be avoided.

　　4. Fried and sweet sticky foods:Such as lard, butter, butter, fried pork chop, fried beef steak, sugar candy, chocolate, etc., which have the effect of moisturizing, which is not conducive to treatment, so they should be avoided.

　　First, prevention:

　　1. Thorough treatment should be given to patients with initial Candida infection:Candida albicans can grow on the mucosal surface and can also invade the deep layer. If the dose of medication is insufficient and the duration is too short during infection, it is not easy to completely kill the hyphae and spores, and it is easy to produce drug resistance, thus causing recurrent vulvovaginal candidiasis. Therefore, it is very important to thoroughly treat initial patients, which can take local treatment or combined systemic treatment, and can also adopt consolidation treatment, that is, repeat treatment 10 days after the initial treatment.

　　The standard for the thorough treatment of initial patients is that the自觉 symptoms disappear and the signs return to normal after the initial treatment, the Candida microscopic examination is negative, and the above-mentioned tests are negative after 3 consecutive menstrual periods. It is also proposed that for recurrent vulvovaginal candidiasis, prophylactic use of antifungal drugs once a month for 6 consecutive months, or antifungal drugs used vaginally once a week for 6 consecutive months can also effectively prevent recurrence.

　　2. Check for systemic diseases, detect and treat them in a timely manner:Candida albicans grows best in a vaginal pH environment of 4 to 5. When various factors increase the acidity of vaginal glycogen, it is most suitable for the proliferation of Candida, causing inflammation. In diabetes, the increase in blood glucose content leads to an increase in local vaginal glycogen content, thereby changing the normal vaginal pH value to create an internal environment favorable for the growth of Candida, causing infection. On the other hand, diabetic patients have multiple defects in white blood cell function, are prone to bacterial infections, and the use of antibiotics is also likely to trigger vulvovaginal candidiasis. Therefore, for patients with recurrent vulvovaginal candidiasis, blood glucose should be checked; for diabetic patients, blood glucose monitoring should be strengthened to control blood glucose levels between 6.11 and 7.77 mmol/L. If dietary treatment cannot achieve ideal blood glucose levels, medication for diabetes should be used. Through systemic treatment, the local vaginal environment should be restored to a normal state, which is not conducive to the growth and reproduction of Candida.

　　3、改善阴道局部环境：致病性白念珠菌生长的最适宜温度是37℃局部环境温度增高更有利于念珠菌生长。月经期除了全身免疫功能低下外，阴道局部pH的变化、潮湿温度增高更易继发念珠菌感染为此从预防感染角度出发劝告妇女应穿较宽松的透气和吸湿性好的内裤保持局部干燥，注意外阴清洁。

　　4、提高机体免疫力：念珠菌外阴阴道炎既是一种局限性疾病，又是一种全身性疾病，也就是说念珠菌是一种条件致病菌，即在宿主抵抗力及免疫力低下时使宿主致病。γ干扰素可抑制巨噬细胞产生PGE2，从而抑制真菌形成芽孢发芽生长因此，对某些疾病使机体免疫力低下者，如长期使用免疫抑制剂等，可使用γ干扰素以预防念珠菌性炎症月经期机体的免疫功能也会发生变化，易发生念珠菌感染因此应多注意休息。

　　5、严格掌握抗生素应用：白念珠菌是人体正常菌群之一约10％的妇女阴道内有此菌寄生而无明显症状抗生素的应用会影响阴道内和肠道内的菌群失调尤其是目前滥用抗生素的现象相当普遍，使微生物之间互相的制约关系失调，也易使念珠菌繁殖而致病抗生素使用时间越长患念珠菌感染的机会越多使用抗生素的人群较未使用者念珠菌性外阴阴道炎感染率高2倍，当使用广谱抗生素10～14天后则患念珠菌性外阴阴道炎的机会提高3倍而抗生素的种类与念珠菌感染无显著关系（Spini-lloA，1999）连续应用抗生素10天的患者患念珠菌性外阴阴道炎占20％，而一次性应用抗生素者未发现有念珠菌感染。

　　抗生素的使用是患念珠菌性外阴阴道炎的短期危险因素长期应用是念珠菌性外阴阴道炎流行增多的直接原因因此在各系统有感染时，应当严格掌握抗生素应用的适应证尤其是广谱抗生素的应用更为注意，适时停药，必要时口服抗真菌药以预防继发念珠菌性外阴阴道炎。

　　6、提倡患病妇女与性伴同时治疗：念珠菌外阴阴道炎是一种性传播性疾病，念珠菌外阴阴道炎患者的性伴其口腔精液及阴茎冠状沟内均有一定比例的念珠菌阳性率临床上对性伴也治疗者，其复发率明显低于性伴不治疗组，治疗组复发率也低（治疗组复发率为15.8％，未治疗组复发率为44.8％）。特别是对有口交者有必要对患者的性伴精液及口腔分泌物进行念珠菌培养及菌种鉴别单纯治疗女方男方也易交叉感染采用避孕套可减少性伴间的交叉感染。

　　7、生物制剂应用及含嗜酸乳酸菌的乳制品摄入：Biological preparations with therapeutic properties, such as lactic acid bacteria, can not only prevent infantile diarrhea and antibiotic diarrhea but also prevent candidal vulvovaginitis and intestinal infections, with no significant side effects, thereby reducing the dependence on antifungal drugs. Therefore, this biological preparation can be tried for patients susceptible to Candida infection, and its effect may be to restore the normal flora ratio.

　　Consuming dairy products containing lactic acid bacteria daily for 6 consecutive months reduces the incidence of intestinal and vaginal candidiasis by 3 times compared to non-consumers, and the colony count of Candida in the intestinal and vaginal tract of the consuming group is also significantly lower than that of the non-consuming group. Consuming a certain amount of lactic acid products daily can reduce the formation of Candida colonies and reduce infection (Hilton E, 1992).

　　In summary, the occurrence of candidal vulvovaginitis is multifactorial, and prevention should be individualized. Appropriate measures should be taken for each corresponding link to reduce recurrence or prevent infection.

　　Secondly, the issue of Candida infection in gynecology and family planning involves many operations inside the uterine cavity through the vagina, including the scope of gynecology and family planning work.

　　Common surgeries include various vaginal minor surgeries, such as physical therapy for cervical erosion commonly used in gynecology - laser electrocoagulation, cryotherapy, microwave, infrared, Ohm wave, etc., cervical dilation and uterine cavity measurement, various dilatation - diagnostic curettage, segmental curettage, resection of submucosal myoma of the uterus under hysteroscope, hysterosalpingography with uterine cornua iodine oil, endometrial electrosurgery, endometrial ablation, and various intrauterine operations. In family planning work, the curettage placement and removal of intrauterine devices after medical abortion and drug-induced abortion, the exploration of intrauterine devices, and artificial insemination in assisted reproductive technology, as well as transvaginal puncture for gynecological diseases such as ovarian puncture for oocyte retrieval through the posterior fornix into the abdominal cavity, reduction surgery, or transvaginal puncture for gynecological diseases, and the commonly used total hysterectomy in gynecology, etc., if there is a candidal infection in the vagina, it will affect the scheduled operation. After treatment, reoperation is often affected by missed surgery opportunities, so in order to reduce postoperative complications, strict control of surgical indications should be exercised, and routine vaginal secretion detection for the presence of Candida and/or mixed infection should be performed before gynecological surgery, family planning surgery, and assisted reproductive surgery, and rapid and effective antifungal treatment should be adopted before timely surgery is recommended.