Overview

What Is It?

A yeast infection in an overgrowth of fungus in the vagina characterized by vaginal itching, burning and discharge.

Vaginal yeast infections, also called candida vaginal infections or candidiasis, are common and easily treated in most women. Candida is a fungus. It commonly exists in small amounts in the vagina, mouth and gastrointestinal tract. When the fungus overgrows in the vagina, a yeast infection develops. This causes uncomfortable symptoms such as vaginal itching, burning and discharge. Uncontrolled diabetes and the use of antibiotics, the contraceptive sponge, the diaphragm and spermicides are associated with more frequent yeast infections. Women who use hormonal birth control—birth control pills, the birth control patch or the vaginal ring—may also have more yeast infections.

Characteristics of Yeast Infections
Most women––as many as 75 percent––will have at least one diagnosis of vaginal yeast infection during their lifetimes. Yeast infections (also called yeast vaginitis or vaginal candidiasis) are one of the most common causes of vaginitis, an inflammation of the vagina characterized by discharge and irritation.

Yeast infections are more common during pregnancy. It seems that the higher levels of estrogen in pregnancy cause the vagina to produce more glycogen (sugar), which feeds the yeast. Similarly, people with diabetes get yeast infections more frequently.

Recurrent Yeast Infections
A small percentage of women (less than 5 percent) develop recurrent vulvovaginal candidiasis (RVVC), defined as four or more symptomatic vaginal yeast infections during a 12-month period. Although RVVC is more common in women who have diabetes or problems with their immune system, most women with RVVC have no underlying medical illness that would predispose them to recurrent candida infections.

Conditions Mistaken for Yeast Infections: Bacterial Vaginosis and Trichomoniasis
Vaginal infections can also be caused by bacterial vaginosis (BV), the most common cause of vaginitis in women of childbearing age, and trichomoniasis, a sexually transmitted infection. BV and trichomoniasis are associated with more serious reproductive health concerns, such as premature birth and increased risk of contracting sexually transmitted diseases. Because these infections can have symptoms similar to those of yeast infections, yet can have more serious reproductive effects, it's important to see a health care professional to evaluate and diagnose any vaginal symptoms. A variety of medications can treat vaginal infections, but proper diagnosis is key.

Diagnosis

Possibly because they are so common, women often self-diagnose yeast infections and self-treat with over-the-counter products.

But self-diagnosis may be a misdiagnosis. In one study, only 11 percent of women accurately diagnosed their yeast infections, and among women who had previously had a yeast infection, only 35 correctly diagnosed the condition. A handful of other vaginal infections, such as bacterial vaginosis (BV) and trichomoniasis cause similar symptoms.

Vaginal yeast infections may cause the following symptoms:

Vaginal itch and/or soreness.
A thick cottage cheese-like vaginal discharge, which may smell like yeast. A fishy odor is a symptom of BV, not of a yeast infection. The vagina normally produces a discharge that is usually described as clear or slightly cloudy, non-irritating, and having a mild odor. There may also be no discharge with a yeast infection or a discharge that is thin and watery.
A burning discomfort around the vaginal opening, especially if urine comes into contact with the area.
Pain, dryness or discomfort during sexual penetration.
Redness and swelling of the vulva and vagina

Contact your health care professional if you have any of these symptoms.

During the normal menstrual cycle, the amount and consistency of vaginal discharge varies. At one time of the month, you may have a small amount of a very thin or watery discharge, while another time of the month the discharge may be thicker. These variations are normal. The normal mid-cycle discharge is slippery.

However, a vaginal discharge that has an offensive odor with irritation is not normal. The irritation can be described as itching or burning or both and often worsens at night. Sexual intercourse typically makes the irritation worse.

To diagnose your vaginal symptoms, your health care professional will perform a gynecological examination and check your vagina for inflammation and abnormal discharge. A sample of the vaginal discharge may be taken for laboratory examination under a microscope, or for a yeast culture, test to see if candida fungi grow under laboratory conditions. Looking under a microscope also helps rule out other causes of discharge such as BV or trichomoniasis, which require different treatment.

Treatment

Antifungal medications are used to treat yeast infections. These medications are available in various over-the-counter (OTC) preparations and in one-, three- and seven-day doses. They include:

butoconazole (Gynazole, Femstat 3)
terconazole (Terazol)
tioconazole (Vagistat-1)
miconazole (Monistat)
clotrimazole (Gyne-Lotrimin)

Differences among the various OTC medications include the length of treatment indicated, preparation type and cost. The shorter course of treatment is more convenient but often more expensive. The one-, three- and seven-day durations of treatment appear to be equally effective. Prescription antifungal treatments also are available.

