Yeast Infection

Yeast Infections (YIs)

Yeast Infections are one of VP's most frequent topics.

What are yeast infections?

Also called candidiasis or thrush, a yeast infection is an overgrowth of yeast in part of the body.

The New Our Bodies, Ourselves (OBOS) tells us that:

Candida Albicans, a yeast fungus, grows in the rectum and vagina. In a healthy vagina, the presence of some yeast may not be a problem. When your system is out of balance, yeast-like organisms may grown profusely and cause a thick, white discharge that may look like cottage cheese and smell like baking bread. If a woman has a yeast infection when she gives birth, the baby will get yeast in its throat or digestive tract. This is called thrush and is treated orally with nystatin drops.

Candida grows best in a mildly acidic environment. The pH in the vagina is normally more than mildly acidic (4.0 to 5.0), except when we take birth control pills or some antibiotics, are pregnant, have diabetes and when we menstruate (when the pH rises to between 5.8 and 6.8, because blood is alkaline). Obviously, we often find ourselves with a vaginal pH favorable to candida, so preventative measures are especially important.

What does a yeast infection look like?

Take a look at an illustration of a yeast infection or take a look at a photograph of an external view of a yeast infection (NSFW).

Who is at risk for yeast infections? What causes yeast infections?

The National Library of Medicine and National Institutes of Health (NLM and NIH) tell us that YIs are "common among women who use estrogen-containing birth control pills and among women who are pregnant. This is due to the increased level of estrogen in the body. The increased hormone level causes changes in the vaginal environment that make it perfect for fungal growth and nourishment. Yeast infections may also occur in association with diabetes or problems that affect the immune system (such as AIDS or HIV). Vaginal candidiasis is not considered a sexually transmitted disease," although it is possible to contract it by having sex with a person who has a yeast infection.

The NLM and NIH also note that a "yeast infection may follow a course of antibiotics (particularly tetracycline) that were prescribed for another purpose. The antibiotics change the normal balance between organisms in the vagina by suppressing the growth of protective bacteria that normally have an antifungal effect." You can read more about that here as well as elsewhere in this entry.

Other things that have been reported to cause yeast infections are: hormonal fluctuations during the menstrual cycle increased warmth and moisture in the vaginal area (sweating in the vulvar region, etc.) menopause not drying the outer vaginal area thoroughly after bathing hormonal birth control feminine hygiene sprays use of personal lubricants containing glycerin (more info here) harsh soaps applied to the vulva (see here for more on vulvae and soap) poor diet poorly ventilated clothing and underwear poor personal hygiene (more info on vulvovaginal hygiene here) pregnancy tight-fitting clothing, underwear or pantyhose use of antibiotics vaginal intercourse with inadequate lubrication or with a partner who has a yeast infection wearing a damp bathing suit or pantyhose for an extended time douching (douches wash away healthy secretions and normal bacteria and dry the surface of the vagina) steroid medicines, such as Prednisone topical anti-microbial agents uncontrolled diabetes mellitus, which raises blood sugar levels making a good environment for yeast to grow using condoms that contain nonoxynol-9 frequent bubble baths (Take showers, not bubble baths, when possible, and always gently pat the vulva completely dry before getting dressed.) genetic predisposition

How do you know if you've got a yeast infection? What are the symptoms?

OBOS says that "Microscopic analysis of vaginal secretions (known as a wet mount) is the only way to be sure that the infection is candida and not something else. Several other conditions (such as cytolytic vaginosis) may respond temporarily to candida treatments and then recur a short time later, so accurate diagnosis is important."

Dr. Elizabeth Gunther Stewart is one of many gynecologists who strongly recommends getting a proper medical diagnosis of your yeast infection before you begin self-diagnosing and/or self-treating. Many other conditions can seem a lot like yeast infections (namely bacterial vaginosis, vulvodynia, some allergies, some itchy skin diseases, and even more serious problems such as HIV or herpes). With a proper diagnosis of your first yeast infection, you'll know what you're looking for next time and won't misdiagnose and/or mistreat yourself (thus making things worse).

Even if you've had and treated yeast infections before, if you're not 100% sure that what you have is a yeast infection, you should see your healthcare provider for an official diagnosis. Treating an infection of another sort with YI remedies can delay recognition and proper treatment of other infections, which could have serious consequences.

That said, symptoms of a yeast infection can vary from person to person, and not all symptoms must be present for you to have a YI. Symptoms can--but do not always--include:

FEELS LIKE: An intense itching, burning sensation, localized in your vagina and vulva. (This itching is not always present, but can get really bad, so bad you can hardly walk, let alone ride your bike to the pharmacy or doctor to get it treated.) Urination and/or intercourse may also be painful, and some women have reported swollen labia and/or tiny labial cuts (perhaps due to the itch factor).

