# Vaginal Yeast Infection 101: Causes, Diagnosis, and Care Last updated on August 20, 2024 ## Summary - Vaginal yeast infection results from the overgrowth of certain yeasts known as _Candida_, which cause inflammation. One of its main symptoms is itching, but there can also be asymptomatic cases. - For pregnant women, having vaginal _Candida_ may slightly increase the risk of preterm birth. If you have a yeast infection, this increases the chances of passing _Candida_ to the baby, which may increase your baby’s risk of diaper rash or oral candidiasis. - The standard treatment for yeast infection is antifungals for a couple of days to a week. These come as pills, creams, and suppositories. Pregnant women should start with creams or suppositories and use antifungal pills only for resistant or severe cases under the guidance of their provider. - Some _Candida_ species are resistant to antifungals. If possible, get a proper diagnosis before using these medications. - Some alternative treatments for yeast infection include boric acid, tea tree oil vaginal suppositories, and the _Candida_ diet. Boric acid shouldn’t be used if you are pregnant or trying to conceive. The effectiveness of the _Candida_ diet in preventing vaginal yeast infection isn’t scientifically supported, but if you decide to follow it, please do so with the guidance of a nutritionist. Vaginal yeast infections are annoying, messy, and very common! Yeast infections are caused by _Candida_ yeasts, but it’s important to note that having _Candida_ in your vaginal microbiome doesn’t always mean you have an infection. These yeasts can actually be harmless members of a healthy vaginal microbiome. So why do they make a mess down there sometimes? It’s probably a combination of several factors, such as your [vaginal microbiome composition](/content/blog/cst/index.html), other diseases, and hormonal changes What we know is that certain things can increase your risk of getting a yeast infection if you have _Candida_ as part of your vaginal microbiome, including: - Antibiotics - Stress - [Douching](/content/blog/is-douching-with-vinegar-safe/index.html), scented soaps - Wearing tight underwear - A weakened immune system - Pregnancy - Hormonal birth control pills high in estrogen - Estrogen therapy - Obesity - Untreated diabetes or gestational diabetes - Genetic factors When the conditions are right, _Candida_ may overgrow, build up an army, and trigger immune cells, leading to inflammation. And voila, you have a yeast infection. This condition is also known as vulvovaginal candidosis, vulvovaginal candidiasis, or vaginal thrush. The main species that causes vaginal yeast infections is _Candida albicans_. Other _Candida_ species like _C. glabrata_, _C. tropicalis_, _C. krusei_, and _C. parapsilosis_ can also cause infections, but this is more common in women with chronic conditions like type 2 diabetes. ## Have a yeast infection? You’re not alone Yeast overgrowth is the second most common vaginal infection in women (the first one is [bacterial vaginosis](/content/blog/bacterial-vaginosis/index.html)). Here are some statistics: - About 70-75% of women have a yeast infection at some point in their lives. - About 10-14% of pregnant women have had a vaginal yeast infection during pregnancy. This is more common to occur in the third trimester. - About 8% will have over four episodes per year, also known as recurrent or persistent yeast infections. ## What does a vaginal yeast infection feel like? The most common symptoms of a yeast infection include: - A thick, usually odorless, white vaginal discharge with a cottage cheese-like consistency - Vaginal and/or vulvar itching - Vaginal and/or vulvar irritation - Inflammation - Pain during sex or urination These symptoms usually range from mild to moderate and tend to be worse before the start of the menstrual period because of hormonal changes. Itching is one of the most reported symptoms. However, for species other than _C. albicans_, the symptoms may be negligible. Apart from these physical symptoms, having a yeast infection can also negatively impact quality of life, especially if recurrent. This situation may create stress and anxiety, decrease self-esteem and confidence, and affect partner relationships. ## Why proper diagnosis is important As with other vaginal infections, looking at symptoms alone may not be sufficient for an accurate diagnosis, especially if you have mild symptoms that don't fit well with the typical description of a yeast infection. That’s why a pelvic exam, microscopic examination, and other tests to rule out other infections may be helpful. Measuring vaginal pH can also provide useful information. If a yeast infection is present, pH tends to be less than 5. If it isn’t possible to visit your provider, they may prescribe you an over-the-counter antifungal based on symptoms. If symptoms persist after one round of treatment, consult your provider as you may have a resistant yeast. Your provider may conduct a lab test