Treatment of Vaginal Fungal Infections

W. Steven Pray, Ph.D., R.Ph.

Professor of Nonprescription Products
and Devices, School of Pharmacy,
Southwestern Oklahoma State University, Weatherford, OK

Vaginitis with vaginal discharge is a common problem, causing 10 million women each year to
visit a physician's office for care.1 The three most common causes of vaginitis are bacterial,
trichomonal, and fungal. In as many as 75% of females with vaginitis, vulvovaginal candidiasis is
the cause.2 Since nonprescription antifungals first became available over a decade ago,
numerous female patients have sought advice from a pharmacist about self-care. The number
may well dwarf those who have made physician appointments.

Recognizing Bacterial Vaginitis: Bacterial vaginitis may be caused by a host of organisms,

including Gardnerella vaginalis (the most common), Mobiluncus species, Mycoplasma hominis,
Prevotella, Bacteroides, and Peptostreptococcus.1 Three points help confirm bacteria as the
source of vaginitis: (1) The discharge is thin, homogeneous, white, and resembles skim milk
adhering to vaginal walls; (2) The pH is above 4.5 (normal vaginal pH is 3.8-4.4); (3) When a
sample of the discharge is mixed with 10% KOH, it will produce a typical "fish-like" odor (this is
indicative of an increase in anaerobic activity, which yields amines such as cadaverine and
putrescine).

Trichomonal Vaginitis: Trichomonal vaginitis causes a frothy, copious discharge that is

yellowish or greenish and may have a fishy odor.1 The vaginal pH exceeds 5-6. While many
patients are asymptomatic, others report vaginal and vulvar discomfort, soreness, burning, and
dyspareunia (pain during sexual intercourse). Patients who report manifestations of these
symptoms must be referred to a physician for prescription medications.

Candidal Vaginitis:
As many as 15%-20% of females with vaginal yeast infections are asymptomatic. 3 The reported
symptoms of vaginal candidal infection are fairly characteristic and duplicative upon recurrence.
They include vulvar and/or vaginal pruritus (which may be intense), burning soreness (especially
when urinating), irritation, dyspareunia, and the well-known curd-like discharge that adheres to
the vaginal walls.4 Several noninfectious etiologies can produce similar symptoms, as illustrated in
TABLE 1. In order to confirm Candida as the cause, the physician should test vaginal pH, and
should treat a vaginal specimen with 10% KOH.5 The alkaline pH of KOH does not affect the
chitinous components of the fungi, whereas all nonchitinous elements in the specimen (white
blood cells, bacteria, epithelial cells) are dissolved. Microscopy reveals the characteristic
architecture of fungal organisms (yeast buds and hyphae). Another clue is the presence of a rash
with a prominent border, similar to that seen in candidally infected diaper rash. The rash may
spread outward from the vulvar area to involve the groin. The patient may also have satellite
lesions outside the visible border.6 In worse cases, the patient may also experience excoriations,
formation of pustules, and fissures of the labia.5

TABLE 1: Situations That Mimic Vaginal Candidal Infection

Condition Possible Causes
Contact dematitis Soaps, deodorants, underwear,
detergents, spermicides, douche,
 solutions, vaginal lubricants, perfumed
cleansing wipes
Irritant vulvitis Excessive use of minipads
Vulvovaginitis Adverse reaction to vaginal antifungal
product
Change in vaginal mucus Normal change that occurs at
ovulation
Coitus-related vaginitis Allergy to partner’s sperm

Source: References 1-7

Species of Candida: Candida albicans is able to adhere to vaginal epithelium more readily than
other Candida species, which is probably why it causes about 80% of yeast infections. Other, less
common, causes are C. glabrata, C. parapsilosis, C. guilliermondii, and C. tropicalis. 6 These latter
organisms may not respond as readily to nonprescription therapy. Unfortunately, there is no
reliable clinical method of differentiating the various Candida organisms. 6 It may be that treatment
failures point to the presence of a non-albicans infection. Researchers hypothesize that the
widespread home use of nonprescription antifungal medications has caused the emergence of
more resistant strains, and that the number of chronic and recurrent cases will eventually
increase as a result.4

Risk Factors for Candidal Infection

Estrogen augments Candida's propensity to adhere to intravaginal tissues. Thus, both pregnancy
and oral contraceptives can increase the risk of vaginal yeast infections. 3 Oral contraceptives
containing 75-150 micrograms of estrogen are most likely to cause the problem; low-dose
products are seldom implicated.

