Vaginal Yeast Infections

What is yeast?

Yeast is a fungus scientifically referred to as Candida. The specific type of fungus most commonly responsible for vaginitis is Candida albicans. Yeast is commonly present on normal human skin and in areas of moisture, such as the mouth and vagina. In fact, it is estimated that between 20%-50% of healthy women normally carry yeast in the vaginal area.

What is vaginitis?

Vaginitis is inflammation of the vagina. Vaginitis is very common and is reported by as many as 75% of women at some point in their lives. Vaginitis can be caused by a number of infections, including bacteria (such as Gardnerella and gonorrhea), protozoans (such as trichomonas), and yeast (Candida). Vaginal yeast infection, which is the most common form of vaginitis, is often referred to as vaginal Candidiasis.

What is vulvitis?

Vulvitis is inflammation of the external genital organs of the female (the vulva). The vulva includes the labia, clitoris, and entrance to the vagina (the vestibule of the vagina). An inflammation of the vulva is referred to as vulvitis. Vulvitis, like vaginitis, may be caused by a number of different infections. Because the vulva is also often inflamed when there is inflammation of the vagina, vaginitis is sometimes referred to as vulvovaginitis.

What causes vaginal yeast infections?

Vaginal yeast infections occur when new yeast is introduced into the vaginal area, or when there is an increase in the quantity of yeast already present in the vagina relative to the quantity of normal bacteria. For example, when the normal, protective bacteria are eradicated by antibiotics (taken to treat a urinary tract, respiratory, or other types of infection) or by immunosuppressive drugs, the yeast can multiply, invade tissues, and cause irritation of the lining of the vagina (vaginitis).

Vaginal yeast infections can also occur as a result of injury to the inner vagina, such as after chemotherapy. Also, women with suppressed immune systems (for example, those taking cortisone-related medications such as prednisone) develop vaginal yeast infections more frequently than women with normal immunity. Other conditions that may predispose women to developing vaginal yeast infections include diabetes mellitus, pregnancy, and taking oral contraceptives. The use of douches or perfumed vaginal hygiene sprays may also increase a woman's risk of developing a vaginal yeast infection.

A vaginal yeast infection is not considered to be a sexually transmitted infection (STD), since Candida may be present in the normal vagina, and the condition does occur in celibate women. However, it is possible for men to develop symptoms of skin irritation of the penis from a yeast infection after sexual intercourse with an infected partner.

What are the symptoms of vaginal yeast infection and vulvitis?

Vaginal yeast infection and vulvitis cause symptoms that are nonspecific, which means that aside from the yeast infection, other conditions can cause the identical symptoms. The most common symptom of a vaginal yeast infection is itching in the vaginal and/or vulvar area. Other symptoms of vaginal yeast infection and vulvitis include:

  • burning
  • soreness
  • pain during intercourse and/or urination
  • vaginal discharge (Vaginal discharge is not always present, but when it occurs, the discharge is odorless and typically has a whitish, thick appearance and texture, like cottage cheese.)

Vulvitis can also cause local pain in addition to the above symptoms. Pain in the vulvar area is referred to as vulvodynia.

In up to 5% of women, yeast vulvovaginitis may cause a recurrent problem. A recurrent yeast infection occurs when a woman has four or more infections in one year that are not related to antibiotic use. Recurrent yeast infections may be related to an underlying medical condition and may require more aggressive treatment.

How are vaginal yeast infections and vulvitis diagnosed?

Vaginal yeast infection is suggested when a cheesy white discharge is noted over the walls of the vagina, but the symptoms of vaginal yeast infection are nonspecific and may be a result of other conditions. To firmly establish the diagnosis and to rule out any other causes of the symptoms, your doctor may take a specimen scraped from the affected area for microscopic analysis or for culture in the laboratory. Identification of yeast under a microscope, when possible, is the least expensive and most rapid and accurate way to establish the diagnosis.

What is the treatment for vaginal yeast infection and vulvitis?

Vaginal yeast infection and vulvitis may be treated with antifungal medications that are applied topically in and around the vagina or with antifungal medications taken by mouth. Sometimes, mixed infections with more than one microbe can require combinations of treatments.
Topically applied antifungal creams include:

  • butoconazole (Femstat 3)
  • clotrimazole (Lotrimin)
  • miconazole (Monistat)
  • terconazole (Terazol 3)

The over-the-counter topical treatments are an option for some women when yeast is the cause of the infection. However, it should be noted that infection other than yeast can cause similar symptoms. These include bacterial vaginosis, chlamydia, and gonorrhea. If symptoms are not eliminated by over-the-counter products, patients should see their doctor for evaluation.

Antifungal medications that are also available as vaginal tablets include:

  • clotrimazole (Lotrimin, Mycelex)
  • miconazole (Monistat; Micatin)
  • terconazole (Terazol)
  • nystatin (Mycostatin)

Oral medications for yeast vaginitis and vulvitis include fluconazole (Diflucan).

Most doctors prefer to treat vaginal yeast infections with vaginal tablets or suppositories rather than oral medications. Oral antifungal medication can cause side effects such as headache, nausea, and abdominal pain , while vaginal treatment is unlikely to cause these side effects. Oral antifungal medications are also not recommended for use during pregnancy.

If yeast is commonly present in normal women, who should be treated?

All women with the symptoms of infection described above should be treated. Women without symptoms should not be treated. Most experts do not recommend treating the sex partners of women with yeast vaginitis if they do not have symptoms themselves, although this has been a controversial issue.

Vaginal Yeast Infection At A Glance

  • Yeast vaginitis is an infection of the vagina caused by a fungus known as Candida.
  • Yeast vaginitis is characterized by itching, burning, soreness, pain during intercourse and/or urination, and vaginal discharge.
  • Yeast vaginitis can be treated with antifungal medications applied to the affected area or taken by mouth.
  • Candida may be normally present in small amounts in some women and not cause disease.
  • The presence of Candida without symptoms of infection does not require treatment.