LOOKS LIKE: Clumpy white stuff. Most medical descriptions compare the discharge to ricotta or cottage cheese, but it can range from thick and not clumpy to faintly yellow to thin and clear. The labia majora and minora (NSFW) may be red, swollen and/or dry. There may be cracked skin or fissures on the vulva caused by inflammation. (Click here [NSFW] for an image of one woman's vaginal YI, but keep in mind that symptoms vary from person to person and not all YIs look the same.)

SMELLS LIKE: bread or beer. In fact, it smells pretty much exactly like yeast, although the yeast used in brewing and baking is an entirely different species (Saccharomyces cerevisiae). (Adapted from here and here)

For more information about the signs and symptoms of yeast infections, check out these doctor-reviewed sites:

• National Library of Medicine
• eMedicineHealth
• U.S. Department of Health & Human Services

OK, I’ve got a yeast infection. How do I treat it?

There are essentially three ways to treat a yeast infection:

1. Prescription treatment from a doctor
2. Non-prescription or over-the-counter (OTC) remedies such as Monistat, Canesten, Gyne-Lotrimin, Femstat, etc.
3. Natural, at-home methods

What are some easy, at-home methods to rebalance the vaginal pH?

Many women use non-medical methods for treating yeast, because the cost of over-the-counter methods is high, because they are unimpressed with OTC methods, or simply because they prefer more natural methods. Following is a partial list of at-home methods from Feminist Women’s Health Center that may be helpful:

At-Home Methods for Yeast Infection Relief: Insert unpasteurized, plain yogurt (this works with soy yogurt as well as long as it still contains active cultures--check regular yogurt ingredients for this too!) with a small spoon or spatula or vaginal cream applicator. Insert at night and wear a pad. Repeat for three to seven nights, until symptoms disappear. Yogurt can be inserted with an empty tampon inserter, vaginal cream inserter or a turkey baster (the baster works best). Symptoms should be relieved within 48 hours. (Douching with yogurt and water can help, too. It also helps to eat a lot of yogurt.) You can read more about using yogurt to treat yeast infections here and more about probiotics here. Insert a garlic suppository or pessary Carefully peel one clove of garlic. Wrap in gauze and insert into the vagina. Leave in for up to twelve hours. Repeat as necessary. It also helps to eat a lot of garlic. Click here for more info on this treatment, including when to experience relief. Drink cranberry juice. Unsweetened is best. (This works best as a preventative measure.) Insert potassium sorbate. This is used in home beer-making and can be found at wine-making stores. Dip a cotton tampon into a 3% solution (15 grams of Potassium Sorbate in one pint of water) and insert into the vagina at night. Remove in the morning. Insert acidophilus capsules. (You may also eat or drink it, but it's more effective when inserted directly into the vagina.) It's available in powder or capsules in health food stores or found in some milk and yogurt products. (Read the label; some dairy products have added acidophilus.) When you get a yeast infection from antibiotics, it's likely you'll want to treat it right away, rather than waiting to be done with the medication. This is okay, but you should know that you may need to re-treat at the end of your course of antibiotics to fully ensure that the natural vaginal balance is restored. (You can read more about acidophilus and other probiotics here. Nix the "feminine deodorant sprays." No soap, nylon bathing suits, or pantyhose without a cotton crotch. Wear only cotton or nothing at all. Hot, moist environments incubate yeast. If neither acidophilus nor yogurt cures the yeast, you may need to re-acidify your vagina. Boric Acid (the kind with a National Formulary or other designation showing it's suitable for pharmaceutical use) is efficient, and you can purchase it in the drug store. Dilute it one teaspoon to one cup of warm water and mini-douche daily with the barrel of a syringe, or use a diaphragm jelly inserter which can be bought at the pharmacy without having to buy the jelly, or buy empty 00-sized capsules and fill them with boric acid powder and insert two of them nightly. Don't use if the skin is raw or broken, and discontinue if an irritation develops. This is wet and messy but boric acid is anti-bacterial and will cleanse some non-specific vaginitis as well. According to U-W Madison, "Insert one capsule in the vagina per night for one week, then one capsule twice a week for three more weeks" to treat your yeast. (Click here for links to more info about boric acid, including a fabulous how-to photo essay on making your own capsules!) Apple cider vinegar douches (two tablespoons vinegar to a pint of warm water) are very effective. Even though yeast flourishes in an acidic environment, there is something in vinegar that inhibits its growth. Vinegar can also inhibit the growth of bacteria and trichomonas by establishing the proper acidity (pH) for the proliferation of "good" bacteria. Don't douche for longer than 10 days. Avoid regular douching! The vagina is a self-cleaning environment, so routine douching shouldn't be necessary and could make your vagina too alkaline. Women who douche more than three times a month are four to five times more likely to have rampant yeast.