Immunocompromise can also induce candidal infection; use of systemic corticosteroids and
having AIDS are both associated with infection. Diabetes, glucosuria, lupus, thyroid dysfunction,
and obesity are all thought to be possible predisposing factors. 1

Use of antibiotics is widely perceived to be a risk factor for Candida vaginitis through alteration of
the intravaginal flora. High-risk antibiotics that more commonly lead to candidal infection are
reportedly ampicillin, tetracyclines, clindamycin, and the cephalosporins. 3 In one study,
researchers found that virtually all gynecology and internal medicine textbooks repeat this as
though it were a proven fact.7 The researchers also explore the theory that the reciprocal balance
between normal vaginal organisms is upset through eradication of bacteria. In a prospective
study, they followed 250 asymptomatic obstetric patients, 46% of whom received an antibiotic
during their pregnancies. Surprisingly, there appeared to be a slightly lower risk of developing a
yeast infection when the female took antibiotics. There was no association between any specific
antibiotic class and greater susceptibility to vaginal candidiasis. Since this group consisted of
pregnant women, however, tetracycline was not one of the prescribed antibiotics. The authors
suggested that tetracycline use might have altered the results.

Certain types of clothing may predispose for Candida. Females should be cautioned to avoid
wearing tight-fitting clothes and synthetic underwear. 1 Frequent coitus and the use of intrauterine
devices may also be contributing factors.

Patients should be counseled against frequent bathing in hot tubs or Jacuzzis, as well as to avoid
any situation in which the outer vaginal area is exposed to prolonged moisture, such as wearing a
wet bathing suit throughout a long summer day at a pool or water park. The chemically treated
water in hot tubs and overly chlorinated water in indoor pools may also be causal through
irritation of delicate vulvar/vaginal tissues.1

Anecdotal evidence implicates such factors as stress, proximity to the onset of menses, and
various dietary components (e.g., too great an intake of milk products, refined carbohydrates, or
artificial sweeteners), but there is little evidence to support these hypotheses. 1,3

Vaginal Infections Are Common, But Often Misunderstood

Vaginitis, the collective term for all vaginal infections, is the most
common reason women in the U.S. see their doctors, accounting
for 10 million office visits each year. Most women (80%), however,
do not recognize the signs of bacterial vaginitis (BV)—the most
common and potentially serious form of infection. They may
confuse the signs of BV for a yeast infection and thus self-treat
inappropriately with OTCs meant to eradicate candidal infection.

Sexual Transmission

Although it would be tempting to assume that Candida infection can be sexually transmitted, there
are few data to support that theory. Concomitant treatment of the male sexual partner seldom
yields any benefit in lowering the incidence of reinfection. 1 For this reason, most authorities do not
suggest that a woman's partner be treated. Further, many females who contracted a vaginal
yeast infection were not sexually active at the time proximate to the infection. 3

Treatment Considerations

Patients with candidal vaginitis should be counseled on appropriate care of the vulvar region.
They should avoid use of harsh soap and perfumes and should keep the vulvar area dry to
discourage overgrowth.1 Vulvar itching may be controlled by careful application of one of the
topical vaginal antifungals. Nonprescription hydrocortisone may enhance the effectiveness of the
antifungal.1

