Yeast infection is a form of vaginitis, or inflammation of the vagina. It is caused by an overgrowth of Candida, a microscopic fungus that normally inhabits the vagina and other parts of the body. There are four types of Candida. However, a variety called Candida albicans (C. albicans) causes the vast majority of vaginal yeast infections.

Several factors can promote the overgrowth of C. albicans in the vagina, including, but not limited to:

• Pregnancy and other causes of hormonal changes
• Diabetes, particularly uncontrolled 
• Birth control pills
• Medications (e.g., steroids, antibiotics)
• Weakened immune system

Symptoms of yeast infection are not always apparent, but may include:

• Thick, white, cottage cheese-like discharge
• Itching, burning or irritation of the vagina
• Redness of the area that surrounds the vagina (erythema)
• Rash on the outer vaginal lips
• Pain during sexual intercourse (dyspareunia)
• Burning during urination (dysuria)

Patients with recurrent yeast infections are often able to diagnose and treat themselves. However, women exhibiting first-time symptoms of infection should immediately consult their gynecologist. Women who are or may be pregnant also should be seen by their obstetrician-gynecologist prior to beginning any treatment for yeast infections. 

Vaginal yeast infections are typically diagnosed based on a woman’s symptoms and a complete pelvic examination conducted by a physician. In some cases, a slide test may be administered by the physician. This test analyzes a woman’s vaginal secretions for the presence of yeast organisms.

Vaginal yeast infections can be treated using over-the-counter (OTC) or prescription medications. They come in various forms including creams, ointments and suppositories that are inserted directly into the vagina and applied topically for symptom relief. Oral medications also may be used but these are available only through prescription.

Treatment options range from one to 14 days in duration although relief from the symptoms usually occurs within the first few days. Yeast infections cannot always be prevented but women can reduce the likelihood of developing them by avoiding risk factors involving clothing and personal hygiene. Additionally, women with recurrent yeast infections may choose to take boric acid capsules or eat yogurt with lactobacillus acidophilus cultures daily. Both of these items have proven to be effective in preventing this condition. 

Male partners of women with vaginal yeast infection do not typically experience any symptoms of the condition, although in rare instances, yeast infection can be transmitted through sexual intercourse. Men who experience symptoms, such as genital itching and irritation, should immediately notify their physician. Left untreated, symptoms of yeast infection may persist and can cause more serious conditions in both women and men, including a life-threatening blood infection called sepsis.

Yeast infection is a form of vaginitis, an inflammation or infection of the vagina. During a lifetime, almost 75 percent of all women are likely to have at least one vaginal yeast infection and nearly half have two or more according to the U.S. Centers for Disease Control and Prevention (CDC). Yeast infections can also affect pubescent girls, and, in rare instances, it may be transmitted to men through sexual intercourse.

Small numbers of Candida, a single-celled fungus, are always present in a woman’s vagina. Normally, the acidic environment of the vagina prevents the yeast from over growing. When the environment becomes disturbed and the acidic level is too low, too many organisms can grow, causing a yeast infection.

Candida albicans, which also grows normally in the mouth and digestive tract, can spread to other parts of the body, including the skin, mucous membranes, esophagus and other areas. It can cause life-threatening systemic infections, such as sepsis (infection of the blood), especially in individuals with a weakened immune system. This population includes pregnant women, individuals with diabetes and HIV-infected people.

Approximately 5 percent of patients with vaginal yeast infections develop a condition called recurrent vulvovaginal candidiasis (RVVC). RVVC is classified as more than three symptomatic vaginal yeast infections over the course of one year. Patients who experience RVVC should notify their gynecologist (a physician who specializes in treating disorders of the female reproductive system) who will attempt to identify the underlying cause of the condition.

Patients with a diagnosed yeast infection who use latex condoms or a diaphragm for birth control should discuss treatment with the physician. Some common medications used to treat yeast infections can weaken latex, and potentially compromise the birth control method. For this reason, another form of contraception may be necessary during the treatment period.

It is difficult to determine the percentage of women who have been affected by yeast infections because individuals do not always have recognizable symptoms and home treatment often goes unreported. Unlike other forms of vaginitis, such as trichomoniasis, yeast infections are not considered sexually transmitted diseases.

Proper diagnosis is important for effective treatment of yeast infections. Because the symptoms are similar to other conditions, yeast infections must be diagnosed correctly to rule out other illnesses or diseases. Left untreated, symptoms of yeast infection – which can be very uncomfortable – may persist. In severe cases, an untreated yeast infection can lead to more serious conditions, such as sepsis.

Several factors can promote the overgrowth of Candida albicans in the vagina, the most common cause of yeast infection. For instance, yeast infections are very common among pregnant women because the hormonal changes associated with pregnancy may increase the amount of sugar in the vaginal secretions. This, in turn, provides nourishment to the yeast.

Similarly, women with uncontrolled diabetes have an increased risk of developing yeast infections because elevated blood sugar levels impair immune function. When blood sugar levels rise, body secretions contain increased amounts of sugar. In addition, body tissues stop functioning properly. Therefore, normal bodily defenses against intrusion by yeast and other outside substances are diminished.