Another at-home method involves gentian violet. Follow the easy steps below to try it for yourself:

Ways to Use Gentian Violent for Yeast Infection Relief: One way is to "paint" the vagina, cervix (you'll need a speculum) and vulva (outside area including the labia or "lips" of vagina) with gentian violet. It stains, so you'll want to wear a pad. This usually works after one treatment. Another way to get the gentian violet (GV) into your vagina and onto the cervix is to use a GV-soaked tampon, and then to "paint" the more easily reachable areas with cotton balls. Because gentian violet will stain anything it comes in contact with (hands, skin, clothing, tile, pets, small children) you may wish to wear gloves while working with it. Supplies needed for the tampon method: gentian violet (either 1% or 2% solution is fine) small dish or jar lid tampon cotton balls gloves Step 1: Unwrap the tampon, but do not remove it from the applicator (if there is one). Step 2: Put about two tablespoons of gentian violet into the dish. Step 3: Put the tampon (applicator and all, if there is one) into the dish and let it sit for a little while, until it has absorbed all the gentian violet it can. Step 4: Insert, and leave for two to six hours. Step 5: Dip a cotton ball in the remaining gentian violet and apply it to the vulva. Step 6: Voila! All done. Repeat if needed, though most users report success with one treatment. As mentioned above, you may wish to wear a pad to avoid staining your underwear. For VPers' experiences using gentian violet to treat yeast infections, you may want to check out this VP on LJ post (NSFW). Where Can I Find Gentian Violet? Gentian violet may or may not be available at your local pharmacy/drugstore. The best way to find out is to give them a call. If they don't have any in stock, they may be able to order some for you. You can also try ordering it online yourself. Walgreens sells it online, and it's also available through Amazon. You can also try ordering from Humco (click on the "Secure Order" link and then scroll down through the alphabetical listings until you come to "G" for gentian violet), the supplier of the gentian violet sold on Amazon--their website isn't fancy, but they do carry both 1% and 2% solutions, both of which are suitable to use for YI treatment.

I see lots of suggestsions, but which YI Treatment is best?

While we all have our personal favorites, the bottom line is that each person is different, and each person's body will respond differently to the various treatments out there. Some women prefer to use a prescription treatment, some prefer OTC treatments like Monistat, and others swear by some of the natural remedies listed above, like yogurt. All of these treatments work for some women -- the "best" one is really the one that you find works for you and that you are most comfortable using.

How can I manage the itching?

Many VPers have recommended tea tree oil to relieve the itching that often accompanies yeast infections.

Monistat and other brands also sell over-the-counter anti-itch creams for the vulva, so check your local drug store!

Is it OK for some of the goopier treatments (Monistat, yogurt, etc.) to ooze out?

Sometimes when you treat a YI with something goopy, it's easy to be concerned that the medication (or yogurt, or whatever) oozes out too soon, and then you won't be treating it at all. This is a common concern, but unfounded - what goes up must come down, after all. It's recommended that you stay horizontal for a while after treatment, but it's to be expected that some of the treatment will drip out. If this happens, it is perfectly okay to wipe the cream away, as it may become sticky if left on the vulva, but there is no need to be worried about the seepage.

Can an OTC antifungal (like Monistat) cause a burning sensation in my vagina?

Some women are sensitive to over-the-counter treatments for yeast infections (like Monistat, Gyne-Lotrimin, etc.). This seems to be most common as a reaction to 1-day treatments; however, it can happen with 3 or 7 day treatments as well.

If this happens to you, you have several options:

• switch to a longer-duration treatment (e.g., from a 1-day to a 3-day treatment or from a 3-day to a 7-day) as it may be milder
• ask your health professional for a prescription for a fluconazole (brand name Diflucan in the U.S.) pill
• try one of the alternative treatments mentioned above in the FAQ

For more information:

• VP on LJ
• Monistat's FAQ

Can an antifungal cream interfere with my hormonal birth control?

Though it may only be of particular concern for Nuva Ring users, it is beneficial to note that according to the Nuva Ring Patient Information (PDF file), "Use of... vaginal yeast products will not alter the contraceptive efficacy of Nuva Ring."

Can YIs go away on their own without treatment? Are they dangerous?