Topical nonprescription antifungals are a good first-line therapy for candidal vaginitis. Adverse
reactions are generally mild, and included burning, stinging and irritation. Pharmacists must
counsel sexually active patients, however, that use of many vaginal products, such as antifungals
or hydrocortisone ointments, may damage certain barrier contraceptives, such as diaphragms
and condoms. Manufacturer toll-free lines cannot answer whether the products degrade
polyurethane products such as the Trojan Supra Condom or the Reality Female Pouch.
Miconazole (Monistat) and clotrimazole (Gyne-Lotrimin) are available as vaginal
suppositories/tablets and cream, in a 7-day or 3-day option. Butoconazole (Femstat 3, Mycelex-3)
is available as a cream or tablet in a 3-day product. Tioconazole (Vagistat-1, Monistat 1) is a 1-
day product that is available in a prefilled applicator containing the ointment. Within this group,
tioconazole appears to be most effective in treating non-albicans cases. Shorter courses of
treatment may result in higher recurrence rates.3

The primary source of the inflammation can help to guide which treatment to use. If the problem
is mainly intravaginal, a suppository/tablet may be superior, while if the problem is primarily vulvar
the creams may be preferable.3 For patients with both areas affected, the combination packs
offering a vaginal suppository/tablet in combination with a small tube of cream may be the better
option.

Homeopathic Products
 Homeopathic products that purport to relieve the burning and itching of vaginal yeast infections
actually contain diluted extracts of Candida parapsilosis and Candida albicans. They lack
scientifically valid proof of efficacy, and are not covered under the 1938 Federal Food, Drug, and
Cosmetic Act.

 PATIENT INFORMATION

Vaginal Fungal (Yeast) Infections

What Are Some Typical Symptoms?
Vaginal fungal infections are a common and
A fungal infection causes severe vulvar itching, often
troubling nuisance for many women. Since 1990,
along with a thick, curd-like vaginal discharge. Your
safe and effective nonprescription products that
vulvar tissues may be red, swollen, and you may have
can cure the problem have been available. There
burning with urination. The symptoms are the same
are specific instructions and precautions you
from episode to episode. However, it is easy to
must know and follow before you attempt self-
misdiagnose your symptoms or to mistake another,
treatment.
more serious, condition (such as an allergy or an STD
like herpes) for vaginal fungus. Also, there are other things besides vaginal fungus that cause discharge.
For this reason, you must have had at least one physician-diagnosed vaginal fungal infection before you
can self-treat the next ones.

Available Products
The first products that were available without a prescription were Gyne-Lotrimin and Monistat 7. Both
require seven days of therapy. Each is available as either a cream or a vaginal suppository/tablet. With
either one, you must insert one applicatorful of cream or one suppository/tablet into the vagina for seven
consecutive nights, preferably at bedtime. You should continue to use them if your period starts, but you
should be sure to use pads rather than tampons to prevent absorption of the medication into the tampon. If
you wish, you may place some of the cream directly on vulvar tissues while itching is severe.Several
manufacturers also make three-day treatments, such as Monistat 3 Suppositories, Gyne-Lotrimin 3 Cream,
Femstat 3 Cream, and Mycelex-3 Cream. They are used for three consecutive days. The newest
vaginal products are one-dose prefilled applicators, such as Vagistat-1 and Monistat 1. They are easier to
use than the three-day and seven-day products. The three-day and one-day products may not work as well
as the seven-day products, however.

How Long Before the Product Works?

All of these products (one-day, three-day, and seven-day) generally produce some relief from symptoms
in fewer than three days, and should effect a cure in seven days or less. If the product you are using fails
to do either of these things, you may have another condition. If this is the case, you should immediately
make an appointment to see a physician.

What Should Be Done If the Condition Returns?

Vaginal fungal infections often return. However, if you experience infection within two months
of use of the product, you may be pregnant or have a serious underlying condition, such as AIDS or
diabetes. A physician appointment should be made if this occurs.

Who Should Not Use Nonprescription Antifungals?

Girls under the age of 12 and pregnant women should not use nonprescription antifungals. If you have
abdominal pain, oral temperature over 100° F, chills, nausea, vomiting, diarrhea, foul-smelling vaginal
discharge, or pain in the back or shoulder, do not use these products. Instead, you should make an
appointment to see a physician.