Women may also develop yeast infections just before they get their menstrual periods. This is due to the hormonal changes in the body that accompany menstruation.

Certain medications can increase the risk of developing a yeast infection. Oral contraceptives, hormone therapy and corticosteroids can alter the hormone balance in women and increase the growth of yeast. Antibiotics are also considered a risk factor for yeast infections. Antibiotics can kill the “good” bacteria that live in the body, which normally keep the Candida in the vagina in check. When it is destroyed, this balance is disturbed and Candida can grow and cause a yeast infection. A common progression occurs when a woman takes antibiotics to treat a urinary tract infection and then develops a yeast infection. 

Tight fitting clothing, especially undergarments, and synthetic materials can also increase yeast infections. These items can trap heat and moisture and create an optimal environment for the growth of Candida. Damp or wet clothing may contribute to the growth of organisms as well.

Research has indicated that the use of irritating soaps, deodorants, douches and sprays may contribute to yeast infections. The products can change the alkaline levels in the genital area and promote yeast growth. The use of scented tampons, sanitary pads or panty liners also may be a risk factor. These items can trap moisture in the genital area and promote bacteria growth.

Other risk factors for yeast infections include:

• Weakened immune system
• Excessive alcohol use
• Hot tubs and saunas
• Stress from poor diet, lack of sleep or illness

Although some women with yeast infections may not exhibit any symptoms of the condition, signs and symptoms often include:

• Thick, white, cottage cheese-like discharge
• Itching or irritation of the vagina
• Redness of the vulva or area that surrounds the vagina (erythema)
• Rash surrounding vagina
• Pain during sexual intercourse (dyspareunia) 
• Burning during urination (dysuria)

Symptoms of yeast infection are generally the same in all patients. However, there can be variations from one individual to the next. For instance, one patient may have more discharge whereas another patient may experience more irritation and redness.

The vaginal tissues are often more sensitive prior to menstruation. Itchiness experienced during this time may simply be a part of the body’s normal hormone fluctuations. If itchiness subsides after menstruation, treatment for yeast infection is not usually necessary.

Male partners of patients with vaginal yeast infection do not typically experience any symptoms of the condition. Rarely, a burning sensation and/or a transient rash on the penis may occur following unprotected sexual intercourse.

Yeast infections are one of several forms of vaginitis. Proper diagnosis is the key to effective treatment. Many women diagnose themselves with a yeast infection based on the symptoms and past experience with the condition. However, the misdiagnosis of yeast infections is common. A study conducted by the American Social Health Association found that 70 percent of women self-treated vaginal infections before calling a healthcare provider. Most often, the women mistook a bacterial infection for a yeast infection. In some cases, the woman had both a yeast infection and another type of infection that was not treatable by the antifungal medications used for yeast infections. Other problems that women may assume are yeast infections may be merely irritation from tampons, sexual intercourse or an allergic reaction.

Following self-diagnosis, women may choose to use over-the-counter (OTC) medications for treatment. Roughly two-thirds of all OTC medications sold to treat yeast infections were used by women who did not have the condition, according to the U.S. Centers for Disease Control and Prevention (CDC). For this reason, women should consult their physician the first time they suspect they may have a yeast infection based on symptoms. In addition, all women who are (or may be) pregnant or breastfeeding must consult their obstetrician-gynecologist before beginning any treatment. There are some medications that cannot be used with these women.

To diagnose a yeast infection, physicians usually first rely on the symptoms described by the patient. It is important to pay close attention to the symptoms, particularly when they first occur, including the type of discharge and location of irritation. Women are advised not to douche prior their doctor’s appointment as it may mask the symptoms or make accurate testing more difficult.

After obtaining the woman’s medical history, including current symptoms, the physician, usually a gynecologist will conduct a pelvic examination. The examination will focus on signs of inflammation or irritation in and around the vagina as well as any vaginal discharge. The physician may conduct a slide test to analyze the vaginal discharge.

In a slide test, the physician will obtain a sample of the vaginal secretions for a quick examination under a microscope for the presence of yeast organisms, such as Candida. This test is sufficient for diagnosing yeast infections in first-time sufferers and those with occasional infections. However, cases of recurrent or resistant yeast infections may require further analysis in the form of a vaginal culture, which is used to identify the presence of other forms of vaginitis as well as sexually transmitted diseases (STDs). The analysis can also aid in diagnosing yeast infections caused by less typical fungi that are often resistant to common yeast therapies.

Treatment for yeast infections may be either prescription or OTC antifungal medications. If a woman is diagnosed by her physician, she is likely to be given a prescription medication in the form of a vaginal cream, suppository or oral pill. Because most women rely on self-treatment, OTC medications are more commonly used for treatment of the condition.

