If you're over 40, it can sometimes be tricky getting a diagnosis for your down-there symptoms. Here's how to get the treatment you need so you can feel better, fast.
"There are a lot of things that can cause an itch that aren't a yeast infection," says Hilda Hutcherson, MD, professor of ob/gyn at Columbia University Medical Center. That could include chafing from your clothing, irritation from shaving, or a product (like laundry detergent or soap) that the sensitive skin on your vulva is reacting to. And discharge and discomfort can be caused by other types of vaginal infections, including bacterial vaginosis (which typically comes with a foul-smelling discharge plus irritation and burning) and sexually transmitted infections like trichomoniasis. Check in with your doctor before you use an over-the-counter medication—the wrong treatment can actually make things worse.
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You have an itch and your first thought is: Aha, yeast infection. But if you treat and your symptoms don't go away, it could be a different down-there infection. In fact,the most common curable sexually transmitted disease in women shares symptoms with a yeast infection and shows up most often in the 40-plus set. And chances are, you've never heard of it.

Its trichomoniasis—an infection caused by a parasite called Trichomonas vaginalis—and more than 1 in 10 women in their 40s and 50s has it (compared with 8 out of every 100 women in their 20s), according to new Johns Hopkins University research. If left untreated, trichomoniasis can lead to inflammation of the vagina, urethra, and cervix, potentially leading to pelvic inflammatory disease, fertility problems, and low birth-weight babies.

Luckily, "trich" is easily cured with a round of antibiotics—once its detected. The real difficulty is diagnosing it in the first place:Its possible to contract trich without realizing it, since between one-third and one-half of cases have no symptoms. And even when there are signs, they can be confusingly similar to what you'd get with a yeast infection (think burning and itching). That means the disease may go undetected or misdiagnosed.

Past 40 and positive

So why are women in their 40s and 50s so vulnerable? Researchers have a few theories: "Its possible that women are getting infected when they're younger, but because doctors don't regularly test for it, they're never properly treated," says Charlotte A. Gaydos, professor of infectious diseases in the Department of Medicine at Johns Hopkins University and senior investigator in the Hopkins study. "The older you are, the more sex you've had, and the more time you've had to be exposed"—meaning you could have the disease even if you've long been married and monogamous. Another explanation: "Postmenopausal women may use less protection because they're no longer worried about getting pregnant," says Paula Castaño, MD, assistant clinical professor of obstetrics and gynecology at New York–Presbyterian Hospital/Columbia University Medical Center. (In fact, a 2010 report in the Journal of Sexual Medicine found that women in their 40s use condoms, —the only birth-control method that protects against STDs—, just 20% of the time with casual partners.)

What does this mean for you? Even if its been years since you thought about the letters S, T, and D, you should ask your gyno to test you, especially if you've had unprotected sex or multiple partners. While you may think you've been swabbed for everything under the sun, "everything" means different things to different docs, Dr. Castaño notes. "Trich is easy to treat," Gaydos adds, "but its also easy to miss."

The good news: That's a mistake MDs shouldn't make anymore. Last April, a new, much-more accurate test came out that detects more than 95% of cases, Gaydos says. "Im hoping the test"—, which can be run on urine samples, Pap smears, or cervical swabs—", will mean that more doctors will regularly start to look for trich."