Vaginal Yeast Infections

Topic Overview

Is this topic for you?

Other problems (like bacterial vaginosis and trichomoniasis) can cause vaginal symptoms that may seem like a yeast infection. If you need help finding out which problem you have, see the Check Your Symptoms section of the topic Vaginal Problems.

What is a vaginal yeast infection?

Yeast is a fungus that normally lives in the vagina in small numbers. A vaginal yeast infection means that too many yeast cells are growing in the vagina . These infections are very common. Although they can bother you a lot, they are not usually serious. And treatment is simple.

What causes a vaginal yeast infection?

Most yeast infections are caused by a type of yeast called Candida albicans.

A healthy vagina has many bacteria and a small number of yeast cells. The most common bacteria, Lactobacillus acidophilus, help keep other organisms-like the yeast-under control.

When something happens to change the balance of these organisms, yeast can grow too much and cause symptoms. Taking antibiotics sometimes causes this imbalance. The high estrogen levels caused by pregnancy or hormone replacement therapy can also cause it. So can certain health problems, like diabetes or HIV infection.

What are the symptoms?

A yeast infection causes itching or soreness in the vagina and sometimes causes pain or burning when you urinate or have sex. Some women also have a thick, clumpy, white discharge that has no odor and looks a little like cottage cheese.

These symptoms are more likely to occur during the week before your menstrual period.

How is a vaginal yeast infection diagnosed?

It's easy to guess wrong about a vaginal infection. See your doctor if you aren't sure what you have or if this is the first time you have had these symptoms. Also see your doctor if you are pregnant. Your doctor may want to do a vaginal exam.

How is it treated?

If you have had a yeast infection before and can recognize the symptoms, and you aren't pregnant, you can treat yourself at home with medicines you can buy without a prescription. You can use an antifungal cream, or a suppository that you put into your vagina, or antifungal tablets that you swallow.

If your symptoms are mild, you may want to wait to see if they clear up on their own.

Yeast infections are common during pregnancy. If you are pregnant, don't use medicine for a yeast infection without talking to your doctor first.

If you use a cream or suppository to treat the infection, don't depend on a condom or diaphragm for birth control. The oil in some medicines weakens latex, the material often used to make these devices.

Many women have infections that come back. If you have more than four yeast infections in a year, see your doctor. He or she may do some tests to see if your yeast infections are being caused by another health problem, such as diabetes.

Can vaginal yeast infections be prevented?

You can prevent yeast infections by making sure that your genital area stays as dry as possible and can 'breathe.' For example:

• Wear cotton, not nylon, underwear, and avoid tight-fitting pants and panty hose.
• Change out of a wet swimsuit right away.
• Avoid douches and feminine sprays, scented toilet paper, and deodorant tampons.

Frequently Asked Questions

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	Should I self-treat a vaginal yeast infection with a nonprescription medication?

Cause

A vaginal yeast infection is caused by an overgrowth of yeast organisms that normally live in small numbers in the vagina. Factors that encourage an excess growth of vaginal yeast include:

• Using antibiotics.
• Having high estrogen levels (hyperestrogenemia), such as during pregnancy, hormone replacement therapy (HRT or ERT) use, high-dose birth control pill use, and the follicular phase of the menstrual cycle.¹
• Having diabetes, especially if your blood sugars are not well controlled and tend to be high.
• Having an impaired immune system.
• Using corticosteroids, such as prednisone.
• Being overweight.
• Having the genital area exposed to moisture for a long period of time (for example, wearing a wet bathing suit all day) or living in a warm, humid climate.

Most yeast infections involve Candida albicans (C. albicans), a yeast that can be treated effectively with standard yeast infection medicine. Recurrent vaginal yeast infections tend to involve non-C. albicans types of yeast, which are more resistant to the standard treatments for C. albicans yeast infections.

Chronic yeast syndrome, a condition in which excess growth of yeast supposedly affects the whole body, has not been medically proved.

Symptoms

The symptoms of vaginal yeast infection include:

• Vaginal itching that is often severe.
• Vaginal discharge that is usually white, thick, clumpy, and odorless.
• Red, irritated skin around the opening to the vagina (labia).
• Pain while urinating when urine touches irritated skin.
• Pain in the vagina during sexual intercourse.

Symptoms of a vaginal yeast infection are more likely to occur during the week before a menstrual period.

