Yeast infections, among the most widespread of vaginal infections, are fortunately the least harmful. Sometimes they disappear on their own, overcome by the body’s natural defenses. If not, they are readily treated with over-the-counter or prescription medications, but they can have a nasty way of recurring.

What causes yeast infections?

Under normal conditions, the healthy vagina is populated by millions of bacteria, collectively known as the vaginal flora. These microorganisms, of many different species, usually coexist peacefully; they create an acidic environment that keeps them in balance and fights off hostile invaders. The presence of these microorganisms does not mean that your vagina is “dirty” or “infected,” or that your hygiene is poor: after all, your skin and the inside of your mouth both play host to thousands and thousands of microorganisms. Sometimes, however, the ideal balance is disrupted and one species of organism reproduces excessively, or a foreign invader gets a foothold and begins to multiply.

Yeast infections are caused by the overgrowth of fungi that belong to the normal vaginal flora and are usually held in check by “good guy” bacteria, notably members of the Lactobacillis family. Because the major culprit is Candida albicans, yeast infections are sometimes called candidiasis.

What are the symptoms of a yeast infection?

Yeast infections can cause itching, redness, and irritation, both on the external genitals and inside the vagina. The vaginal discharge, usually thick and white, has the curdy consistency of cottage cheese. Inflammation and dryness can make intercourse uncomfortable, although it is all right to have intercourse when you have a yeast infection if it is comfortable for you. Many women find the vaginal symptoms less distressing than the labial itching, which can be intense. Occasionally yeast infections can cause discomfort or pain on urination, or the need to urinate frequently. Sometimes it is difficult to differentiate between a yeast infection and a urinary tract infection.

How can you be sure your symptoms are caused by a yeast infection?

Usually your physician can diagnose a yeast infection through a pelvic exam or by examining the vaginal discharge microscopically. If your infection responds in a few days to antifungal medications, then you probably had a yeast infection. If there is any doubt, your doctor can send a sample of the vaginal discharge to a laboratory where it will be cultured for Candida albicans or other fungi that sometimes cause yeast infections.

Who is at risk for yeast infections?

The most common risk factor is antibiotic use. Maybe your dermatologist has put you on tetracycline for severe acne; while killing off the harmful bacteria that caused your skin problems, the medication also stifled the protective bacteria that check the growth of yeast cells in your vagina. All of a sudden you have a yeast infection. Diabetes can also disrupt the normal vaginal balance, and diabetic women often have recurrent yeast infections that can be difficult to treat. Pregnancy sometimes disrupts the normal balance and predisposes women to yeast infections, though women who have recurrent yeast infections during pregnancy usually have had them previously. Obesity is a risk factor. Overweight women often sweat heavily, providing the warm moist atmosphere that nurtures yeast cells; these women may also be predisposed to diabetes or may have borderline glucose metabolism.

Tight nonbreathable clothing such as lycra encourages yeast growth by providing that warm moist atmosphere. Some people believe that a diet rich in starches and yeast can contribute to an environment conducive to yeast growth.

Emotional stress, which lowers your immune response, can predispose you to a yeast infection, just as it can predispose you to a cold. Women with suppressed immune systems are candidates for all kinds of opportunistic infections, including those from yeast. Although some women with Acquired immunodeficiency syndrome have frequent yeast infections, the vast majority of women who have yeast infections, even recurrent ones, do not have Acquired immunodeficiency syndrome.

Since menopause can lead to vaginal dryness and hence vaginal irritation, many post-menopausal women get yeast infections. Women who choose hormonal replacement after menopause are less likely to have recurrent yeast infections because their vaginas are better lubricated and more elastic.

Do birth control pills makeyou susceptible to yeast infections?

No one knows precisely whether oral contraceptive use contributes to yeast infections. Some scientific papers have suggested that birth control pills may increase your susceptibility, and several of my patients swear that ever since they went on the pill, they have had one yeast infection after another. Other women believe that condoms increase susceptibility to yeast infections, possibly because they irritate vaginal tissues.

Are yeast infections during pregnancy harmful to the fetus?

