Cytolytic vaginosis (CV) is an under-recognized cause of vulvovaginal symptoms, characterized by lactobacillus overgrowth, epithelial cytolysis, and low vaginal pH. Its clinical overlap with vulvovaginal candidiasis (VVC) and bacterial vaginosis (BV) often leads to misdiagnosis and prolonged ineffective antifungal or antibiotic treatments.A 28-year-old woman, previously healthy, presented with cyclic vulvovaginal burning, dyspareunia, and increased non-adherent discharge, without pruritus, persisting for over three years. Despite multiple courses of antifungals (long-term fluconazole) and antibiotics for presumed VVC or urinary tract infection, symptoms persisted. Routine gynecological evaluations, cytology, and HPV testing were normal. Discontinuation of combined oral contraception did not improve symptoms, which worsened premenstrually and after alcohol intake. After five years of recurrent complaints and multiple gynecological consultations, the patient presented again for a primary care appointment. A vaginal smear revealed abundant lactobacillus, marked cytolysis, low pH, and absence of fungal or bacterial pathogens, confirming the diagnosis of CV. Treatment with intravaginal sodium bicarbonate irrigations (monthly cycles) achieved complete symptom resolution after three months. A limitation of this case report was the absence of continuous primary care follow-up. Although common etiologies were repeatedly considered, targeted microscopic evaluation was delayed, likely contributing to prolonged morbidity.This case illustrates a prolonged diagnostic delay and highlights primary care role in early differentiation, aligning with the literature that underscores lack of diagnostic criteria and frequent misclassification as candidiasis.Early recognition of CV requires systematic inclusion in differential diagnosis for cyclic vulvovaginal symptoms without pruritus. Primary care protocols should incorporate microscopy examination, pH testing, and structured follow-up. Further research should standardize diagnostic criteria and define optimal alkalinization regimens.CV can be reliably distinguished from VVC and BV by microscopy and this case report emphasizes CV’s cyclical pattern, poor response to antifungals and good response to alkalinizing therapy. In patients with persistent vaginal symptoms despite treatment for other suspected causes, cytolytic vaginosis should be always considered, as it can lead to psychological distress and significantly affect self-esteem and sexual wellbeing.CV is a clinically significant yet under-recognized condition. Timely diagnosis and targeted alkalinizing therapy are crucial to avoid unnecessary interventions and to enhance patient quality of life.