There are other conditions with similar symptoms, such as bacterial vaginosis or a sexually transmitted disease. Itching and redness of the vulva can also be caused by a reaction to vaginal products such as soap, bath oils, spermicidal jelly, or douches. If you are unfamiliar with your symptoms, see your doctor for an accurate diagnosis.

What Happens

Vaginal yeast infections often clear up on their own without treatment, usually when menstruation begins. Menstrual blood raises the vaginal pH, causing the number of yeast cells to decrease because they can't grow in the pH present during menstruation.

There are significant differences between occasional, easily treatable yeast infections and recurrent infections that seriously affect a woman's life. Recurring vaginal yeast infections can be difficult to prevent or cure. Women who have recurring yeast infections should be evaluated for other causes (such as diabetes, hormone therapy, or treatment-resistant strains of yeast) so that the cause can be treated or reversed.

What Increases Your Risk

Your risk of developing a vaginal yeast infection can be increased by a number of medical and lifestyle factors.

Some of the common risk factors for vaginal yeast infection include:

• Use of antibiotics. These medicines upset the normal balance between yeast and bacteria in the vagina. Antibiotics can kill too much "good" bacteria and result in too much yeast growing in the vagina, sometimes causing symptoms of a yeast infection.
• Problems with your immune system that affect the normal balance of yeast and bacteria in the body. Having a condition such as poorly controlled diabetes or HIV (human immunodeficiency virus) can lead to too much yeast growing in the vagina. Taking corticosteroid medicines sometimes also weakens the immune system and increases the risk for yeast infections. Pregnant women are also at higher risk for developing yeast infections because of shifting hormones that can weaken the immune system.
• Wearing tight-fitting, nonabsorbent pants or undergarments that hold in warmth and moisture.
• Using feminine hygiene sprays, talcs, or perfumes in the vaginal area.
• Douching.

Vaginal yeast infections are not sexually transmitted.

When To Call a Doctor

Use the following guidelines for seeking medical care when you have vaginal symptoms.

Call your doctor immediately if you:

• Develop lower abdominal pain and a fever higher than 101 °F (38.3 °C) along with a vaginal discharge. This may indicate pelvic inflammatory disease (PID).
• Are pregnant and have symptoms of a vaginal infection or a urinary tract infection (UTI).

Call your doctor for an appointment within 1 week if you:

• Develop an unusual vaginal discharge, and this is the first time you have had an infection that might be a vaginal yeast infection.
• Have unusual vaginal itching.
• Have pain during sex or urination.
• Develop any other symptoms that may indicate a vaginal infection.
• Continue to have symptoms despite home treatment with a nonprescription medicine.
• Have symptoms return within 2 months, and you have not been taking antibiotics.

Watchful Waiting

If you are sure your symptoms are caused by a vaginal yeast infection, waiting several days to see if the symptoms clear up on their own is not harmful, especially if you expect your menstrual period within that time. Sometimes a menstrual period will relieve the symptoms of a mild yeast infection. If your symptoms continue, you can use nonprescription medicine. If symptoms continue after treatment, see your doctor.

Who To See

Health professionals who can diagnose and treat a vaginal yeast infection include:

• Physician assistants.
• Nurse practitioners.
• Family medicine doctors.
• Internists.
• Gynecologists.

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

Your doctor may be able to diagnose your vaginal symptoms based on your medical history and a vaginal examination.

If your vaginal symptoms are not typical of a vaginal yeast infection, your doctor can look for signs of yeast or other organisms using a wet mount test of vaginal discharge.

You may have other tests if you have vaginal yeast infections that are severe or that keep coming back (recur), such as:

• A vaginal culture. This test can confirm that you have a yeast infection. A sample of vaginal discharge can be taken during a wet mount test. If more than the normal amount of yeast grows in the sample over a short period of time (a few days), then your symptoms are likely caused by a yeast infection.
• A blood test to find out if you may have diabetes or another health problem that makes you more likely to get yeast infections.

Although a yeast infection can be detected during a routine Pap test, this type of test is not typically done to diagnose vaginal infections.

Treatment Overview

You have a number of treatment options for a vaginal yeast infection, including nonprescription vaginal medicine, prescription oral or vaginal medicine, or nonprescription vaginal boric acid capsules.