In general, it's acceptable to use OTC antifungal medication to self-treat your symptoms if you've had a yeast infection diagnosed by a health care professional before and you are now experiencing the same symptoms.

However, if you meet any of the following circumstances, do not self-treat. Instead, contact a health care professional for guidance.

You've never had a yeast infection.
You have a fever and/or abdominal pain.
Your vaginal discharge is foul-smelling.
You are diabetic, HIV-positive, pregnant or nursing.
You used an over-the-counter yeast treatment but your symptoms have not gone away or they returned almost immediately.

If you take medication to treat a yeast infection—OTC medication or prescription medication—be sure to take the full course of the prescription. Don't stop using it, even if you begin to feel better.

If your symptoms don't respond or return shortly after they'd cleared up, consult your health care professional. Don't just try a different over-the-counter treatment; your symptoms may not be caused by yeast.

Studies find up to an 89 percent error rate in self-diagnosis of yeast infections. Thus, if you think that you have a yeast infection, there's a high chance you're wrong. If your symptoms don't ease after a few days of self-treatment with OTC medicine, or if they return promptly, see your health care professional. Keep in mind, however, that vaginal and vulvar irritation may persist for two weeks.

Yeast infections also may clear up without any treatment. However, there is a very small chance that a yeast infection may lead to a serious infection known as systematic candidal disease. This complication usually only occurs in women with compromised immune systems.

Side effects of OTC medications for yeast infections are generally minor and include burning, itching, irritation of the skin and headache. However, as with any medication, more serious side effects are possible, though rare, and may include hives, shortness of breath and facial swelling. Seek emergency treatment immediately if any of these symptoms occur.

Antifungal medications may damage condoms and diaphragms, so if you're using such a medication, take other precautions to protect against pregnancy and sexually transmitted diseases. Also, don't use tampons while treating yeast infections with medication inserted into the vagina.

If you see a health care professional, he or she may prescribe a single dose of oral fluconazole (Diflucan) or a generic equivalent, although this treatment is not recommended during pregnancy. Also, do not take fluconazole if you are taking cisapride (Propulsid) because this drug combination could cause serious, even fatal, heart problems. There have been reported drug interactions between warfarin, an anticoagulant (blood thinner) medication, and topical miconazole nitrate products (such as Monistat) and oral fluconazole (Diflucan). Additionally, fluconazole may cause liver damage in rare instances, particularly in conjunction with alcohol use. Discuss all the medications you may be taking when you discuss your symptoms with your health care professional.

Also, notify your health care professional immediately if you develop a rash while taking fluconazole. Other, less serious side effects may be more likely to occur. These include:

diarrhea
headache
dizziness
stomach pain
heartburn

If you have a yeast infection, your sexual partners do not need to be treated. However, if a male sex partner shows symptoms of candida balanitis—redness, irritation and/or itching at the tip of the penis—he may need to be treated with an antifungal cream or ointment.

Medications cure 80 to 90 percent of vaginal yeast infections within two weeks or less, often within a few days with less severe infections.

A small percentage of women (less than 5 percent) experience recurrent vulvovaginal candidiasis (RVVC), defined as four or more yeast infections per year. Treatment involves a longer course of treatment—between 7 and 14 days of a topical cream or suppository or oral fluconazole followed by a second and third dose three and six days later. Your health care professional may also recommend a preventative treatment after the infection has resolved. This treatment may involve a 150 mg dose of fluconazole or 500 mg of topical clotrimazole once a week.

Prevention

Among the strategies that may prevent vaginal yeast infections are:

Keep the external genital area clean and dry.
Avoid irritating soaps (including bubble bath) and vaginal sprays.
Avoid scented soaps, powders or toilet tissue.
Avoid daily use of panty liners, which can trap moisture and prevent good airflow.
Change tampons and sanitary napkins frequently.
Wear loose cotton underwear that doesn't trap moisture.
After swimming, change immediately into dry clothing instead of staying in your wet bathing suit.
If you have diabetes, try to maintain stable blood sugar levels.
Take antibiotics only when prescribed by your health care professional and never for longer than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the "good" bacteria that keep the yeast in the vagina at a normal level. If you tend to get yeast infections whenever you take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent at the same time.

Wipe from the front to the rear (away from the vagina) after a bowel movement or urination.
Don't use douches. Douching with vinegar or other chemicals increases the rate of vaginal yeast infections because it alters the vaginal bacterial balance.

