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| |    Yeast Infections by Marjorie Greenfield, M.D. reviewed by Laura Jana, M.D., F.A.A.P. Itching, white discharge, irritation, burning, rawness, vaginal dryness, pain with intercourse--these all are symptoms of yeast vaginitis. Sometimes the symptoms are intermittent--like maybe right before the menstrual period--and other times they are unremitting. While some women may suffer just from itching, other unfortunate individuals can have every symptom in the book. The same woman can even have different symptoms with subsequent infections. What causes a yeast infection? There are a few strains of fungi that cause classic yeast infections, mostly in the Candida (pronounced CAN-did-uh) family. Candida albicans and other species of fungi are in the air around us all the time. They normally live in the intestines and even sometimes in the vagina without causing problems or symptoms. Infection with yeast, then, isn't from exposure to the germ--in this way, yeast infections differ from our understanding of most other infections, like strep throat. Rather, the vaginal "ecosystem," not exposure to the germ, plays the greatest role in determining if one actually gets an infection. First, it helps to understand that yeast requires the normal estrogen-influenced acidic pH of the vagina. It normally doesn't invade the vagina of postmenopausal women or prepubescent girls. They are impeded by the good bacteria lactobacilli and by intact skin (that is, skin that's free of cuts or lesions) and a healthy vaginal surface. But antibiotics, taken for any variety of reasons, can wipe out the good bacteria, giving the yeast the chance to invade. The weakened immune state that accompanies pregnancy, diabetes, steroid use (like prednisone), or some immune deficiencies also may allow yeast to set up shop. High estrogen states, such as those found during pregnancy or while taking birth control pills, can predispose a woman to yeast vaginitis as well. Men do not normally get yeast infections of the penis, as these fungi prefer warm, moist places. Some uncircumcised men can carry yeast beneath the foreskin, and occasionally a man can have a candida skin infection of the penis. In both cases, treatment is needed. There is no benefit, however, to treating the circumcised male partner of a woman with yeast vaginitis, even one who gets recurrent infections. Treatment Once an infection establishes itself, the yeast are harbored inside the vagina. So, in order to eradicate the infection, the inside of the vagina must be treated--even though the symptoms are external.
How can I tell if I have a yeast infection? Up until just a few years ago, all the treatments for yeast infections had to be prescribed by a doctor. But the Food and Drug Administration (FDA) liberalized the distribution of vaginal antifungals because, it was argued, the medications were pretty harmless. However, some experts had concerns that women would misdiagnose their infections and end up delaying getting proper therapy. You may notice that TV advertisements often say, "If you think you have a yeast infection, see your doctor. If you know you have a yeast infection, use (our product.)" Some women have classic yeast symptoms--itching and thick white discharge--following a situation that's known to lead to yeast, like the recent use of antibiotics. When the diagnosis is unclear, however, it is best to see your nurse or doctor. The medical examination for yeast usually involves taking a small amount of the discharge from the vagina and looking at it under a microscope. Unfortunately, if you use an over-the-counter treatment prior to the examination, the medication is all the doctor will see under the scope, as it takes about three days for the medication to be absorbed by the vagina. So if you've recently tried an over-the-counter remedy, ask your doctor if you should come in right away or wait a few days before having an exam. Conditions that can be confused with yeast Common conditions that cause vulvar irritation include contact dermatitis and herpes. Vaginal discharge can be caused by trichomonas, bacterial vaginosis, and atrophic vaginitis. It is normal to have some vaginal discharge during pregnancy or when ovulating.
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