Only use nonprescription vaginal yeast infection treatment without a doctor's diagnosis and advice if you:

• Are not pregnant.
• Are sure your symptoms are caused by a vaginal yeast infection. (In one study, only 1 out of 3 women who had self-diagnosed a simple vaginal yeast infection actually had one.²) If you have never been diagnosed with a vaginal yeast infection, see your doctor.
• Have not been exposed to a sexually transmitted disease (STD), which would require a medical examination.
• Are not having multiple, recurrent infections.

The risk of self-treatment is that your symptoms may be caused by another vaginal infection, such as a sexually transmitted disease, that requires different treatment. If you may have been exposed to an STD, it is best to discuss your symptoms with your doctor before using a nonprescription medicine. Your doctor may recommend testing for STDs if you have risk factors for these diseases.

For more information about self-treatment, see:

Should I self-treat a vaginal yeast infection with a nonprescription medicine?

Yeast infection during pregnancy

Vaginal yeast infections are common during pregnancy, likely caused by elevated estrogen levels. If you are pregnant, don't assume you have a yeast infection until it is diagnosed, and don't use nonprescription medicines without discussing your symptoms with your doctor.

Vaginal medicine is used to treat a vaginal yeast infection during pregnancy. If you are pregnant, do not use antifungal medication pills that you take by mouth. Also, do not use vaginal boric acid treatment.

Acute vaginal yeast infection

For the occasional yeast infection, you can use a nonprescription vaginal medicine without seeing your doctor first. Only use these medicines if you are certain that your symptoms are caused by a yeast infection. If you prefer, you can use a single-dose prescription oral tablet, a prescription vaginal tablet, or boric acid capsules. Vaginal treatments are applied at bedtime. Medicines are used for 1 to 7 days, depending on the type. All treatments cure vaginal yeast infection 80% to 90% of the time.^{3, 4}

If you have HIV infection, your vaginal yeast infection treatment options are the same as those for women without HIV.⁴ But your treatment may take longer or need to be repeated.

Recurrent yeast infection

For a vaginal yeast infection that recurs within 2 months of treatment, or four times in 1 year (recurrent vaginal yeast infection), see your doctor. Further testing or a different treatment may be needed. If you have been using a nonprescription medicine for your vaginal symptoms, be sure to tell your doctor. This information could affect what treatment is recommended.

Recurrent vaginal yeast infection can be treated with prescription oral medicine (one or two doses), nonprescription vaginal medicine (7 to 14 days), or vaginal boric acid capsules (14 days), followed by less frequent suppressive or maintenance therapy over 6 months to 1 year to prevent reinfection.^{5, 3} About 30% to 40% of women develop another yeast infection after stopping maintenance therapy.⁵

Although both men and women can get yeast infections, most doctors do not treat sex partners. A vaginal yeast infection is not a sexually transmitted disease (STD). After having unprotected sex with a man who has a yeast infection, you may have more than the normal amount of yeast in your vagina. But if after having sex you develop a yeast infection that causes symptoms, it is most likely because other factors are also involved.

What To Think About

It is important to complete the entire recommended treatment to cure a yeast infection.

Studies have shown that vaginal infections caused by types of yeast other than Candida albicans may be more difficult to cure with standard antifungal medicine. For treatment-resistant infections, a culture of vaginal discharge is done to identify the type of yeast causing the infection.

Boric acid is usually effective for treating Candida albicans (C. albicans) infection, as well as non-C. albicans yeast infections that don't respond to antifungal medicine.^{5, 3}

Women who take the anticoagulant medicine warfarin (such as Coumadin) and use a nonprescription vaginal yeast-fighting medicine, such as Monistat, may have increased bruising and abnormal bleeding. If you take warfarin, talk with your doctor before using a yeast-fighting medicine.

Prevention

The following actions can help prevent a vaginal yeast infection.

