Vaginal Yeast Infection

Yeast is a type of fungus that generally thrives in the vagina in small numbers. When the yeast grows uncontrollably in the vagina, vaginal yeast infection occurs. Candida albicans is the type of yeast that causes this overgrowth. Girls and women of all ages can acquire this fungal infection. Three in four women (75%) will have a vaginal yeast infection at least once in a lifetime. As per Center for Disease Control (CDC), about 75% of women have a yeast infection at least once in a lifetime, and about 40% to 45% of women will have two or more yeast infections.

What is Vaginal Yeast Infection?

Vaginal yeast infection, also known as candidiasis, is an infection of the vagina caused by a yeast named Candida. Candida is a normally occurring yeast that lives in several sites of the body, such as the gut, mouth, throat, skin, and vagina, without causing any trouble. The problem arises when the Candida multiplies and causes an infection. The multiplication of Candida is affected when the environment inside the vagina changes. The infection causes itching and burning in the vulva and vagina. Vaginal yeast infection or Candidiasis is also known by the names Candida vaginitis or vulvovaginal candidiasis.

Although vaginal yeast infections are mild, some women may develop serious infections involving swelling, cracks in the vaginal wall, and redness. The signs of vaginal yeast infection are similar to those of other types of vaginal infections. Your doctor can identify if you have candidiasis or any other infection. Symptoms of vaginal candidiasis are as follows:

• Burning sensation or pain during urination. (Painful urination treatment)
• Itching and irritation in the tissues of the vaginal opening (vulva) and the vagina.
• Pain during sexual intercourse.
• Vaginal soreness or pain.
• Swelling and redness of the vulva.
• Vaginal rash.
• White, thick, odour-free vaginal discharge with an appearance of cottage cheese.
• Watery vaginal discharge.

If you have the following symptoms, you might have a complicated vaginal yeast infection if:

• you have had four or more yeast infections in a year.
• you are pregnant.
• you have uncontrolled diabetes.
• you have serious symptoms, such as swelling and itching that cause cracks, tears or sores, or extensive redness.
• your immune system becomes weak due to some medications or conditions, such as HIV.
• your infection is caused by another type of Candida species and not from Candida albicans.

Causes

Vaginal yeast infections occur due to overgrowth of the yeast Candida. Most of the yeast infections in the vagina occur due to Candida albicans. This infection is effectively treated with the standard infection medications. If vaginal yeast infection occurs repeatedly (more than 4 times in a year) it means that you are infected with a different type of yeast other than Candida albicans. Such infections are resistant to the standard treatment for Candida albicans yeast infections and need more aggressive therapies. Although yeast infections are not sexually transmitted, they occur after some certain sexual acts such as oral sex. Besides, women who are not sexually active can also acquire vaginal yeast infections. The vagina naturally has a balanced mixture of bacteria and yeast, including Candida. The lactobacillus bacteria produce an acid that helps stop the excess growth of the yeast. When this balance is disrupted, it causes abnormal growth of the fungus and leads to a yeast infection.

Risk factors

Here are some of the factors that increase your risk of getting a yeast infection:

• Weak immune system
  Women who have taken steroid medications or those who have an HIV infection have lower immunity levels and are likely to acquire yeast infections.
• Uncontrolled diabetes
  Women with diabetes and having poorly controlled blood sugar levels are at a higher risk of developing a yeast infection than women with well-controlled diabetes.
• Sexual activity
  Vaginal yeast infections are not transmitted sexually; however, oral-genital sexual contact can spread the Candida fungus.
• Increased levels of estrogen
  Yeast infections are common in women with higher estrogen levels. Women who are pregnant or those taking estrogen therapy or high dose estrogen birth control pills have increased estrogen levels.
• Use of antibiotics
  Women who are taking antibiotics over a long period of time are more prone to get yeast infections. Broad-spectrum antibiotics kill almost all ranges of bacteria including the healthy bacteria in your vagina. Loss of the healthy bacteria can cause an imbalance in the vaginal environment and lead to overgrowth of the yeast.

One of the key steps in preventing vaginal yeast infection is to practice good genital hygiene. To cut down your risk of vaginal yeast infections, follow these prevention tips:

• Avoid tight-fitting clothing such as skinny jeans and pantyhose. They make you sweat more and increase body temperature in your genital area. Wear loose-fitting pants, cotton underwear, or skirts. Try not to wear underwear while sleeping.
• Stay away from scented or deodorized tampons, feminine powders, sprays, perfumes, or douche. These products can change the natural balance of micro-organisms in your vagina.
• Change out of wet clothes, such as swimsuits or workout attire, right away. Wearing a wet swimsuit for hours may keep your vaginal area moist and war, leading to vaginal yeast infection.
• When you are on your period, change your pads or tampons often. (Read more - Period pain remedies)
• Stay out of very hot baths and hot tubs.
• Keep your vaginal area clean. Use unscented mild soaps and water. Rinse well.
• Avoid unnecessary use of antibiotics for viral infections or colds.
• Wipe from front to back after using the toilet. Avoid spreading the bacteria or yeast from your anus to the urinary tract or vagina.
• Cotton innerwear is a good option. Wear underwear that helps your genital area dry and does not hold in moisture and warmth.

