Vaginal yeast infections are the second most common cause of vaginal discharge in the United States (the first is Bacterial Vaginosis). Yeast infection is not considered a sexually transmitted disease, but is included here because it is such a common cause of vaginal discharge. Candida yeast can be found in the vaginas of almost one in every two woman of childbearing age though the majority of these women have no symptoms unless something occurs to disrupt the normal vaginal environment (see below). The vast majority of yeast infections are caused by the Candida albicans species.
Common Signs & Symptoms
Vaginal itchiness and a cottage cheese-like discharge are the most common symptoms of a yeast infection. The vagina and labia can be red, swollen, sore, and quite irritated. Burning with urination and pain during intercourse (dyspareunia) are also common complaints. Odor, if present, is minimal (in contrast to the fishy odor of bacterial vaginosis).
How’s it Diagnosed?
Diagnosis is made on examination. A pelvic exam is done and a sample of the discharge is obtained (pictured is the curd-like discharge as seen through a speculum during pelvic examination). A sample of the discharge is often viewed under the microscope and reveals the yeast organisms. Looking under a microscope also helps rule out other causes of discharge (e.g., bacterial vaginosis, trichomonas) that would require different treatment.
How’s it Treated?
Treatment is with an antifungal medication of which there are many. Over-the-counter creams and vaginal suppository medications are available without a doctor’s prescription and include clotrimazole (Gynelotrimin, Mycelex), butoconazole (Femstat), and miconazole (Monistat). An oral antifungal, fluconazole, is commonly prescribed by physicians as it is a one time dose with minimal side effects (including ease of administration; one pill and not a number of days applying something onto or into one’s vagina). Yeast infections are not considered sexually transmitted, and therefore sexually partners do not need treatment ( though it is interesting to note that 1 in 5 men whose partners had a yeast infection were found to have microscopic yeast present in their urethras).
How do I avoid Getting It (Prevention)?
Though not currently believed to be sexually transmitted, yeast infections are associated with a number of medications and personal states. Avoidance of these will decrease your chance of getting a yeast infection. One of the most common cause of yeast infections is the use of an antibiotic. In addition to destroying bacteria that cause illness, antibiotics kill off the “good” bacteria that normally live in the vagina. Without the normal lactobacillus bacteria in the vagina, yeast cells can take-over and grow out-of-control. This is why some woman douche with yogurt. Unpasturized yogurt contains the “good” bacteria that are normally found in the vagina. It is unclear, however, if douching with yogurt helps or hurts, and we do not recommend trying this without first checking with your doctor. Vaginal yeast infections are just one more reason why antibiotics should be avoided except in the treatment of a bacterial infection (e.g., and not for the treatment of colds and flu - which are caused exclusively by viruses upon which an antibiotic will have no effect). Also, douching with vinegar or other chemicals has been shown to increase the rate of vaginal yeast infections. This is likely a result of the same process that occurs with antibiotics: the “good” bacteria living in the vagina are destroyed by the douche, leaving the yeast to grow and multiply.
Yeast infections are quite common during pregnancy. It is believed this is due to a chemical change in the vaginal environment (essentially there is more sugar in the vaginal juices on which the yeast feed). Similarly, people with diabetes (a disease of sugar metabolism) also get yeast infections more frequently.
It has been shown than tight fitting, poorly ventilated clothing and non-cotton undergarments result in an increase in groin warmth and moisture (sweat), and can lead to yeast infections. This is one reason yeast infections are more prominent in the warmer tropical and sub-tropical climates.
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