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Vaginal Yeast Infections

Vaginal Yeast Infections

Topic Overview

What is a vaginal yeast infection?

Yeast is a fungus that normally lives in the vagina in small numbers. A vaginal yeast infection means that too many yeast cells are growing in the vagina. These infections are very common. Although they can bother you a lot, they are not usually serious. And treatment is simple.

What causes a vaginal yeast infection?

Most yeast infections are caused by a type of yeast called Candida albicans.

A healthy vagina has many bacteria and a small number of yeast cells. The most common bacteria, Lactobacillus acidophilus, help keep other organisms—like the yeast—under control.

When something happens to change the balance of these organisms, yeast can grow too much and cause symptoms. Taking antibiotics sometimes causes this imbalance. The high estrogen levels caused by pregnancy or hormone therapy can also cause it. So can certain health problems, like diabetes or HIV infection.

What are the symptoms?

A yeast infection causes itching or soreness in the vagina and sometimes causes pain or burning when you urinate or have sex. Some women also have a thick, clumpy, white discharge that has no odor and looks a little like cottage cheese.

These symptoms are more likely to occur during the week before your menstrual period.

How is a vaginal yeast infection diagnosed?

It's easy to guess wrong about a vaginal infection. See your doctor if you aren't sure what you have or if this is the first time you have had these symptoms. Also see your doctor if you are pregnant. Your doctor may want to do a vaginal exam.

How is it treated?

If you have had a yeast infection before and can recognize the symptoms, and you aren't pregnant, you can treat yourself at home with medicines you can buy without a prescription. You can use an antifungal cream or a suppository that you put into your vagina. Or your doctor may prescribe a medicine to treat the infection.

If your symptoms are mild, you may want to wait to see if they clear up on their own.

Yeast infections are common during pregnancy. If you are pregnant, don't use medicine for a yeast infection without talking to your doctor first.

If you use a cream or suppository to treat the infection, don't depend on a condom or diaphragm for birth control. The oil in some medicines weakens latex, the material often used to make these devices.

Many women have infections that come back. If you have more than four yeast infections in a year, see your doctor. He or she may do some tests to see if your yeast infections are being caused by another health problem, such as diabetes.

Can vaginal yeast infections be prevented?

If you practice good genital hygiene, you can help prevent infection.

  • Keep your vaginal area clean. Use mild, unscented soap and water. Rinse well.
  • After using the toilet, wipe from front to back to avoid spreading yeast or bacteria from your anus to the vagina or urinary tract.
  • Wear underwear that helps keep your genital area dry and doesn't hold in warmth and moisture. One good choice is cotton underwear.
  • Avoid tight-fitting clothing, such as panty hose, and tight-fitting jeans. These may increase body heat and moisture in your genital area.
  • Change out of a wet swimsuit right away. Wearing a wet swimsuit for many hours may keep your genital area warm and moist.
  • Change pads or tampons often.
  • Don't douche or use deodorant tampons or feminine sprays, powders, or perfumes. These items can change the normal balance of organisms in your vagina.

Cause

A vaginal yeast infection is caused by an overgrowth of yeast organisms that normally live in small numbers in the vagina. Things that may encourage an excess growth of vaginal yeast include:

  • Using antibiotics.
  • Having high estrogen levels (hyperestrogenemia), such as during pregnancy, hormone therapy (HT or ET) use, high-dose birth control pill use, and the menstrual cycle.
  • Having diabetes, especially if your blood sugars are not well controlled and tend to be high.
  • Having an impaired immune system.
  • Using corticosteroids, such as prednisone.
  • Being overweight.

Most yeast infections involve Candida albicans ( C. albicans), a yeast that can be treated effectively with standard yeast infection medicine. Recurrent vaginal yeast infections tend to involve non– C. albicans types of yeast, which are more resistant to the standard treatments for C. albicans yeast infections.

Symptoms

The symptoms of vaginal yeast infection include:

  • Vaginal itching that is often severe.
  • Vaginal discharge that is usually white, thick, clumpy, and odorless.
  • Red, irritated skin around the opening to the vagina (labia).
  • Pain while urinating when urine touches irritated skin.
  • Pain in the vagina during sexual intercourse.

Symptoms of a vaginal yeast infection are more likely to occur during the week before a menstrual period.

There are other conditions with similar symptoms, such as bacterial vaginosis or a sexually transmitted infection (STI). Itching and redness of the vulva can also be caused by a reaction to vaginal products such as soap, bath oils, spermicidal jelly, or douches. If you are unfamiliar with your symptoms, see your doctor for an accurate diagnosis.

