Yeast Infections: A Ladies’ Management Guide

by Shannon Connolly, MD

Ladies, if you have ever been in the unfortunate position of having a rip-roaring vaginal yeast infection, this is the article for you. If you have never had a rip-roaring vaginal yeast infection, this article is also for you…for the future. Because chances are, if you are in possession of a vagina, you will, at some point in your life, have a yeast infection.  It’s just one of those things that happens to those of us that are fortunate enough to have a vagina. Luckily, a yeast infection is a temporary problem that can be treated pretty easily.  How, you ask?  Read on for a comprehensive breakdown of the key steps to the healthy vagina you’ve grown to love.

So here are five things that you should know about the disease that doctors unsexily call vaginal candidiasis:

#1.  Not every problem with your vagina is a yeast infection.   A yeast infection, a vaginal infection caused by the fungus, Candida albicans, can result in severe itching or burning of the vagina and vulva, a white clumpy discharge that some people say looks like cottage cheese (hungry, anyone?), and/or discomfort with sex.  But there are a bazillion other things that can cause vaginal itching, discharge, and pain with sex. For example, bacterial vaginosis (BV), which is an overgrowth of normal vaginal bacteria, can cause a lot of discharge and vaginal discomfort—in addition to a very characteristic odor.  Most importantly, BV has a completely different treatment than candidiasis. Similarly, a number of sexually transmitted infections, like chlamydia and gonorrhea can also cause discharge and pain with sex.  Just because you feel a discomfort or have a funky discharge, does NOT mean you should go high-tailing it to the pharmacy for some Monistat—at least not until you have made sure that you do indeed have a yeast infection.

As it turns out, most women are not very good at identifying yeast infections. One study looked at 95 ladies who had diagnosed themselves and purchased over-the-counter treatments.  Of this group of ladies, only 34% of them actually had yeast infections. The rest of them had bacterial vaginosis, trichomonas, and other vaginal infections. A whopping 14% of them did not have anything wrong at all, and had interpreted normal vaginal discharge as an infection (1)!

All medications, even over the counter ones, have possible side effects. Furthermore, using an antifungal medication when you don’t have a true yeast infection can lead to more resistant types of infections in the future. The bottom line: Make sure you know what you have so you know how to treat it. Go see your doctor if you are not sure, if this is your first yeast infection, if you have other illnesses, or if you have more serious symptoms.

#2. It is not a sexually transmitted disease, but it can be sexually transmitted.  You can certainly get a yeast infection even if you have never been sexually active. Why? Because yeast live everywhere.  Diaper rash that babies get? That is often yeast. Many normal asymptomatic women have a small amount of yeast living in their vaginas, and this is A-ok.  It only becomes a problem when the yeast flourish into the type of party that disturbs the neighbors, disrupting the delicate balance of vaginal flora (yes, “flora”).

Now, that said, you can get yeast from your partner—whether they are male or female.  Did you know men can get yeast infections on their penises and foreskins? True story. Most doctors do not routinely treat the partners of their patients with yeast infections, though, because there isn’t a lot of good evidence that it makes a difference in terms of recurrence rates (2).

#3.  A number of things can predispose you to getting yeast infections.  One of the most common culprits is a recent course of antibiotics. Now, sometimes, you are truly sick with a bacterial infection and your doctor prescribes you antibiotics because you need it. But you know that urge to run to your doc and beg for antibiotics every time you get a cold even if you know that it might just be a virus? Resist that urge, because, among other things, taking antibiotics increases your risk of yeast infections.

Other things that increase your risk include having poorly-controlled diabetes (definitely go see your doc if that is the case), your individual genetic makeup (thanks, mom and dad), obesity, some hormonal contraceptives, and being sexually active.  People with weakened immune systems, such as those on chemotherapy, transplant patients, people on medication like corticosteroids, and people with HIV are also more likely to get yeast infections.

#4. If you get a lot of yeast infections, you should see a doctor. Most of the time, if you have correctly diagnosed your yeast infection, you can treat it with an over the counter medication and be back to your badass self in no time. However, if you are getting yeast infections recurrently, as in more than once or twice a year, this could be a signal that something is wrong.  Frequent yeast infections can be the presenting symptom of undiagnosed diabetes and immune system deficiencies.  There is also a possibility that you do NOT actually have a yeast infection (see #1) or that you have a resistant type of yeast that requires a different treatment.

#5. You can treat yeast infections at home, but NOT with probiotics, tea tree oil, yogurt, garlic, or douches.  Ladies, let’s be real. If it came out of your fridge, or if you pinned it off of some random board on Pintrest, it’s probably not the most effective treatment for your yeast infection.  Just sayin’. There are a lot of folks out there proffering “natural” remedies for yeast infections.  Despite their convincing anecdotes, the evidence is just not there for frozen yogurt or garlic suppositories in the treatment of yeast infections. And douches? Douching is just not good vaginal care.  According to the American College of Obstetricians and Gynecologists, no one needs to douche for any reason….ever.  Douching can actually increase your risk of vaginal infections and pelvic inflammatory disease.  So please, no douching.

The easiest and least messy way of treating your garden-variety yeast infection is with oral fluconazole. This is a prescription-only medication that you can get from your doctor.  The best part is that a single dose is all you need. That’s it. Easy peasy.

If you 1) prefer the over-the-counter approach and 2) are certain that you have a yeast infection, you can purchase one of the many topical antifungal treatments from your local pharmacy.  You may be familiar with the various miconazole-containing creams and suppositories.  This is a slightly more messy process whereby you insert a suppository into your vagina before you go to bed—and wear a panty liner! That said, miconazole is every bit as effective as oral fluconazole. And, if you happen to be pregnant, it is the treatment of choice.

Take Home Message: Yeast infections are a drag, but easily treatable for most people. Always talk to your doctor about new symptoms you develop to be sure you have the correct diagnosis and treatment…there’s nothing worse than wasting time and money on unnecessary or harmful treatments, delaying your path to a normal healthy vagina. 


References:

1.  Ferris DG, Nyirjesy P, Sobel JD, et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstet Gynecol. 2002;99(3):419.

2. Fong IW.  The value of treating the sexual partners of women with recurrent vaginal candidiasis with ketoconazole. Genitourin Med. 1992;68(3):174.

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