Facts to Know

Seventy-five percent of women are likely to have at least one yeast infection during their lifetime; nearly half have two or more.
Vaginal yeast infections are the second most common cause of abnormal vaginal discharge in the United States (the first is bacterial vaginosis).
Yeast infections are quite common during pregnancy. It seems that the higher levels of estrogen in pregnancy cause the vagina to produce more glycogen (sugar), which feeds the yeast. Yeast infections are also more common in women with diabetes.
A small percentage of women (less than 5 percent) develop recurrent vulvovaginal candidiasis (RVVC), defined as four or more symptomatic vaginal yeast infections in a 12-month period. Most women with RVVC have no underlying medical illness that would predispose them to recurrent candida infections.
A woman's vagina normally produces a discharge described as clear or slightly cloudy, non-irritating and odor-free or having only a mild scent. During the normal menstrual cycle, the amount and consistency of discharge may vary.
Douching disrupts the balance of normal bacteria in the vagina and can cause more frequent vaginal infections.
Vaginal yeast infections can clear up without treatment. However, if you don't treat a yeast infection, there is a very small chance you may develop a serious infection.
If you have a yeast infection, treatment of sexual partners is usually not generally recommended, since it's not clear if vaginal yeast infections are transmitted sexually. However, if a woman has recurrent infections and her male sex partner shows symptoms of candida balanitis—redness, irritation and/or itching at the tip of the penis—he may need to be treated with an antifungal cream or ointment.
Medications cure 80 percent to 90 percent of vaginal yeast infections within two weeks or less, often within a few days.
Take antibiotics only when prescribed by your health care professional and never take them for more or less time than directed. In addition to destroying bacteria that cause illness, antibiotics kill off the "good" bacteria that normally live in the vagina. Stopping treatment early, even when symptoms have improved, can cause infections to return and make them resistant to the medication.

Questions to Ask

Review the following Questions to Ask about yeast infections so you're prepared to discuss this important health issue with your health care professional.

Is there a difference between the various over-the-counter treatments for yeast infections? Which one would you recommend?
Am I a candidate for the one-dose, oral prescription medication fluconazole (Diflucan)? (Be sure to tell your health care professional if you may be pregnant, are nursing, have any health problems or are taking any other medications.)
Are the drugs used for treating yeast infections safe for pregnant women?
Are the drugs used for treating yeast infections safe for nursing women?
Does my male partner need to be treated? What if I have a female partner?
Are different vaginal infections treated differently?
How do I identify a yeast infection in the future?
Do I need to refrain from sexual contact while I am being treated?
How much douching is excessive?
How do I avoid yeast infections in the future?

Key Q&A

I think I might have a yeast infection, but I'm not sure. Should I go ahead and try one of the over-the-counter preparations to see if my symptoms go away?

If you've had a yeast infection before and now have the same symptoms—vaginal discharge that has a yeast-like smell, with burning, itching and discomfort—self-treatment with an over-the-counter antifungal treatment is generally acceptable. However, many vaginal infections, including some that can cause serious reproductive health conditions, such as premature birth or increased risk of sexually transmitted diseases, have similar symptoms. If you're not sure, have never had a yeast infection before, are pregnant or have a health condition, consult a health care professional for an evaluation of your symptoms before treating yourself with OTC medications.

I'm on the third day of a seven-day treatment and my symptoms are all gone. Can I stop using the medication?

No, you need to use all of the medication as directed. Your symptoms can disappear before your infection is completely treated. If you stop using the medication now, the yeast infection could recur.

I have vaginal itching and a discharge with a fishy odor. Is this a yeast infection?

No, a discharge with a fishy odor is not a symptom of a yeast infection. It's a symptom of bacterial vaginosis (BV), another common, but more serious, vaginal infection. BV requires a different treatment than that used for yeast infections. Contact a health care professional for additional guidance.

What is the risk of self-treating yeast infection for women who are pregnant or nursing or those who have diabetes or HIV?

First, women who are pregnant or have diabetes or HIV have a higher risk of developing a yeast infection. Second, and most important, these woman, as well as nursing mothers, should always see their health care professional if they suspect a yeast infection rather than self-treat because yeast medications may interfere with medications needed for their other health problems (HIV, diabetes) or pose risks for the baby.

If I'm pregnant, can a yeast infection hurt my developing baby?

No, but you do need to see your health care professional for treatment. Also, some treatments currently on the market, such as fluconazole (Diflucan), are not recommended during pregnancy. Be sure your health care professional and pharmacist are both aware that you are or may be pregnant.

I keep getting recurrent yeast infections. Should my sexual partner be treated?

It's not clear whether vaginal yeast infections can be transferred during sexual intercourse. However, if your sexual partner has the symptoms of candida—redness, irritation and/or itching at the tip of the penis in a male—he may need to be treated. In rare cases, treatment of partners of women with recurrent yeast infection is recommended. Additionally, recurrent yeast infections may be representative of a different problem. Thus, it is important to see your health care provider for an evaluation.