Vaginal candidiasis is a fungal or yeast infection of the vulva and/or vagina. It causes a
smelly, thick, white-yellow discharge that might be accompanied by itching, burning and
swelling. It can also can make walking, urinating or sex very painful.
Vaginal candidiasis can be an occasional problem for even the healthiest woman. However, it's
more common and severe in women with weakened immune systems. For many, a repeating
or worsening vaginal yeast infection is the first symptom of HIV infection. This infection can
occur at any CD4+ cell count but is likely to occur more often when your CD4+ count falls
below 100.

Cause
Vaginal candidiasis is caused by the fungus
called Candida. Everyone has small
quantities of the fungus in the mouth,
vagina, digestive tract and skin. In healthy
persons, "friendly" bacteria and the immune
system prevent the fungus from causing
infection. However, if you have a damaged
or weakened immune system, it's easier for
Candida to grow and cause disease.
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 Certain drugs can alter the natural organisms in the vagina, which can then promote the
growth of Candida. These include the extended use of antibiotics, steroids and oral
contraceptives (birth control) with a high estrogen content. Other factors that may cause
candidiasis include: diabetes, pregnancy, using antihistamines (drugs commonly used to
prevent allergies and rash) and iron, folate, vitamin B12 or zinc deficiency. Factors that may
weaken the immune system -- from cancer chemotherapy to stress and depression -- can also
cause candidiasis. Tight fitting pants and reactions to chemical ingredients found in soaps and
detergents can lead to vaginal candidiasis as well.

Diagnosis
Vaginal candidiasis is usually diagnosed by appearance and symptoms. Because symptoms are
similar to many other conditions, like the sexually transmitted disease trichomonas, your
doctor should confirm a diagnosis by scraping an affected area for examination under a
microscope. Other lab tests are usually done if the infection does not clear up after treatment.
 Treatment
Topical treatments (active only on the area where applied) are the first choices for yeast
infections and these generally work for mild-to-moderate cases. These include vaginal creams,
suppositories or tablets. Many are available over-the-counter in a drugstore.

Most topical treatments are put into the vagina once or twice a day for three days or once a
day for seven days. (See table for drug names and doses). Longer courses (7-14 days) may
be more effective in HIV-positive women.

Generally, topical treatments do not cause side effects, but in a small number of women they
may lead to vaginal burning, itching or skin rash. A few women have experienced cramps or
headaches. Oil-based vaginal creams should be used with caution as they may weaken latex
condoms and diaphragms (see table).

If topical treatment does not work, or if outbreaks recur often, you may need systemic
(throughout the body) drugs. A single oral dose of fluconazole (Diflucan) is increasingly used
to treat vaginal candidiasis.

Treating Vaginal Candidiasis

Drug Name Dose Notes
Topical Therapies
Butoconazole 2% 5 grams for 3 days Available over-the-counter. May weaken
cream latex condoms and diaphragms.
Clotrimazole 5 grams for 7-14 days Available over-the-counter. May weaken
(Lotrimin) 1% cream latex condoms and diaphragms.
Clotrimazole One 100mg tablet for 7  
(Mycelex) 100mg days or two 100mg
vaginal tablet tablets for 3 days
Clotrimazole Single dose  
(Mycelex) 500mg
vaginal tablet
Miconazole (Monistat) 5 grams for 7 days Available over-the-counter. May weaken
2% cream latex condoms and diaphragms.
Miconazole (Monistat) Once a day for 3 days Available over-the-counter.
200mg vaginal
suppository
Miconazole (Monistat) Once a day for 7 days Available over-the-counter.
100mg vaginal
suppository
Miconazole (Monistat) Single dose  
1,200mg vaginal
suppository
Tioconazole (Vagistat) A single dose Available over-the-counter.
300mg ointment
Terconazole (Terazol 5 grams for 7 days May weaken latex condoms and
7) 0.4% cream diaphragms.
Terconazole (Terazol 5 grams for 3 days May weaken latex condoms and
3) 0.8% cream diaphragms.
Terconazole (Terazol Once a day for 3 days  
3) 80mg vaginal
 suppository
Oral Therapies
Fluconazole (Diflucan) One 150mg dose Not recommended for pregnant women;
sometimes used weekly as a preventive
measure.
Itraconazole One 100mg dose Not recommended for pregnant women;
(Sporanox) sometimes used weekly as a preventive
measure.
Ketoconazole (Nizoral) One 200-400mg dose Not recommended for pregnant women;
sometimes used weekly as a preventive
measure.
Other Therapies
Nystatin vaginal tablet Applied to affected Available over-the-counter. May be
(Mycostatin) areas twice a day for useful for recurrent infections (apply
three days. every 7 days for 1 month); messy
application; can cause vaginal swelling;
refraining from sex or use of condom
recommended.

