Yeast – plant, animal, bacteria or virus?
Actually, yeast is none of these. Yeasts belong to a class of tiny organisms called fungi. Many different types of yeast can cause infection in humans. Vaginal yeast infections are most often caused by the organism Candida albicans, one of several micro-organisms that live in the normal, healthy vagina. Changes in the environment of the vagina can upset the natural balance of these organisms. This allows yeast infections (also known as vaginal candidiasis) to develop.
Who is most likely to get a yeast infection?
Many different factors can increase a woman’s chance of getting a yeast infection. Some medications upset the natural environment of the vagina, allowing yeast to take hold. These include antibiotics, oral contraceptives, hormone replacement therapy, cortisones, and chemotherapy. Pregnant women, those with diabetes or a weakened immune system are more at risk for developing yeast infections in the vagina. Other factors include stress, a diet high in sugar, or wearing tight, synthetic underwear. Women who use vaginal deodorants, sprays and douches may also have more yeast infections.
What are the symptoms of a yeast infection?
The most common symptoms include severe itching and irritation of the vagina area and the surrounding vulva (external genital) area outside the vagina. Often a white, cottage cheese-like discharge from the vagina occurs as well. Some women may feel stinging or burning when passing urine, caused by urine touching the irritated area. Usually there is no unusual odor present with a vaginal yeast infection.
When should a woman see her doctor?
The first time a woman suspects she has a vaginal yeast infection, she should see her doctor to be sure of her own diagnosis. The symptoms can be similar to other types of infections causing different kinds of vaginal discharge and odors. Examples of those are infections such as bacterial vaginosis, trichomoniasis and some sexually transmitted diseases need to be treated with prescription medication.
Bladder infections can also cause a burning feeling when urine is passed. They need to be treated with oral antibiotics. Girls who have not reached puberty (started their menstrual periods) but have urinary symptoms should see a doctor for assessment. Vaginal candidiasis is not common in this age group. Pregnant women, those with chronic illness or who have repeated yeast infections should also see a doctor. In these cases prescription medication may be necessary.
Women who have had a past diagnosis of vaginal candidiasis and again experience the same symptoms may decide to use an over-the-counter product.
What non-prescription medication is available?
Many different products are available in pharmacies without a prescription. Vaginal creams, tablets, suppositories and ovules containing miconazole (e.g. Monistat™) and clotrimazole (e.g. Canesten™) are the most common candidiasis medications used in Canada. Both medications are about 90 per cent effective, decrease symptoms quickly and are tolerated well by most women. Side effects are uncommon, but may include local irritation, headache, and abdominal cramps.
How to decide – one, three, six or seven-day treatment?
When a woman looks at treatment options for a vaginal yeast infection, the choice of products can seem overwhelming. In general, the newer, shorter treatments are more concentrated than the older, longer treatments. One and three-day treatments are convenient and effective but do not achieve results any faster. They may be slightly more likely to irritate than the six and seven-day treatments. All treatments (if successful) resolve symptoms within seven days.
Vaginal creams are just as effective as vaginal ovules, tablets and suppositories. Cream may be used internally or externally (on the outside areas of the vulva) for irritation. Some combination packages contain a small tube of external cream plus internal treatment. These are convenient for a woman who has significant external irritation as well as the internal yeast infection.
If symptoms have been present for several days, the infection may respond better to a six or seven-day treatment. If the infection has not resolved after a week, or symptoms get worse, see a doctor.
How are these products used?
Vaginal creams, ovules, tablets and suppositories are inserted into the vagina using an applicator. Some come with several applicators. Others have only one, which must be washed with warm, soapy water and dried well following each use. Some products contain pre-filled, disposable applicators and some must be filled each time. All are effective when used properly. The applicator should be inserted into the vagina as high as is comfortable and the plunger pressed to release the product into the vagina.
Using the products before going to bed allows more time for medication to be in contact with the wall of the vagina. There is also less possible leakage of medication from the vagina. Many women find vaginal ovules, tablets and suppositories less messy than vaginal creams. Panty liners or pads can be used to absorb leakage.
The entire treatment should be used even if symptoms go away before all doses are used. This ensures the infection is treated properly. If a woman needs to use cream for external irritation, it can be applied two times a day for comfort.
Treatment should be continued even if the menstrual period starts, though tampons should be avoided. The tampon may absorb some of the medication, making the treatment less effective. A woman should also avoid sexual intercourse during treatment. Vaginal treatments for candidiasis may make condoms, spermicides and diaphragms less effective during treatment and for up to three days afterwards. There is also a risk of infecting her partner.
What about prevention?
Candida albicans grows well in dark, warm, moist environments. Wearing cotton underpants, loose-fitting cotton pants, and pantyhose with cotton crotch pieces may help women reduce the chance of a yeast infection. Feminine products like vaginal deodorants, sprays, scented towelettes and douches should be avoided. They can irritate genital skin and the vaginal wall and make the area more easily infected. Good genital hygiene is both simple and important. Just cleanse the external genitals regularly with mild soap and water.
Some women find reducing sugar and increasing the amount of yogurt containing the bacteria Lactobacillus in their diet helps reduce yeast infections. (Lactobacillus is normally present in the vagina and may help keep C. albicans under control.) Women have also tried vaginal douching with yogurt (to increase Lactobacillus in the vagina) or a vinegar-and-water mixture (to maintain the slightly acidic nature of the normal vagina). Neither treatment has been proven effective. If prescribed antibiotics, some women take Lactobacillus acidophilus capsules orally to help prevent yeast infections. However, the effectiveness of this treatment has not been proven.
Regular daily, weekly or twice-weekly preventive doses of medication should be taken only under a doctor’s supervision, to help prevent resistance from developing.
What about him – does he need treatment?
Treatment for a woman’s sexual partner is not usually necessary. However, in some cases the penis (usually when uncircumcised) may harbor Candida that could re-infect the woman. If a woman has recurrent or resistant yeast infections, her partner might try applying anti-candidiasis cream (e.g. clotrimazole or miconazole) to his penis daily while she is having treatment.
What’s available by prescription?
Prescription medication is usually reserved for those with resistant or recurrent cases of vaginal yeast infection. It is also for women who are more at risk (such as those who have a weakened immune system), or who want the convenience of a single dose of oral therapy.
Several different prescription products are available for yeast infections. They include products such as nystatin or terconazole vaginal cream or ovules, and fluconazole 150 milligram capsules. The fluconazole capsule is taken by mouth as a one-time dose and symptoms usually start to resolve within 48 to 72 hours.
Most pharmacies have a wide selection of products available to help treat vaginal yeast infections. Ask a pharmacist for advice – they are happy to help!