What Happens

Vaginal yeast infections often clear up on their own without treatment, usually when menstruation begins. Menstrual blood raises the vaginal pH, causing the number of yeast cells to decrease because they can't grow in the pH present during menstruation.

There are significant differences between occasional, easily treatable yeast infections and recurrent infections that seriously affect a woman's life. Recurring vaginal yeast infections can be difficult to prevent or cure. Women who have recurring yeast infections should be evaluated for other causes (such as diabetes, hormone therapy, or treatment-resistant strains of yeast) so that the cause can be treated or reversed.

What Increases Your Risk

Your risk of getting a vaginal yeast infection can be increased by a number of medical and lifestyle factors.

Some of the common things that put you at risk for vaginal yeast infection include:

  • Use of antibiotics. These medicines upset the normal balance between yeast and bacteria in the vagina. Antibiotics can kill too much "good" bacteria and result in too much yeast growing in the vagina, sometimes causing symptoms of a yeast infection.
  • Problems with your immune system that affect the normal balance of yeast and bacteria in the body. Having a condition such as poorly controlled diabetes or HIV (human immunodeficiency virus) can lead to too much yeast growing in the vagina. Taking corticosteroid medicines sometimes also weakens the immune system and increases the risk for yeast infections. Pregnant women are also at higher risk for getting yeast infections because of shifting hormones that can weaken the immune system.
  • Wearing tight-fitting, nonabsorbent pants or undergarments that hold in warmth and moisture.
  • Using feminine hygiene sprays, talcs, or perfumes in the vaginal area.
  • Douching.

Vaginal yeast infections are not sexually transmitted. After having unprotected sex with a partner who has a yeast infection, you may have more than the normal amount of yeast in your vagina. But if after having sex you develop a yeast infection that causes symptoms, it is most likely because other things are also involved.

When should you call your doctor?

Call your doctor now if you:

Call your doctor for an appointment if you:

  • Have an unusual vaginal discharge with an unusual or foul odor.
  • Have unusual vaginal itching.
  • Have pain during sex or urination.
  • Have any other symptoms that may point to a vaginal infection.
  • Still have symptoms after trying home treatment with a nonprescription medicine.
  • Have symptoms return within 2 months, and you have not been taking antibiotics.

Watchful waiting

If your symptoms are mild and you are sure they are caused by a vaginal yeast infection, waiting several days to see if the symptoms clear up on their own isn't harmful, especially if you expect your menstrual period within that time. Sometimes a menstrual period will relieve the symptoms of a mild yeast infection. If your symptoms continue, you can use nonprescription medicine. If you still have symptoms after treatment, see your doctor.

Exams and Tests

Your doctor may be able to diagnose your vaginal symptoms based on your medical history and a vaginal exam.

If your vaginal symptoms are not typical of a vaginal yeast infection, your doctor can look for signs of yeast or other organisms using a wet mount test of vaginal discharge.

You may have other tests if you have vaginal yeast infections that are severe or that keep coming back (recur), such as:

  • A vaginal culture. This test can confirm that you have a yeast infection. A sample of vaginal discharge can be taken during a wet mount test. If more than the normal amount of yeast grows in the sample over a short period of time (a few days), then your symptoms are likely caused by a yeast infection.
  • A blood test to find out if you may have diabetes or another health problem that makes you more likely to get yeast infections.

Although a yeast infection can be detected during a routine Pap test, this type of test is not typically done to diagnose vaginal infections.

Treatment Overview

You have a number of treatment options for a vaginal yeast infection, including nonprescription vaginal medicine, prescription oral or vaginal medicine, or nonprescription vaginal boric acid capsules.

Only use nonprescription vaginal yeast infection treatment without a doctor's diagnosis and advice if you:

  • Are not pregnant.
  • Are sure your symptoms are caused by a vaginal yeast infection. If you have never been diagnosed with a vaginal yeast infection, see your doctor.
  • Have not been exposed to a sexually transmitted infection (STI), which would require a medical exam.
  • Are not having multiple, recurrent infections.

The risk of self-treatment is that your symptoms may be caused by another vaginal infection, such as a sexually transmitted infection (STI), that requires different treatment. If you may have been exposed to an STI, it is best to discuss your symptoms with your doctor before using a nonprescription medicine. Your doctor may recommend testing for STI if you have risk factors for these infections.

Yeast infection during pregnancy

Vaginal yeast infections are common during pregnancy, likely caused by elevated estrogen levels. If you are pregnant, don't assume you have a yeast infection until it is diagnosed, and don't use nonprescription medicines without discussing your symptoms with your doctor.

