Vaginal Burning, itching, and cottage cheese-like discharge. The classic symptoms of a vaginal yeast infection. Everyone gets them, and nobody likes it.
Most women will get a vaginal yeast infection at some point in their life. This common and frustrating issue is a common complaint in an Obgyn office. Many women want to know why yeast happens and how to fix it fast.
Yeast infections are easy to treat. Over-the-counter treatments are safe to use, but it is essential to see a doctor to confirm the diagnosis if the infection is not going away. Many assume abnormal vaginal symptoms are due to yeast, but yeast infection symptoms are similar to other vaginal infections and sexually transmitted infections (STIs).
Self-diagnosing often leads to errors, but the situation “down there” will not improve if we are not treating the right thing.
What is a vaginal yeast infection?
A yeast infection is a fungal infection, typically by candida, causing itching and burning of the vulva, the area around the vagina.
The vagina always contains small amounts of yeast. We have yeast on our skin, our mouth, and our gastrointestinal tract all the time. Our bodies keep yeast in check with healthy bacteria.
The vagina is an ecosystem maintained by a variety of yeast and bacteria living in perfect harmony. Periodically, something disruptive happens to break the status quo allowing yeast to flourish. When yeast outgrows the counterbalancing bacteria, women will notice a yeast infection.
Antibiotic use is a perfect example. When we take antibiotics to kill a bacterial infection, the medication also destroys the protective vaginal bacteria- balancing yeast. As a result, almost 50% of women end up with a yeast infection.
What causes yeast infections?
An overgrowth of the microscopic fungus Candida causes yeast infections. Candida albicans is the most common culprit accounting for 75% of the cases. Candida glabrata and candida tropicales are two other types of yeast causing candida species.
Who gets vaginal yeast infections?
Any woman can develop a yeast infection. In fact, three out of four women will have a yeast infection at some point in their life, and almost half of women have two or more infections.
Some medical conditions increase the risk of yeast infections. The risk is higher if:
- You are pregnant
- You have diabetes. Yeast loves glucose and will flourish in this environment.
- You use a type of hormonal birth control that has higher doses of estrogen.
- You douche. Douching disrupts the vaginal ecosystem by altering the vaginal acidity allowing yeast to grow.
- You recently took antibiotics
- You have a weakened immune system, such as from HIV or taking steroid medication
What are the symptoms of vaginal yeast infections?
Vaginal and vulvar itching is the most common symptom followed by an abnormal, thick, white cottage-cheese vaginal discharge. Some women notice pain during sex or painful urination. Others notice vulvar burning, irritation, or swelling.
Everyone’s experience will vary. Symptoms may be severe for some and barely noticeable for others.
Can I get a yeast infection from having sex?
The relationship between sex and yeast is tricky. A yeast infection is not considered an STI, but sexual intercourse alters the vaginal chemistry by changing the pH balance. The vagina regulates its ecosystem by maintaining a normal pH level. A vaginal pH between 3.5–5.5 suppresses yeast and anaerobic bacteria.
Sex temporarily disrupts the balance. Vaginal secretions and semen change the chemistry, and in some cases, allow abnormal amounts of yeast or bacteria to flourish. The good news is vaginas, in most cases, effectively reestablish normal pH to keep itself healthy.
In rare cases, some women get yeast infections from a sexual partner or improperly-washed sex toys. The cases are not common. In my experience, most cases of sex-induced yeast are misdiagnosed and warrant a second opinion.
Because yeast infections are not STIs, sexual partners do not need to be treated.
Should I call my doctor if I have a yeast infection?
It is acceptable to self-medicate with an over-the-counter antifungal medication if you feel certain a yeast infection is present. If the infection is recurrent or not going away, then it is time to call a doctor.
Seeing your doctor or practitioner is the only way to find out for sure if you have a yeast infection and not a more serious problem.
The signs and symptoms of a yeast infection are a lot like symptoms of other more serious infections. Trichomoniasis is an STI that also causes itching, and bacterial vaginosis (BV) often causes vaginal discharge.
If left untreated, STIs and BV raise your risk of getting other STIs, including HIV. Untreated gonorrhea and chlamydia can lead to problems getting pregnant. BV can also lead to problems during pregnancy, such as preterm labor and premature delivery.
How is a yeast infection diagnosed?
A doctor will do a pelvic exam to look for swelling and characteristic discharge. The doctor may also use a cotton swab to take a sample of the discharge from the vagina, and then look at the sample under a microscope to evaluate for fungus.
Nucleic acid amplification microbial testing is a widely available rapid test technology to help distinguish between yeast, bacterial vaginosis, and trichomoniasis. Yeast cultures are sometimes performed to determine the candida species to help guide treatment in recurrent cases.
How is a yeast infection treated?
Yeast infections are treated with antifungal medicine.
Antifungal medications can be purchased at any pharmacy without a prescription. Antifungal medicines come in the form of creams, tablets, ointments, or suppositories to be inserted into the vagina. Treatments vary from single-dose therapy to daily use for up to seven days.
A doctor or practitioner can also prescribe a single dose of oral antifungal medicine such as fluconazole.
Patients suffering from recurrent vaginal yeast infections may qualify for more robust testing and treatment.
Are over-the-counter yeast medications safe?
In general, self-treatment for suspected yeast is safe. If the diagnosis is uncertain or not improving, it is best to talk with a provider to confirm we are treating the correct problem.
It may sound silly, but if we are not treating the right problem then it will not get better. Studies show that two out of three women who buy yeast infection medicine don’t really have a yeast infection.
If a yeast infection is not going away then some other infection may be causing the problem.
How do I treat a yeast infection if pregnant?
During pregnancy, it is safe to treat a yeast infection with vaginal creams or suppositories that contain Terconazole, Miconazole, or Clotrimazole.
Obgyns typically avoid the oral fluconazole tablet to treat a yeast infection during pregnancy. Some studies show high-dose first-trimester use may cause birth defects. This medication may be indicated in certain clinical situations.
How can I prevent a yeast infection?
These steps may lower the risk of getting yeast infections:
- Do not douche.
- Do not use scented feminine products
- Change tampons, pads, and panty liners often.
- Avoid tight underwear or restrictive clothing that increases body heat, sweat, and genital moisture.
- Change out of wet swimsuits and workout clothes when finished.
- Wipe from front to back when using the bathroom.
- Avoid hot tubs and very hot baths.
- Control your blood sugar if you have diabetes. ,
What should I do if I get repeat yeast infections?
If you get four or more yeast infections in a year, talk to your doctor or nurse.
About 5% of women get four or more vaginal yeast infections in one year. This is called recurrent vulvovaginal candidiasis (RVVC). RVVC is more common in women with diabetes or weak immune systems, such as with HIV, but it can also happen in otherwise healthy women.
Doctors most often treat RVVC with antifungal medicine for up to six months.