to identify which _Candida_ species is causing the infection and check for antifungal resistance, especially in cases of recurrent yeast infections. ## _Lactobacillus_ may not be very protective against _Candida_ _Lactobacillus_ are considered protective bacteria for vaginal health overall. High numbers of these species provide protection against infections like bacterial vaginosis and [aerobic vaginitis](/content/blog/aerobic-vaginitis/index.html). However, for yeast infections, the effectiveness is not clear. Women with yeast infections often have high numbers of vaginal _Lactobacillus_, comparable to healthy women. Most women with yeast overgrowth have [_L. iners_ as the dominant _Lactobacillus_ species](/content/blog/cst/index.html). This may indicate less protective efficacy than other _Lactobacillus_ and is frequently detected along with bacterial vaginosis. However, some studies found that _C. albicans_ detection was more frequent in women with a vaginal microbiome dominated by _L. crispatus_. ## Vaginal yeast infection while pregnant There may be an association between yeast infection or asymptomatic carriage of vaginal _Candida_ and preterm birth, but it’s not as clear as for other vaginal infections. Clinical trials suggested that treating asymptomatic women positive for vaginal _Candida_ with clotrimazole may reduce the risk of preterm birth. Apart from this potential association with preterm birth, mothers with vaginal _Candida_ may pass these yeasts to their baby during birth, possibly increasing the risk of oral candidiasis or diaper rash during the first year of life. Having _Candida_ as part of your vaginal microbiome doesn’t necessarily mean you have a yeast infection. Furthermore, detection in the absence of symptoms, such as with a vaginal microbiome test, may not require treatment with medications. If you wish to decrease your chances of passing _Candida_ to your baby, always discuss your concerns with your provider to see if a treatment would be suitable. ## The standard treatment for yeast infection For symptomatic cases of vaginal yeast infections, the standard treatment is antifungals. These medications come as creams, vaginal suppositories, and pills. Some examples include: - Miconazole (Monistat®, Vagistat®), available as a cream - Fluconazole, available as pills - Clotrimazole, available as a cream and vaginal suppositories - Nystatin, available as a cream and vaginal suppositories The treatment duration depends on the severity of your symptoms and whether or not you are pregnant. Treatment generally lasts from one to seven days. If you’re pregnant, it’s advisable to avoid oral antifungals like fluconazole, as some studies suggested it may increase the risk of malformations in the baby. Therefore, vaginal creams or suppositories are more appropriate for pregnant women. If breastfeeding, fluconazole is considered safe for the baby. Recurrent yeast infections require longer treatment. Following a maintenance regimen with fluconazole for a year resulted in 77% of women remaining free of infection. _Candida_ species different from _C. albicans_ are often resistant to antifungals. For instance, _C. krusei_ is intrinsically resistant to fluconazole and others. Thus, it’s crucial to always consult your provider before taking any of these medications. If you have antifungal-resistant _Candida_, using the wrong medication may lead to treatment failure and recurrence. ## Home remedies for yeast infection If you search online, you’ll find alternative treatments for yeast infections. After several failed antifungal treatments, you may be tempted to explore these remedies. But are they safe? Do they work? Let’s take a brief look at some of these treatments: - **Boric acid suppositories**: Studies indicate these to be an effective alternative to antifungals. However, pregnant women and women trying to conceive should not use boric acid suppositories. - **Tea tree oil suppositories**: Laboratory and animal experiments support that tea tree oil (_Melaleuca alternifolia_) effectively combats _Candida_ yeasts. Preliminary research in humans shows that tea tree oil suppresses symptoms and decreases the number of vaginal _Candida_. If pregnant, consult your provider before trying tea tree oil suppositories. - **The Candida diet**: This is a low-sugar anti-inflammatory diet avoiding foods promoting _Candida_ growth. While this diet is popular, its effectiveness in reducing vaginal _Candida_ hasn’t been tested. If you're pregnant and want to try it, ensure you do so with the guidance of a nutritionist. ## Things you can do to keep yeasts under control There are some general guidelines to help maintain a healthy vaginal microbiome. Regularly check for any changes in the color and quantity of your vaginal discharge, itching, and any other unpleasant symptoms. It’s normal for your vaginal microbiome to vary during your menstrual cycle, but any significant change or unpleasant smell should be evaluated and treated if necessary.