Preventing Vaginal Candidiasis

There are many practical ways to try to prevent vaginal candiaisis (see below). For women
with recurrent vaginal candidiasis, a single dose of fluconazole weekly is sometimes used to
prevent the infection. Caution is recommended when considering this approach since extended
use of fluconazole can result in candidiasis that becomes resistant to treatment.

Gentian violet has been used to treat and prevent fungal infections for years. It is available
without a prescription, but your doctor may have special instructions for preventing vaginal
candidiasis. As a prevention strategy, it is applied onto the affected areas with a cotton swab
once a week for four weeks, or as instructed by your doctor.

Treating and Preventing Fungal Infections Naturally

There's a strong connection between what you eat and the health of your immune system.
Nevertheless, nutritional approaches to prevent and treat conditions like candidiasis are
complicated and controversial. While there isn't a magic recipe that prevents or treats yeast
infections in everyone, following some basic guidelines may lower the risk of yeast becoming a
problem for you.

Sugar, yeast, dairy, wheat, caffeine, nicotine and alcohol promote the growth of yeast.
Nutritionists recommend ingesting as little as possible of these foods and products to decrease
the risk and/or severity of yeast infections. Eating larger amounts of foods that may suppress
the growth of yeast, like garlic or milk and yogurt that contain acidophilus, may help prevent
yeast infections or provide extra treatment for infections that occur.
 Practical Prevention Tips
 Avoid douching. Douching changes the normal acid level of the
vagina and causes inflammation, both of which may increase the
risk of infection.
 Try not to use scented laundry soap, bleach or fabric softeners.
Chemicals in scented laundry soap can cause yeast infections.
Bleach in your clothes may harm the friendly bacteria that stop
Candida from taking over. Also, fabric softeners stop moisture from
escaping, keeping the skin damp and more likely for yeast to grow.
 Avoid tight clothes that block air flow.
 Wear cotton underwear, as it lets air in and moisture out.
 Avoid washing the vaginal area with deodorant, scented soaps,
or bubble baths.
 Try a non-soap cleanser that is less likely to irritate the vaginal
area if yeast infections are a problem for you.

Food as Prevention
 Decrease or avoid sugars (corn
and maple syrup, glucose, fructose
and sucrose). Sugars are food for
Candida and help it grow.
 Decrease or avoid alcohol. Alcohol
converts to sugar and helps
Candida grow.
 Swallow large amounts of garlic. (Fresh is considered best --
mince and put into empty gelatin capsules, up to six cloves a day.)
Garlic is believed to have some natural anti-fungal properties.
(Note: it is unknown if large amounts of garlic interfere with
anti-HIV drugs, but some evidence exists that it may
increase the risk of side effects from ritonavir [Norvir].)
 Drink milk or eat yogurt that contains acidophilus bacteria.
Acidophilus is "friendly" bacteria that helps keep your body in
balance.

Anti-Fungal Drugs and Pregnancy

The U.S. Public Health Service Guidelines for the Prevention of Opportunistic Infections include
recommendations about using anti-fungal drugs during pregnancy. In short, the Guidelines
recommend that oral azole anti-fungals -- including fluconazole (Diflucan), itraconazole
(Sporanox) and ketoconazole (Nizoral) -- should not be used during pregnancy because they
have caused birth defects in animal studies.