Brown University has this to say on the subject:

Yeast infections can cause severe discomfort but rarely cause serious health problems. Left untreated, vaginal yeast infections often clear up on their own, 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. Recurring yeast infections may be difficult to prevent or cure. There are significant differences between occasional, easily treatable yeast infections and recurring infections that seriously affect a woman's life. Women who have recurring yeast infections should be tested for underlying causes so that the appropriate treatment can be chosen.

Can men get yeast infections too?

Yes! Especially if you're a woman with a heterosexual partner, it's something to educate yourself about since it's possible to pass the yeast back and forth, even with condom use!. In fact, the NLM and NIH tell us that "12% to 15% of men will develop [yeast infection] symptoms such as itching and penile rash following sexual contact with an infected partner." Click here or here to see images of yeast infections in men (NSFW). You can read more about yeast infections and men here.

NOTE: If your YI “is persistent and you experience chronic or repeated overgrowths, then all of your lovers need to be treated as well. If your partner is male, have him soak his penis in yogurt or diluted apple cider for five minutes daily to kill the yeast living in or on the glans; this way he won't keep re-infecting you.” (source)

According to the Mayo Clinic, men can also safely use OTC antifungal creams to treat penile yeast infections. If the infection does not clear up within 7 days, however, it's recommended that he seek the advice of a medical professional for a different treatment.

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Chronic Yeast: It seems like I always have a yeast infection--what’s the deal?!

Brown University says: "Recurring yeast infections may be difficult to prevent or cure. There are significant differences between occasional, easily treatable yeast infections and recurring infections that seriously affect a woman's life. Women who have recurring yeast infections should be tested for underlying causes so that the appropriate treatment can be chosen."

If you are someone who is prone to yeast conditions and gets yeast infections frequently, you may want to pay attention to precipitating factors, which can vary from person to person. Some things which commonly cause or worsen yeast overgrowth are listed below.

Factors That Contribute to Chronic Yeast Overgrowth: stress sudden diet changes weather changes birth control pills (especially those that contain higher amounts of estrogen) use of the contraceptive sponge the use of some IUDs a high sugar, carbohydrate, caffeine, or yeast diet (very common!) douching pregnancy diabetes having sex with an infected partner (thus passing the yeast back and forth) antibiotics frequent bubble baths

Perhaps the biggest contributing factor in the creation of yeast overgrowth is the use, and overuse, of antibiotics. Although designed to kill "bad" bacteria (those that make us ill) antibiotics, to varying degrees, kill "beneficial" bacteria (those that keep us well, such as the digestive bacteria in our intestines). Any use of antibiotics will kill off some good bacteria and prolonged and overly aggressive use of antibiotics can cause systemic problems for both men and women. When the balance of good and bad bacteria is thrown off, yeast can build up in the intestines and cause a whole host of health problems. Whenever you take antibiotics, keep in mind this is strong medication. Ask your provider: How does it work? Is there a topical antibiotic I could use instead? Sometimes, antibiotics are needed but their overuse can cause serious problems. Adding acidophilus and bifidus to your diet (in capsules) can re-balance the intestinal bacteria, and build up resistance to future overgrowths. Check out this thread in VP on LJ for more info on preventative acidophilus treatment during a course of antibiotics.

Women experiencing persistent vaginal yeast overgrowth who are using a cervical cap or diaphragm need to wash and dry it well after use. Some women have found relief from tenacious conditions with the "sucking air" method of douching. In a bathtub, a woman can insert yogurt, vinegar or other remedy. Lying on her back, hands at her side and palms down, she can bring her feet back over her head. This action causes the vagina to balloon out and pulls the vinegar or yogurt all the way in to fill the vagina and get every fold of skin.

Systemic yeast is a system-wide infection/overgrowth throughout the body. It requires dramatic changes in diet and long-term attention to avoiding things that encourage yeast to grow. (source)

CAUTION: Sometimes chronic yeast infections can be indicative of a larger, much more serious problem that needs medical attention/treatment. If you are experiencing what you think may be chronic yeast, it is a good idea to check with a health professional for a proper diagnosis and/or treatment.

But I'm doing everything right! How come I still get YIs?

Luck of the draw? Dr. Elizabeth Gunther Stewart says that "up to 25 to 33 percent of patients with recurrent yeast infections are genetically predisposed to developing the problem, probably because along with inheriting the Lewis blood protein, they also inherited a vaginal immune system that doesn't fight off yeast the way it should. This would explain how you can be perfectly healthy, do everything right, avoid all the known risk factors, and still have yeast problems! Unfortunately, it's still only a theory; no targeted treatments exist yet."