I thought douching helped keep a woman clean. What is the risk in douching?

The healthy vaginal ecosystem requires just the right balance of bacteria flora. The vaginal mucosa, which protects against pathogens, is made up predominantly of healthy bacteria called lactobacillus. These bacteria make hydrogen peroxide, which keeps unhealthy bacteria from getting out of hand. This, in turn, keeps the amount of yeast at a normal level. Too much douching can disrupt the bacterial balance and lead to infection.

My health care professional has prescribed antibiotics to treat an unrelated illness. What precautions should I take to avoid getting a yeast infection?

Wear loose clothing and loose cotton underwear. Keep yourself clean and dry. Avoid scented or irritating soaps, powders, and toilet tissue. Avoid douching. Use a preventive dose of yeast medication.

Lifestyle Tips

Think twice before taking antibiotics
If you need to take antibiotics, you may wind up with a yeast infection. The use of antibiotics will frequently tip the balance among the normal microorganisms of the vagina, allowing harmful bacteria to dominate vaginal flora. Antibiotics suppress the growth of protective vaginal bacteria, which normally have an antifungal effect. Before rushing to the drugstore for an over-the-counter treatment, it's wise to consult your health care professional. Many self-diagnosed yeast infections turn out to be other vaginal problems.
Keep your vagina clean, dry and clear of deodorants and soaps
Here are some simple steps you can take that may help you avoid yeast infections: Don't douche or use feminine hygiene sprays, bubble bath or sanitary pads or tampons that contain deodorant. These items seem to affect the balance of acidity of the vagina, which can lead to an infection. Wearing cotton panties, avoiding tight-fitting clothing, avoiding regular use of panty liners and wiping from front to back after using the toilet can help you avoid yeast infections. Since the microorganisms responsible for yeast infections thrive in warm, moist environments, be sure to dry your genital area well after bathing and before getting dressed.
Watch out for repeat symptoms
Women who get recurrent yeast infections may in fact be battling a more complicated infection that requires a longer course of treatment and/or a change in behaviors that may be at the root of the problem. If your symptoms last more than a few days or return promptly, ask your health care professional about a longer course of treatment (seven to 14 days with a topical antifungal therapy or three doses of fluconazole). You should also be sure to complete the full course of the medication, even after symptoms disappear. In addition, watch out for behaviors that can lead to recurrent yeast infections, such as using panty liners, panty hose or sexual lubricants or drinking cranberry juice.
Consider switching your birth control method
Researchers believe that certain methods of birth control may be to blame for recurrent yeast infections. Spermicidal jellies and creams increase a woman's susceptibility to infection by altering vaginal flora, allowing candida (yeast microorganisms) to take firmer hold. It seems that the estrogen in oral contraceptives causes the vagina to produce more glycogen (sugar), which feeds the yeast. Vaginal sponges and intrauterine devices (IUDs) may also make you more prone to infection, and diaphragms are thought to promote colonization of candida.

Organizations and Support

For information and support on coping with Yeast Infections, please see the recommended organizations, books and Spanish-language resources listed below.

American College of Obstetricians and Gynecologists (ACOG)
Website: https://www.acog.org
Address: 409 12th Street, SW
P.O. Box 96920
Washington, DC 20090
Phone: 202-638-5577
Email: resources@acog.org

Books

The Candida Albican Yeast-Free Cookbook: How Good Nutrition Can Help Fight the Epidemic of Yeast-Related Diseases
by Pat Connolly and Associates of the Price-Pottenger Nutrition Foundation

Chronic Candidiasis: Your Natural Guide to Healing with Diet, Vitamins, Minerals, Herbs, Exercise, and Other Natural Methods
by Michael T. Murray

Complete Candida Yeast Guidebook, Revised 2nd Edition: Everything You Need to Know About Prevention, Treatment & Diet
by Jeanne Marie Martin and Zoltan P. Rona M.D.

Spanish-language resources

Family Doctor American Academy of Family Physicians
Website: https://familydoctor.org/online/famdoces/home/women/reproductive/vaginal/234.html
Address: American Heart Association
7272 Greenville Avenue
Dallas, TX 75231
Hotline: 1-800-AHA-USA1
Email: Review.personal.info@heart.org

Centers for Disease Control and Prevention
Website: https://www.cdc.gov/std/spanish/vb/stdfact-bacterial-vaginosis-s.htm
Address: Centros para el Control y la Prevencion de Enfermedades
P.O. Box 6003
Rockville, MD 20849
Hotline: 1-800-458-5231
Phone: 1-800-232-4636
Email: cdinfo@cdc.gov

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Yeast Infections