If you are pregnant and treating or preventing vaginal candidiasis, topical therapies are
preferable. Moreover, it's recommended that oral azole drugs be stopped in women who
become pregnant and that women taking these drugs use effective birth control.
 Conclusions
Candidiasis is among the most common conditions in people with HIV. While it's a relatively
common condition in general, it's often the first sign of illness that HIV disease is progressing
to a more severe stage, particularly yeast infections that recur or respond less to treatment.
Candidiasis outbreaks can be frequent, cause great discomfort and add to the decline in health
seen in AIDS.

It's important for you to prevent and treat vaginal candidiasis, like other forms of candidiasis.
This will improve the discomfort created by the infection and reduce further damage
candidiasis may cause to your immune system.

Vaginal Yeast Infections

What is a vaginal yeast infection?
Vaginal yeast infections are caused by a fungus called Candida albicans. Yeast are tiny
organisms that normally live in small numbers on the skin and inside the vagina. The acidic
environment of the vagina helps keep yeast from growing. If the vagina becomes less acidic, too
many yeast can grow and cause a vaginal infection.

The acidic balance of the vagina can be changed by your period (menstruation), pregnancy,
diabetes, douche products, some antibiotics, birth control pills and steroids. Moisture and irritation
of the vagina also seem to encourage yeast to grow.

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How do I know if I have a yeast infection?

Yeast infections can be very uncomfortable, but are usually not serious. Symptoms include the
following:
 Itching and burning in the vagina and around the vulva (the skin that surrounds your
vagina)
 A white vaginal discharge that may look like cottage cheese
 Pain during sexual intercourse
 Swelling of the vulva

Yeast infections are so common that every 3 out of 4 of women will have one in their lifetime. Half
of all women have more than one infection in their lifetime. If you have symptoms of a yeast
infection, your doctor will probably want to talk to you about your symptoms and examine you to
make sure a yeast infection is the cause.

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How are these infections treated?

Yeast infections are usually treated with medicine that you put into your vagina. This medicine
may be a cream that you insert in your vagina with a special applicator, or it may be a suppository
that you put into your vagina and allow to dissolve on its own. Medicine in a cream form can also
be put on your vulva to help relieve itching. Medicine in a pill form that you take by mouth is also
available.

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Should I see my doctor every time I have a yeast infection?
Be sure to see your doctor the first time you have symptoms of a yeast infection. It's very
important to make sure you have a yeast infection and not another more serious infection. The
symptoms of a yeast infection are also the symptoms of other infections, such as some STIs.
Treating yourself for a yeast infection when you actually have another type of infection may make
the problem much worse.

If you have often been diagnosed with yeast infections, talk to your doctor about using a medicine
you can buy without a prescription to relieve your symptoms and treat the infection.

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How can I avoid getting another infection?

Here are some things you can do to help prevent another yeast infection:
 Don't wear tight-fitting clothing or clothing made out of synthetic material.
 Wear cotton panties.
 Don't wear pantyhose or leotards every day.
 Use your blow dryer on a low, cool setting to help dry your genital area after you bathe or
shower and before getting dressed.
 Wipe from front to back after using the toilet. This may help prevent the bacteria that
normally live in your rectum from getting into your vagina.
 Change out of wet swimsuits or other damp clothes as soon as you can.
 Don't douche or use feminine hygiene sprays, deodorant sanitary pads or tampons.
 Also avoid using colored or perfumed toilet paper. These items seem to affect the
balance of acidity in the vagina and can lead to yeast infections.

Does my sexual partner need to be treated?

Although it is rare, you can transmit a yeast infection to your partner through sexual intercourse. If
your partner begins to develop symptoms of a yeast infection, talk to a doctor about treatment
options.

Vaginal Infection Causes

← Bacterial vaginosis (bacterial vaginosis) is the most common cause of vaginitis, accounting for 50%
of cases. bacterial vaginosis is caused by a change in the bacteria normally found in the vagina
and causes an overgrowth of organisms such as Gardnerella vaginalis.

