Yeast Infections

March 19, 2010

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Yeast Infections

by Marjorie Greenfield, M.D.
reviewed and revised by Marjorie Greenfield, M.D.

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. Yeast 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.

Over-the-counter treatments consist of creams, ointments, or suppositories containing antifungal medications such as miconazole or clotrimazole. These products are placed into the vagina anywhere from one to seven times, usually at bedtime (when you'll be lying down) so that they don't leak out of the vagina.

All these treatments are fairly effective: About 80 percent of women will experience some relief of the symptoms by the third day. Some creams will irritate users. If one brand irritates you, try switching to a product that uses a different base. An allergic reaction to the active ingredient is rare.

Prescription vaginal therapies containing terconazole are similar to the over-the-counter treatments. They treat a slightly broader spectrum of fungi, however, so occasionally a woman with a resistant organism will respond to better to these treatments if her over-the-counter product didn't seem to work. One benefit of using a prescription medication is that its cost may be covered by insurance.

Fluconazole (Diflucan) is a prescription pill you take by mouth. This approach to treating vaginitis appeals to a lot of women, who don't want to deal with the mess of a cream or are uncomfortable using a suppository. And like those treatments, fluconazole takes three days to relieve symptoms and has about an 80 percent cure rate.

This prescription pill does have a couple of downsides, however. Because it is a systemic medication, it can cause side effects such as nausea and headache. And it's not compatible with some other drugs, including certain antidepressants, antibiotics, seizure medications, and heart meds. However, it does not interfere with birth control pills.

To soothe or diminish the inflammation while you wait for your treatment to provide some relief, try soaking in plain warm or cool water in the bathtub. (For some women, this is the only way to get a respite from the terrible itching that can accompany a yeast infection.)

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.


RELATED INFORMATION

			Urinary and Vaginal Symptoms During Pregnancy
			Vaginitis

Created June 05, 2001
Reviewed and revised August 27, 2004

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