Vaginal medicine is the recommended treatment for vaginal yeast infections during pregnancy.footnote 1

Recurrent yeast infection

For a vaginal yeast infection that recurs within 2 months of treatment, or four times in 1 year (recurrent vaginal yeast infection), see your doctor. Further testing or a different treatment may be needed. If you have been using a nonprescription medicine for your vaginal symptoms, be sure to tell your doctor. This information could affect what treatment is recommended.

Recurrent vaginal yeast infection can be treated with prescription oral medicine, nonprescription vaginal medicine, or vaginal boric acid capsules, followed by less frequent medicine over 6 months to 1 year to prevent reinfection.footnote 1

A vaginal yeast infection is not a sexually transmitted infection (STI). After having unprotected sex with a partner who has a yeast infection, you may have more than the normal amount of yeast in your vagina. But if after having sex you develop a yeast infection that causes symptoms, it is most likely because other factors are also involved.

What to think about

It is important to complete the entire recommended treatment to cure a yeast infection.

Vaginal infections caused by types of yeast other than Candida albicans may be more difficult to cure with standard antifungal medicine. For treatment-resistant infections, a culture of vaginal discharge is done to identify the type of yeast causing the infection.

Boric acid is usually effective for treating Candida albicans ( C. albicans) infection, and non– C. albicans yeast infections that don't respond to antifungal medicine.footnote 2

Prevention

The following actions can help prevent a vaginal yeast infection.

  • Eat a balanced diet rich in fruits, vegetables, whole grains, and nonfat dairy products. Some women think that eating foods with lactobacillus organisms, such as yogurt or acidophilus milk, will help prevent yeast infections. So far there is no evidence for this connection. But eating foods that contain lactobacillus can be part of a healthy diet.
  • Control diabetes. Good control of blood sugar levels decreases the risk of yeast infections anywhere on your body.
  • Avoid unnecessary use of antibiotics. Antibiotics can change the normal balance of vaginal organisms, allowing excess growth of yeast.

If you practice good genital hygiene, you can also help prevent infection.

  • Keep your vaginal area clean. Use mild, unscented soap and water. Rinse well.
  • After using the toilet, wipe from front to back to avoid spreading yeast or bacteria from your anus to the vagina or urinary tract.
  • Wear underwear that helps keep your genital area dry and doesn't hold in warmth and moisture. One good choice is cotton underwear. Try sleeping without underwear.
  • Avoid tight-fitting clothing, such as panty hose, and tight-fitting jeans. These may increase body heat and moisture in your genital area.
  • Change out of a wet swimsuit right away. Wearing a wet swimsuit for many hours may keep your genital area warm and moist.
  • Change pads or tampons often.
  • Don't douche or use deodorant tampons or feminine sprays, powders, or perfumes. These items can change the normal balance of organisms in your vagina.

Home Treatment

Do not self-treat a vaginal yeast infection if you:

  • Are pregnant.
  • Are not sure your symptoms are caused by a vaginal yeast infection. If you have never been diagnosed with a vaginal yeast infection, see your doctor before treating it with a nonprescription antifungal cream. Sometimes women think they have a vaginal yeast infection when symptoms are caused by a different condition, such as bacterial vaginosis or a sexually transmitted infection (STI).
  • Have been exposed to a sexually transmitted infection (STI), which would require a medical exam.
  • Are having a recurrent infection.

Using nonprescription medicine

When using a nonprescription vaginal medicine for a vaginal yeast infection, follow the directions on the package insert, as well as these guidelines:

  • Use pads instead of tampons while you are using nonprescription vaginal medicines. Tampons can absorb the medicine.
  • Avoid using soap when cleaning the vaginal area—rinse with water only.
  • If sexual intercourse is painful, avoid it. Otherwise, use a water-soluble lubricating jelly (such as K-Y Jelly) to reduce irritation. The oil in antifungal creams or suppositories can weaken latex. This means condoms and diaphragms may break, and you may not be protected from STI or pregnancy.
  • If the genital area is swollen or painful, sitting in warm water (in a bathtub or sitz bath, not a hot tub) may help. Or instead, you may try putting a cool, damp cloth on the area. Do not rub to try to relieve itching.

Report your symptoms to your doctor if:

  • You are not sure that you have a yeast infection.
  • Your self-treatment is not working after one complete course of therapy.

Things to consider

The risk of self-treatment is that your symptoms may be caused by a type of vaginal infection other than a yeast infection, such as bacterial vaginosis or a sexually transmitted infection (STI). If you have pelvic pain or fever, get an evaluation by a doctor.

If you are pregnant, it is important to be evaluated for vaginal symptoms. Some vaginal infections, such as bacterial vaginosis, gonorrhea, or chlamydia, may increase your risk of complications during pregnancy.