← Risk factors include pregnancy, intrauterine device (IUD) use, and frequent douching. It is
associated with sexual activity, and possibly a new sexual partner or multiple sexual
partners. Women who have never had sexual intercourse are rarely affected.
← You do not get bacterial vaginosis from toilet seats, bedding, or swimming pools.
← In the United States, as many as 16% of pregnant women have bacterial vaginosis. This
varies by race and ethnicity from 6% in Asians and 9% in whites to 16% in Hispanics and
23% in African Americans.

← Vaginal yeast infections are caused by a fungus, mainly by Candida albicans. This is also called
candidiasis, genital candidiasis, or vulvovaginal candidiasis (VVC). Yeast infection can spread to
 other parts of the body including skin, mucous membranes, heart valves, esophagus, and other
areas. It can cause life-threatening systemic infections mostly in people with weakened immune
defenses (such as women who are pregnant and people who are HIV positive, have diabetes, or
are taking steroids).

← Nearly 75% of all adult women have had at least one genital yeast infection in their
lifetime. Vaginal yeast infection is not considered a sexually transmitted disease, but 12%
to 15% of men will develop symptoms such as itching and penile rash following sexual
contact with an infected partner.
← Yeast infections are caused by an overgrowth of normally growing fungi in the vagina that
creates unpleasant symptoms. The yeast are kept under control by normally growing
bacteria in the body. If the natural balance of microorganisms is disrupted, the yeast grow
out of control. It is not clear how fungal infections originate, but they are not thought to be
sexually transmitted. Your own natural bacteria cause this type of infection when an
imbalance occurs, possibly caused by any of these events:
← Antibiotics use: Antibiotics destroy protective bacteria in the vagina. These
bacteria normally stop the candidal organisms from overgrowing. Yeast infection
may occur after taking a course of antibiotics for another condition such as strep
throat.
← Diabetes: Both diabetes and pregnancy make the vagina better suited for fungal
growth. These conditions lower the glycogen store in certain vaginal cells. They
may also raise the sugar content (and the pH) of the vagina and increase the risk
of yeast infection.
← Birth control pills: Changes in the vaginal environment occur with increased
hormonal levels from estrogen-containing birth control pills. This change creates
an environment for the fungus to grow and cause symptoms.
← Hormonal changes such as ovulation, menopause, or pregnancy
← Steroid use
← Wearing underwear that is tight or non-cotton: This can increase
temperature, moisture, and local irritation.
← Weakened immune system: HIV/AIDS, for example
← Use of douches, perfumed feminine hygiene sprays
← Scratches in the vagina (during insertion of a tampon or other objects)

← Trichomoniasis is a sexually transmitted disease (also called trich, pronounced "trick") caused by
the parasite Trichomonas vaginalis. Trichomoniasis is primarily an infection of the urinary and
genital tract. For women, the vagina is the most common site of infection. For men, the urethra is
most commonly affected.

← Other causes of vaginal infection may be allergies to spermicides, vaginal hygiene

products, and detergents and fabric softeners. Another type of sexually
transmitted disease may be present. Older women may experience atrophic
vaginitis (a thinning of the vaginal walls with menopause). Foreign objects such
as a forgotten tampon or another foreign object may cause vaginal irritation.

Vaginal Yeast Infections

Health Library
We all enjoy the sweetness of fresh fruit and sweeteners. Did you ever consider that these foods could be
affecting an underlying health condition and subsequently how you feel? Simple and complex sugars found in
many foods could be contributing to the growth of excess yeast in your body.

Yeasts are single cell living organisms that live on the surface of all living things, even the foods we eat and
our skin. Under certain conditions, they can become so numerous they cause infections, particularly in warm
and moist areas. Examples of such infections are vaginal yeast infections, thrush, skin and diaper rash, and
nailbed infections.

75% of all women are likely to have at least one vaginal Candida infection during their lifetime, and about half
have two or more. Vaginal yeast infections, also called "Candida vaginal infections," typically are caused by
the Candida albicans fungus.

Symptoms

The symptoms of a vaginal yeast infection include: V

 aginal itching or soreness.