• Eat a balanced diet rich in fruits, vegetables, whole grains, and nonfat dairy products. Some women think that eating foods with lactobacillus organisms, such as yogurt or acidophilus milk, will help prevent yeast infections. So far there is no evidence for this connection. But eating foods that contain lactobacillus can be part of a healthy diet. Be aware that taking lactobacillus supplements or inserting vaginal forms of lactobacillus have not been shown to prevent yeast infections from developing in women who have recently taken antibiotics.⁶
• Wear cotton and avoid tight-fitting clothing. Cotton underwear can prevent moisture from developing in the genital area. Clothing such as leggings, panty hose, and tight-fitting jeans increase body heat and moisture in the genital area. Wearing a wet swimsuit for many hours may also keep the genital area warm and moist.
• Keep the vaginal area clean. Use mild, unscented soap and water. Rinse completely.
• After using the toilet, wipe from front to back to avoid spreading yeast from the anus to the vagina.
• Control diabetes. Good control of blood sugar levels decreases the risk of yeast infections anywhere on your body.
• Avoid unnecessary use of antibiotics. Antibiotics can change the normal balance of vaginal organisms, allowing excess growth of yeast.
• Avoid the use of feminine sprays, talcs, or perfumes in your vaginal area, which may affect the normal balance of organisms. Also, avoid scented toilet paper and deodorant tampons.
• Avoid douching. Douching can change the normal balance of vaginal organisms. Of greater concern, douching can spread other types of infections from the vagina into the uterus and fallopian tubes, causing pelvic inflammatory disease (PID).

Home Treatment

Do not self-treat a vaginal yeast infection if you:

• Are pregnant.
• Are not sure your symptoms are caused by a vaginal yeast infection. If you have never been diagnosed with a vaginal yeast infection, see your doctor before treating it with a nonprescription antifungal cream. Sometimes women think they have a vaginal yeast infection when symptoms are caused by a different condition, such as bacterial vaginosis or a sexually transmitted disease (STD).
• Have been exposed to a sexually transmitted disease (STD), which would require a medical examination.
• Are having a recurrent infection.

For more information on self-treatment, see:

Should I self-treat a vaginal yeast infection with a nonprescription medicine?

Using nonprescription medicine

When using a nonprescription vaginal medicine for a vaginal yeast infection, follow the directions on the package insert, as well as these guidelines:

• Eat a balanced diet rich in fruits, vegetables, whole grains, and nonfat dairy products. Eating right helps your body fight off infections. Although there is no clear connection between eating foods with lactobacillus organisms, such as yogurt or acidophilus milk, and reducing symptoms of a vaginal yeast infection, these foods can be part of a healthy diet. Be aware that taking lactobacillus supplements or inserting vaginal forms of lactobacillus have not been shown to prevent yeast infections from developing in women who have recently taken antibiotics.⁶
• Use pads instead of tampons while you are using nonprescription vaginal medicines. Tampons can absorb the medicine.
• Avoid using soap when cleaning the vaginal area-rinse with water only.
• If sexual intercourse is painful, avoid it. Otherwise, use a water-soluble lubricating jelly (such as K-Y Jelly) to reduce irritation. Do not trust a condom or diaphragm for birth control when using an antifungal cream or suppository. Many of the vaginal creams and suppositories used to treat yeast infections are oil-based, which can weaken rubber (latex).
• If the genital area is swollen or painful, sitting in warm water (in a bathtub or sitz bath, not a hot tub) may help. Or instead, you may try putting a cool, damp cloth on the area. Do not rub to try to relieve itching.

Report your symptoms to your doctor if:

• You are not sure that you have a yeast infection.
• Your self-treatment is not working after one complete course of therapy.

Considerations

The risk of self-treatment is that your symptoms may be caused by a type of vaginal infection other than a yeast infection, such as bacterial vaginosis or a sexually transmitted disease (STD). If you have pelvic pain or fever, get an evaluation by a doctor.

If you are pregnant, it is important to be evaluated for vaginal symptoms. Some vaginal infections, such as bacterial vaginosis, gonorrhea, or chlamydia, may increase your risk of complications during pregnancy.

Women who take the anticoagulant medicine warfarin and use a nonprescription vaginal yeast-fighting medicine, such as Monistat, may have increased bruising and abnormal bleeding. If you take warfarin, talk with your doctor before using a yeast-fighting medicine.

If you have risk factors for an STD, discuss your symptoms with your doctor before using a nonprescription medicine.

Talk to your doctor before you try unproven home treatment methods, such as applying tea tree oil in the vagina or taking garlic supplements. These treatments have not been well studied. They may even cause other problems, such as allergic reactions, in some women.⁷ Douching is not recommended because it can make some infections worse.