The OTC medications for yeast infections are antifungal drugs that work to break down the wall of the Candida organism until it disappears. The drugs also inhibit the ability of the fungus to multiply and form new membranes. OTC medications for yeast infections contain one of four active ingredients:

• Butoconazole nitrate
• Clotrimazole
• Miconazole
• Tioconazole
  

The medications for treatment are available in two forms, vaginal and oral. Vaginal medications are available by prescription and OTC. They include vaginal creams and ointments that are inserted into the vagina by the woman with a special applicator. Vaginal suppositories that dispense medicine as they dissolve can also be placed directly into the vagina for treatment. Creams also may be applied topically to the genital area for symptom relief. Treatment with these medications can range from several days to two weeks.

Oral medications are only available by prescription and come in the form of tablets or capsules. The dosage and frequency depends on the severity of the yeast infection. Women with mild infections may only need a single dose or daily doses for a short duration.

The use of oral or vaginal forms of medication depends on a number of factors, including the severity of the yeast infection and whether the infection is recurrent. A woman’s personal medical history also affects the type of medication that should be used. For example, certain medications should not be used with individuals with a comprised immune system, diabetes or pregnancy. Women with these conditions must consult with their physician before beginning treatment for yeast infections.

Some drug regimens may include a combination of treatments, such as an oral agent followed by vaginal application of a cream. Severe or recurrent infections may require changing the type of medicine or remaining on a medicine for maintenance treatments.

Yeast infection treatments include:

There are drug or food interactions that may occur with some of the oral medications. Antacids or other drugs that decrease stomach acidity may decrease the effectiveness of oral antifungal drugs. In addition, creams and suppositories may contain oil that can weaken latex condoms. Patients should check with their physician or pharmacist if they are taking other medications before starting yeast infection treatment.

The most common side effects experienced with vaginal medications include vaginal burning and itching. Less common side effects include contact dermatitis, inflammation and pain during urination or sexual intercourse. Common side effects with oral medications include fever, dizziness, mild itching and nausea.

Yeast infections generally respond to treatment within a few days. However, individuals are instructed to complete the entire course of treatment, even if symptoms subside before treatment has concluded. It is important to note that although these treatments have an 80 to 90 percent success rate, frequent or prolonged use can reduce their effectiveness, according to the CDC.

If an infection clears up for some period of time but the same symptoms reappear, a woman may be advised by her physician to use a different type of treatment. A new type of medication may be able to completely cure the infection. Women should see their physician if:

• All of the symptoms do not go away completely
  
  
• The symptoms return immediately or shortly after completion of treatment
  
  
• They have any serious medical problems such as diabetes or immune disorder
  
  
• They are pregnant or breastfeeding

Treatment of sex partners is usually not necessary because most vaginal yeast infections are not transmitted sexually. In some cases, a male partner may exhibit some symptoms of Candida balanitis, a yeast infection on the male genitalia. It is characterized by redness, itching or irritation at the tip of the penis. If these symptoms appear, he may need to be treated with an antifungal cream as well. This condition occurs rarely in men as a result of a yeast infection in his female partner. However, the use of a condom will help prevent transmission of yeast infections between partners. 

Yeast infections cannot always be prevented. However, adhering to the following guidelines may reduce a woman’s risk of developing a yeast infection:

• Wear loose-fitting undergarments and avoid garments that trap heat and moisture.
  
  
• Wear only undergarments made of cotton or natural fiber or those that have a cotton panel.
  
  
• Do not wear panty liners every day and avoid scented tampons.
  
  
• Avoid the use of vaginal sprays, deodorants or douches.
  
  
• Avoid hot tubs, whirlpool spas and bubble baths.
  
  
• Immediately change out of wet clothes (e.g., bathing suit, exercise apparel).
  
  
• Exercise proper toilet habits (e.g., wipe from front to back).
  
  
• If menopausal, discuss hormone pills or creams to keep the vagina lubricated and healthy.
  
  
• Monitor and regulate blood sugar (if patient has diabetes).

Women who experience three or more yeast infections per year may want to speak with their gynecologist about taking boric acid capsules or eating yogurt with lactobacillus acidophilus cultures. Studies indicate that using these capsules in the vagina and consuming yogurt with live acidophilus cultures daily can help “good” bacteria grow and balance the growth of Candida.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions regarding yeast infections:

1. What may have caused my yeast infection?
   
   
2. How do I know my symptoms are from a yeast infection?
   
   
3. What steps can I take to prevent developing yeast infections?
   
   
4. Should I avoid sexual relations while I have a yeast infection?
   
   
5. Does one yeast infection place me at higher risk for more in the future?
   
   
6. What is the difference between over-the-counter and prescription treatments?
   
   
7. When can I expect to have relief once I start treatment?
   
   
8. What does it mean if I continually have yeast infections?
   
   
9. Can I treat recurrent yeast infections myself?
   
   
10. Are there any vitamin or herbal supplements that can help prevent yeast infections?
    
    
11. How can my diet affect my risk for yeast infections?
    
    
12. Why do some women get more yeast infections than others?
    
    
13. I’m pregnant. Will a yeast infection harm my baby?
    
    
14. What treatment methods are safe to use while pregnant/breastfeeding?