Is it OK to have sex while I'm treating my yeast infection?

The short answer? Probably not.

Some health professionals advise that women avoid vaginal intercourse during treatment (source). Some people argue that yeast infections can in fact be caused or made worse by insufficiently lubricated sexual intercourse; as a general rule, it is always a good idea to stick to lubricants specifically designed for sex. As a general rule, this means lubes free of glycerin and sugars; as Come As You Are notes, silicone lubes are also considered hypoallergenic and unlikely to trigger yeast infections.

Keep in mind also that condoms containing nonoxynol-9 can aggravate or cause yeast infections, so it's important to be especially careful about condom use during your yeast infection treatment/prevention plan. Additionally, you should know that some external treatments can erode condoms, making them less effective against preventing infection and/or pregnancy.

The best plan is to abstain from sex until you are positive you and your partner are YI-free. It's advisable to wait until you're no longer experiencing any YI-like symptoms and until all remnants of the treatment are gone. This may take approximately 3 to 5 days, though your mileage may vary. :)

Can I masturbate during my yeast infection?

Unfortunately, it's probably not a good idea.

The University of Iowa says, "Having a manual orgasm may increase the irritation and the itching sensation caused by the yeast infection, but it will not cause further complications. It is best to avoid sexual activity when you have a yeast infection to allow your vaginal tissues time to heal."

Can I treat my infection while I'm on my period?

None of the research we have reviewed so far seems to suggest that you shouldn't treat yeast infections during menstruation, although several sources, such as Brown University's Health Services, suggest that yeast infection symptoms can be eliminated or lessened during menstruation due to the fact that "[m]enstrual blood raises the vaginal pH, causing the number of yeast cells to decrease because they can't grow in the pH present during menstruation."

Remember that if you do decide to treat during your period, as this doctor-reviewed site says, "[t]ampons can absorb medication, so use sanitary napkins if you are being treated with vaginal medications during your period."

What if my yeast infection spreads?

Occasionally, yeast will spread to locations on the body outside the vulvovaginal area. Such yeast infections on the skin are known as cutaneous candidiasis.

Possible symptoms include:

• Itching.
• Red or purplish rash on the skin.
• Blisters or spots surrounding the itchy patches.

If you suspect your yeast infection has spread -- or started out -- on your skin, you may wish to see a health care provider for diagnosis. (S)he may advise treating it with either a topical or systemic antifungal.

OK, great. But how do I prevent YIs in the future?

Dr. D. Ashley Hill tells us the following:

Preventing yeast infections is obviously more desirable than treating them. Wearing loose clothing, cotton underwear (or at least underwear with a cotton crotch panel), removing damp clothing soon after swimming or working out, and carefully drying the vulvar area after bathing will all help prevent yeast infections. Some advocate using a blow dryer on warm to briefly blow dry the vulva after bathing to insure adequate drying. Others suggest using vaginal or oral yogurt [...] However, there are articles in the medical literature that support eating 8 ounces a day of yogurt containing lactobacillus acidophilus, which may reduce the yeast infection recurrence rate by threefold. IF you choose to do this, however, please make sure the yogurt you buy specifically contains lactobacillus acidophilus, as many do not. Some also advocate taking anti-fungal medications intravaginally or orally at specific intervals to prevent overgrowth of yeast. In some diabetic patients this is very helpful. Yeast infections are common and sometimes difficult to treat, but with the appropriate evaluation and treatment they can be effectively treated. Any symptomatic vaginal discharge should be evaluated to ensure proper treatment. (source)

Specifically in the instance of antibiotic-induced yeast infections, boric acid can be used as prevention. You buy boric acid powder (typically available at your pharmacy in the first aid section for around $5US per 4 ounces) and size 00 empty gel caps (also available from the pharmacy or health food stores). Fill the caps with the powder and insert two nightly (right before you get into bed) for every night that you take the antibiotic. This method works by keeping the environment in your vagina nice and acidic, which keeps the yeast from over-proliferating when the other vaginal flora die from the efforts of the antibiotic. (Read more about how to use Boric Acid here.)

See also:

• NLM and NIH
  
• The New Our Bodies, Ourselves
  
• The Feminist Women’s Health Center
• Brown University: Yeast Infections
• VPers on yeast infections

NOTES AND DISCLAIMERS: This FAQ (and VP) is no substitute for medical care. Much of the information above has been adapted from the indicated sources. Click on the links to see their original text or to get more information. Any non-quoted items come from the VP Team's personal experience, which, again, is no substitute for medical care. As always, there is a limit to the information internet resources can provide; if you require additional assistance, it's best to contact an appropriate professional.