If you have risk factors for an STI, discuss your symptoms with your doctor before using a nonprescription medicine. Risk factors for an STI include having sex without a condom or having more than one sex partner.

Talk to your doctor before you try unproven home treatment methods, such as applying tea tree oil in the vagina or taking garlic supplements. These treatments have not been well studied. They may even cause other problems, such as allergic reactions, in some women.footnote 3 Douching is not recommended, because it can make some infections worse.

Medications

Antifungal medicines are the standard treatment for a vaginal yeast infection. You can insert a cream or suppository antifungal cream into your vagina or take a pill by mouth. Vaginal boric acid capsules are sometimes used.

Antifungal medicines that you take as a pill by mouth affect the entire body (so it can also treat any yeast infection elsewhere in the body). Vaginal medicine only affects the area in which it is applied.

If you are thinking about using nonprescription treatment, see:

Medicine choices

  • Vaginal antifungal medicines, such as miconazole (Monistat) and tioconazole (Vagistat), are available in 1-day, 3-day, and longer courses, depending on the strength of the medicine. These are available over-the-counter or with a prescription.
  • Oral antifungal medicines are available with a prescription and are easy to use.
  • Vaginal boric acid capsules are available over-the-counter. But they are not safe to use if you are pregnant.

What to think about

Antifungal creams and suppositories that you put into your vagina have fewer side effects than antifungal pills you take by mouth. This is because vaginal medicine isn't absorbed into your body and only affects the genital area. Antifungal pills that are taken by mouth affect your entire body. Side effects from these pills are rare with one treatment dose. Side effects can include nausea, headaches, and belly pain. But taking a pill is convenient and is not messy. Medicine put into the vagina can be uncomfortable. And it may seem like more of a hassle than taking a pill.

The oil in antifungal creams or suppositories can weaken latex. This means condoms and diaphragms may break, and you may not be protected from STI or pregnancy.

If you are taking the anticoagulant medicine warfarin and you use a nonprescription vaginal yeast-fighting medicine, you may have increased bruising and abnormal bleeding. Talk with your doctor before using an antifungal medicine along with warfarin.

You are more likely to use a treatment correctly and complete the treatment if you get to choose the type you prefer. Talk with your doctor about the advantages and disadvantages of vaginal and oral medicines, including:

  • How a medicine can be administered. Most of the vaginal treatments are available as creams, vaginal tablets, or suppositories.
  • Whether oral or vaginal medicine is recommended. You may prefer to take pills rather than use medicine that is inserted into the vagina. Or the type of yeast infection you have may respond better to one method than to the other.
  • Whether you should avoid sexual intercourse if you are using vaginal medicine. Some doctors advise that women avoid sex during treatment.
  • Whether treatment should be continued during your menstrual period. Tampons can absorb medicine, so use pads if you are being treated with vaginal medicines during your period.

Check with your doctor or pharmacist to see whether you can get a generic form of a prescription medicine. Many generic medicines are now available to treat vaginal yeast infections. They are often less expensive than brand-name medicines.

Other Treatment

Some experts may recommend vaginal boric acid capsules as a treatment option for vaginal yeast infection, particularly infections that can't be cured by prescription or nonprescription antifungal yeast infection medicines.footnote 4 Boric acid is a white, crystalline chemical substance that has antifungal and antiviral properties. It is used in various pharmaceutical products and is also available without a prescription.

If you are pregnant, do not use vaginal boric acid treatment.

References

Citations

  1. Centers for Disease Control and Prevention (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64(RR-03): 1–137. http://www.cdc.gov/std/tg2015. Accessed July 2, 2015. [Erratum in MMWR, 64(33): 924. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a9.htm?s_cid=mm6433a9_w. Accessed January 25, 2016.]
  2. Centers for Disease Control and Prevention (2010). Vulvovaginal candidiasis section of Sexually transmitted diseases treatment guidelines 2010. MMWR, 59(RR-12): 61–63. Also available online: http://www.cdc.gov/std/treatment/2010/default.htm.
  3. Lopez JEM (2015). Candidiasis (vulvovaginal). BMJ Clinical Evidence. http://clinicalevidence.bmj.com/x/systematic-review/0815/overview.html. Accessed April 15, 2016.
  4. Centers for Disease Control and Prevention (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR, 64(RR-03): 1–137. http://www.cdc.gov/std/tg2015. Accessed July 2, 2015. [Erratum in MMWR, 64(33): 924. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6433a9.htm?s_cid=mm6433a9_w. Accessed January 25, 2016.]

Other Works Consulted

  • Pappas PG, et al. (2009). Clinical practice guidelines for the management of candidiasis: 2009 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 48(5): 503–535.

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