Yeast infections, fairly common during pregnancy, are in no way harmful to the fetus. There are treatments that are perfectly safe for mother and child, so it is possible to treat a yeast infection during pregnancy even though it is not harmful to the fetus if you do not.

Can you getayeast infection if you are not sexually active?

Many women who are not sexually active do get yeast infections. I treat several nuns, who get these infections from time to time. A couple of them are overweight, which increases their risk.

Can you get yeast infections from your sexual partner?

Yeast infections are not considered sexually transmitted diseases, but women can be infected by their male partners. Some of my patients are sure this happens: they take their medication, get cured of their symptoms, but when they resume intercourse with their partner after an infection-free period of abstinence, they immediately get another yeast infection. In these situations it seems useful to treat the man as well. Yeast infections can also be transmitted through oral sex.

Although yeast cells dry out and die when exposed to the air, men can get yeast infections from contact with an infected female partner. The primary symptom is the presence of itchy red patches on the penis. Men are treated with the same oral or topical antifungal medications that are used for women.

How can you lower your risk for yeast infections?

There is no surefire preventive, but there are some commonsense steps you can take. Let your vagina “breathe.” Don’t wear skintight jeans or binding undergarments. Wear cotton panties or panties with a cotton crotch. Don’t sit around in a wet bathing suit or sweaty exercise clothes. Don’t wear nylon panty hose every day. When you use the toilet, wipe from front to back to avoid spreading yeast and bacteria from the rectum to the vagina. Try to keep your weight in the normal range.

If you are taking an antibiotic orally or vaginally, for a yeast infection or some other problem, try to replenish the natural vaginal flora to help prevent a recurrence. Any yogurt with live cultures contains Lactobacilli; you can eat yogurt to get these desirable bacteria into your digestive tract and thence into the rest of your system. Or you can use plain un-flavored yogurt as a topical medication: use an applicator (they come with contraceptive foams or other vaginal medications) or even a tampon to get the yogurt up into the vagina. Or use it in a douche solution.

Another source of helpful bacteria is Acidophilus, available at health food stores as a powdered supplement to use in juice or water, or as tablets that you take daily. Certain Acidophilus products contain a combination of “friendly flora.” Some physicians do not believe that these preventive measures do much good, but many of my patients find them helpful.

Are there any self-help approaches onceyou already have ayeast infection?

You can use Acidophilus or yogurt to treat yeast infections, just as you would use these friendly bacteria to prevent them.

Another remedy especially helpful for hard-core yeast infections is boric acid, used in homemade vaginal suppositories. This mild acid is sold over the counter in drugstores, usually in the eye-care department, as packets of powder. Do not take it orally. Pharmacists who are skilled in filling capsules may make some up for you. (Your gynecologist may know a local “compounding” pharmacist.) If you are unable to find someone to fill the capsules for you, you can make your own.

To make the suppositories, you will need, in addition to the powdered boric acid, some size 0 empty gelatin capsules, also available at drug stores or health food stores. Fill the capsules loosely with the boric acid powder and use them as vaginal suppositories, inserting one at night before you go to bed and one in the morning. The gelatin will melt and release the boric acid into the vagina. These capsules are less messy than creams or purchased suppositories, but they do leave a small amount of watery, gritty residue. After a week of this twice-daily treatment, decrease the dosage to one capsule daily for another week.

Do frequent yeast infections mean you have some serious underlying medical condition?

Most women who get repeated infections do not have serious underlying diseases; they are simply unlucky. In many cases there is no discernible reason for the recurrences. Nevertheless, when someone tells me she has had ayeast infection every month for the past year, I do consider such predisposing diseases as diabetes or Acquired immunodeficiency syndrome, but the vast majority of women who have yeast infections have neither Acquired immunodeficiency syndrome nor diabetes. If you seem to get “yeast” infections frequently, see your health care provider for a culture. What you think is ayeast infection could be something different, perhaps another type of infection or irritation from an allergen.

Cancer of the vulva, which is rare especially in younger women, often shows up with persistent itching, which of course is the main symptom of yeast infections. If you have an area of itchiness that does not go away with a week or two of treatment, or a tender area that does not heal in about a month, be sure to contact your health care provider.

Treating Yeast Infections

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