 Thick, white, cheeselike discharge.

 "Burning" discomfort around the vaginal opening, especially if urine touches the area.
 Pain or discomfort during sexual intercourse.
 Swelling of the vulva

Causes

There is a natural balance among the various bacteria, candida and other organisms that naturally inhabit the
vaginal area. A bacterial or a yeast infection can occur when that balance is upset. When healthy conditions
prevail, the vagina?s acidic environment helps keep yeast from growing out of control, but the acidic balance
can be changed by any number of factors including menstruation, pregnancy, diabetes, some antibiotics,
birth control pills and steroids.

If the vagina becomes less acidic, too many yeast can grow, causing a vaginal infection. Moisture and
irritation are other factors that seem to encourage yeast to grow. It has also been shown that women are
more likely to get to vaginal yeast infections if their bodies are under stress from poor diet, lack of sleep or
illness. Women with immune-suppressing diseases such as diabetes and HIV infection are also at increased
risk.

Treatment

Although many medications used to treat vaginal yeast infections are now available without a prescription,
these medications should only be used for treating repeat infections, not the first time a woman suspects she
may have a yeast infection. Any woman who experiences symptoms of a vaginal infection for the first time
should visit a doctor. This is important to be sure that the vaginal discharge and discomfort is caused by
yeast and not sexually transmitted infections such as gonorrhea, chlamydia or trichomoniasis.

Yeast infections are usually treated with a non-prescription cream or suppository that you put into your
vagina. The cream can also be applied to the vulva to help relieve itching. Treatment of sex partners is not
usually necessary, since most vaginal yeast infections are not transmitted sexually, however, if a male sex
partner shows symptoms of Candida balanitis (redness, irritation and/or itching at the tip of the penis), he
may need to be treated with an antifungal cream or ointment.

Prevention

Here are some things you can do to help prevent yeast infections:

 Keep the external genital area clean and dry.

 Avoid irritating soaps (including bubble bath), vaginal sprays and douches.
 Change tampons and sanitary napkins frequently.
 Wear loose cotton (rather than nylon) underwear that doesn't trap moisture.
 Avoid tight-fitting or synthetic-fiber clothes and daily wear of pantyhose.
 After swimming, change quickly into dry clothing instead of sitting in a wet bathing suit for prolonged
periods.
 Take antibiotics only when prescribed by your doctor, and never take them for longer than your
doctor directs.
 If you are diabetic, try to keep tight control over your blood sugar levels.

Recurrent Yeast Infections and Health Related Problems

About 5% of women with vaginal yeast infections develop recurrent vulvovaginal candidiasis (RVVC), defined
as four or more vaginal yeast infections in a one-year period. Although RVVC is more common in women
who have diabetes or weakened immune systems, most women with RVVC have no underlying medical
illness that would predispose them to recurrent Candida infections. Most doctors treat this problem with two
weeks of oral medication, followed by up to six months of a low maintenance dose. Women with RVVC,
should consult their doctor for treatment and possible testing for diabetes or HIV.

Women between 20 and 55 are especially prone to yeast-related health problems. Some of the symptoms
may include:

 Recurrent vaginal yeast infections

  Recurrent urinary tract infections
 PMS
 Vulvodynia (burning vulva)
 Sexual dysfunction (lack of libido or loss of orgasm)
 Dyspareunia (pain on intercourse)
 Infertility
 Endometriosis
 Interstitial cystitis

If you are experiencing a number of these symptoms, your health problems may be yeast-related. We
suggest you consult with your health care professional.

Recommended For Maintaining a Healthy Balance Between Yeast and Bacteria

Florajen Acidophilus - 16 billion live bacteria in each capsule. After antibiotic therapy, oral contraceptives,
hormonal changes or chronic yeast infections, the ?friendly? acidophilus can restore balance to your system.
Extensively studied and recommended by health professionals throughout the world. 1 capsule equals the
acidophilus in 8 cups of yogurt. Click here to order online. (bottle of 30s or 60s available)