Your doctor will ask a detailed history of your symptoms along with aggravating and relieving factors. In addition, your doctor will perform a pelvic examination. On pelvic examination, the following signs may be detected by your doctor:

• Dry white spots on the vaginal wall.
• Redness and swelling in the vagina, vulva, and on the cervix.
• Cracks on the skin of the vulva.
• You may also be required to get a Wet mount and KOH (potassium hydroxide) test done to test your vaginal discharge.
• The doctor may ask for a culture test if your infection recurs often or if the infection does not improve with treatment.
• The doctor may test your vaginal discharge using a cotton swab, and a lab technician will look for any fungal overgrowth in the swab sample.
• Other tests may be suggested to rule out the other causes of your symptoms.

The treatment of vaginal yeast infections depends on if it is an uncomplicated or complicated yeast infection.

If your yeast infection does not happen repeatedly and the symptoms are mild to moderate, it is an uncomplicated yeast infection. The following treatment is advised for an uncomplicated vaginal yeast infection:

• Single dose anti-fungal medication
  You might be prescribed a one-time single oral dose of fluconazole, which is an antifungal medication. You may also take two single doses for three days if symptoms are severe.
• Vaginal creams and suppositories
  Over-the-counter antifungal vaginal creams and suppositories are useful for many women, and they are a safe choice during pregnancy. Treatment with these lasts typically from three to seven days.
• Short course vaginal therapy
  ​Antifungal medications available as ointments, creams, tablets, and suppositories may be used. An antifungal regimen lasting up to one, three, or seven days will typically clear the yeast infection. Following medications have been shown to be effective:
  • Butoconazole
  • Clotrimazole
  • Miconazole
  • Terconazole

These medications are available as over-the-counter or as prescription-only medicines. You may experience irritation or slight burning while applying the medication. The creams and suppositories are oil-based, so they could weaken the diaphragms and latex condoms, which is why you may need to use an alternative form of birth control.

Make sure to have a follow-up appointment with your doctor if your symptoms do not resolve after following the treatment or if you notice the signs coming back within two months of the treatment. (Read more - Vaginal yeast infection remedies)

If you have a complicated yeast infection, your doctor may recommend the following therapies:

• Multidose antifungal medication
  Two to three doses of oral fluconazole may be prescribed instead of a vaginal treatment. This therapy would not be recommended for pregnant women.
• Long course vaginal therapy
  The treatment regimen of azoles medications for 7-14 days can effectively clear the yeast infection. Medications are usually in the form of vaginal creams, vaginal ointments, vaginal tablets, or suppositories.
• Maintenance plan
  If you have frequent yeast infections, your doctor may advise you to follow a medication routine to prevent yeast overgrowth and future infections. A maintenance treatment is started once the yeast infection is cleared with treatment. A lengthy treatment of up to 14 days to remove the yeast infection may be needed before starting the maintenance therapy. The maintenance regimen may include.
• Fluconazole
  These tablets are prescribed once a week for six months.
• Clotrimazole
  Few doctors may prescribe clotrimazole as a suppository once a week instead of an oral medication.

If you have had recurrent vaginal yeast infections, your doctor might advise treatment for your sex partner. If any symptoms arise of a genital yeast infection or while using a condom during intercourse, the partner would have to be treated for a yeast infection.

Lifestyle management

Here are some tips that you can take a note of to manage a vaginal yeast infection:

• If you have diabetes, make sure to keep your blood sugar levels under control.
• Research says eating non-flavoured plain yogurt with live cultures may help prevent yeast infections. It contains the ‘good’ lactobacillus bacteria. Yeasts love sugars so choose a sugarless brand. Daily oral probiotics may also be beneficial.
• The best way to stay away from yeast infections would be to make changes in your intimate hygiene and diet.
• Make sure that you change your tampons and sanitary pads often.
• Avoid using bubble baths, coloured toilet paper, body washes, and scented feminine products.

In most of the cases, symptoms of vaginal yeast infections go away entirely with appropriate treatment.

Complications

Vaginal yeast infections cause discomfort and no specific medical complications. Possible complications that arise due to vaginal yeast infections are as follows:

• Excessive scratching may crack your skin and make you more prone to a skin infection.
• Vaginal candidiasis is the most typical form of fungal diseases reported in pregnant women. It might cause infections in babies specifically in low birth weight babies and in premature babies after delivery.