The yeast infection is an extremely annoying and extremely common condition that affects millions of women each year and can be stubborn and hard to treat. Between 5-10% of women who are affected will have recurrent yeast infections which are defined as more than 4 per year.
Yeast infections are caused by a fungus called Candida. Normally, Candida causes no symptoms. However, when there are changes in the environment of the gastrointestinal tract and vagina (which can be caused by medicines, injury, or stress to the immune system), Candida can overgrow and cause the symptoms
Treatment for yeast infection is dependent on why you have a yeast infection and what exact kind of yeast infection you have.
Step 1: Determine that you actually have a yeast infection
Women with itching or vaginal discharge often guess that their symptoms are caused by a yeast infection and try to treat it using over-the-counter medications. However, studies have shown that patients often misdiagnose themselves. A study in the journal of Obstetrics and Gynecology showed that only ~34% of women who self-diagnosed with yeast infection were actually correct.
The rest had bacterial vaginosis (BV), mixed vaginitis, trichomonas infection, no infection and other diagnoses.
Treatments for vulvovaginal candidasis (yeast infection) will not work on other illnesses.
Step 2: Do a root cause analysis
If you are sure you have a yeast infection (and not bacterial vaginosis, trichomonas, etc), do a quick sanity check on possible root causes.
There are a number of underlying situations that may cause a yeast infection, so check if any of these apply to you:
- Diabetes mellitus – Women with diabetes who have high blood sugar are more prone to vulvovaginal candidiasis than women whose blood sugar is normal. Check if you have high blood sugar by taking a hemoglobin A1c test (read more).
- Antibiotics – Many women are prone to vulvovaginal candidiasis during or after taking broad spectrum antibiotics. In women susceptible to symptomatic yeast infections with antibiotic therapy, a dose of oral fluconazole at the start and end of antibiotic course may prevent postantibiotic vulvovaginitis.
- Increased estrogen levels – Yeast infection appears to occur more often in the setting of increased estrogen levels, such as oral contraceptive use (especially when estrogen dose is high), pregnancy, and estrogen therapy.
- Immunosuppression –Yeast infections are more common people whose immune system is weakened, including those who are on corticosteroids.
- Contraceptive devices – Vaginal sponges, diaphragms, and intrauterine devices (IUDs) have been associated with yeast infections, but the research is not very conclusive on the linkage.
Step 3: Treatment
If diabetes, antibiotics, estrogen levels, immunosuppression or contraceptives are an issue, you may need to work with your doctor to manage other conditions before taking action on a yeast infection.
These are common treatments for yeast infections that do not have a proximate cause. Some of these are have not been clinically validated. Keep a dialogue open with your healthcare provider on what course of treatment might be right for you.
- Vaginal application of garlic (not clinically validated)
- Eating probiotic products containing Lactobacillus acidophilus , or applying them to the affected area (not clinically validated)
- Vaginal cream or suppository such as Monistat (no prescription, varying strengths and lengths of course), or other imidazoles.
- Boric acid vaginal suppository (typical course it 2x/week for one week). In this case the boric acid powder, not crystals, is loaded into a capsule, boric acid is not applied directly.
- Fluconazole tablet (prescription, sold under brand Diflucan) – one or more doses as prescribed by a doctor
Step 4: Additional Considerations – what kind of yeast infection is it?
As part of diagnosis you should understand what kind of yeast infection you have. The most common kind of yeast infection is infection with C. albicans. C. albicans infections are often effectively treated by imidazoles (e.g. Monistat).
It’s possible that the yeast infection has a rarer variety, such as C. glabrata, C. krusei or C. tropicalis. In this case imidazoles will not work and boric acid is recommended.
Overall, a clear diagnosis confirming yeast infection and which variety of yeast will help inform treatment and save frustration.