Medications

Antifungal medicines are the standard treatment for a vaginal yeast infection. You can insert a cream or suppository antifungal cream into your vagina or take a pill by mouth. Vaginal boric acid capsules are an alternative treatment that is gaining wider use for treating vaginal yeast infections.³

Antifungal medicines that you take as a pill by mouth affect the entire body (so it can also treat any yeast infection elsewhere in the body). Vaginal medicine only affects the area in which it is applied. During pregnancy, only vaginal treatment is considered safe.

If you are thinking about using nonprescription treatment, see:

Should I self-treat a vaginal yeast infection with a nonprescription medicine?

Medication Choices

• Vaginal antifungal medicines are available in 1-day, 3-day, and longer courses, depending on the strength of the medicine.
• Oral antifungal medicines are easy to use but are not prescribed to pregnant women.
• Vaginal boric acid capsules (600 mg boric acid in a size 00 gelatin capsule) are used once daily for 2 weeks.

What To Think About

Antifungal creams and suppositories that you put into your vagina have fewer side effects than antifungal pills you take by mouth. This is because vaginal medicine isn't absorbed into your body and only affects the genital area. Antifungal pills that are taken by mouth affect your entire body. Side effects from these pills are rare with one treatment dose, but they can include nausea, headaches, and abdominal pain. But taking a pill is convenient and is not messy. Medicine put into the vagina can be uncomfortable, and it may seem like more of a hassle than taking a pill.

Do not trust a condom or diaphragm for birth control when using an antifungal cream or suppository. Many of the vaginal creams and suppositories used to treat yeast infections are oil-based, which can weaken rubber (latex).

If you are taking the anticoagulant medicine warfarin and you use a nonprescription vaginal yeast-fighting medicine, you may have increased bruising and abnormal bleeding. Talk with your doctor before using an antifungal medicine along with warfarin.

You are more likely to use a treatment correctly and complete the treatment if you get to choose the type you prefer. Talk with your doctor about the advantages and disadvantages of vaginal and oral medicines, including:

• How a medicine can be administered. Most of the vaginal treatments are available as creams, vaginal tablets, or suppositories.
• Whether oral or vaginal medicine is recommended. You may prefer to take pills rather than use medicine that is inserted into the vagina, or the type of yeast infection you have may respond better to one method than the other.
• Whether you should avoid sexual intercourse if you are using vaginal medicine. Some doctors advise that women avoid sex during treatment.
• Whether treatment should be continued during your menstrual period. Tampons can absorb medicine, so use pads if you are being treated with vaginal medicines during your period.

Check with your doctor or pharmacist to see whether you can get a generic form of a prescription medicine. Many generic medicines are now available to treat vaginal yeast infections. They are often less expensive than brand-name medicines.

Surgery

There is no surgical treatment for vaginal yeast infection.

Other Treatment

Experts now recommend vaginal boric acid capsules as a treatment option for vaginal yeast infection, particularly infections that can't be cured by prescription or nonprescription antifungal yeast infection medicines.^{5, 3} Boric acid is a white, crystalline chemical substance that has antifungal and antiviral properties. It is used in various pharmaceutical products and is also available without a prescription.

If you are pregnant, do not use vaginal boric acid treatment.

Other Places To Get Help

Organizations

Related Information

• Bacterial Vaginosis
• Trichomoniasis
• Vaginal Problems

References

Citations

1. Bauters TGM, et al. (2002). Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. American Journal of Obstetrics and Gynecology, 187(3): 569-574.

2. Ferris DG, et al. (2002). Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstetrics and Gynecology, 99(3): 419-425.

3. Kessel KV, et al. (2003). Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: A systematic review. Obstetrical and Gynecological Survey, 58(5): 351-358.

4. Centers for Disease Control and Prevention (2006). Vulvovaginal candidiasis section of Sexually transmitted diseases treatment guidelines, 2006. MMWR, 55(RR-11): 54-56.

5. Eschenbach DA (2003). Vaginitis section of Pelvic infections and sexually transmitted diseases. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 585-589. Philadelphia: Lippincott Williams and Wilkins.

6. Pirotta M, et al. (2004). Effect of lactobacillus in preventing post-antibiotic vulvovaginal candidiasis: A randomised controlled trial. BMJ, 329(7465): 548.

7. Spence D (2007). Candidiasis (vulvovaginal), search date October 2006. Online version of BMJ Clinical Evidence. Also available online: http://www.clinicalevidence.com.

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