What is it?

It is called a vaginal yeast or candida infection, but that is a misnomer. What is really happening is an overgrowth of yeast in the vagina. Yeast commonly exists in small amounts in the vagina, it is kept in check by, among other things, the healthy lactobacilli which also live there. So when we have a yeast infection what we have is an overgrowth of this one element. Candida albicans is the most common strain of yeast, though others exist, this is important to remember if you are having a treatment failure: you could have a different strain.

Where does yeast grow?

Anywhere where it is warm and moist is a lovely home for yeast—skin folds anywhere, under breasts and under arms, anywhere around the genitals, inner thighs and buttock where air does not circulate. It can occur in the mouth and digestive tract, typically this is not seen unless you have a weakened immune system.

The most common symptom of yeast overgrowth is itching and redness either inside the vagina or outside on the labia and surrounding areas. Men get yeast too causing itching and redness around the scrotum inner thighs and buttocks. Vaginal discomfort during sex and vaginal burning after sex is common. Yeast can make the skin fragile and easier to tear. Occasionally you will notice some minor bleeding, especially with irritation-either scratching, or sex. Vaginal discharge is variable. There is a classic “cottage cheese” type discharge which can be very heavy and smell “yeasty” like bread yeast. However, it is not uncommon to have no significant change in one’s discharge or a dry less fluid discharge.

What causes yeast infections?

Yeast is everywhere in our environment, it’s just doing it’s thing looking for a warm moist place to grow. Sometimes yeast infections just happen. Often when it’s hot and you are sweaty or hanging about in a wet bathing suit you are creating a lovely yeast environment.

Typically one good round of treatment and your yeast infection will resolve.

Unfortunately sometimes women get into what I call the Yeast Times or recurrent yeast infections. See below for thoughts and approaches to that.

Treatments available without prescription

Natural approaches:

Active culture yogurt: eating this will help prevent getting yeast overgrowth, inserting it vaginally can treat yeast. But it is a bit tricky actually getting it inside. To accomplish this buy plain active culture yogurt and a turkey baster—make sure the edges of the baster are smooth. At night, right before bed, draw up yogurt into the baster insert the baster into your vagina and GENTLY squeeze out the yogurt. You will want to wear a pad overnight. Repeat nightly for one week. If you are pregnant you have to be very careful and squeeze the baster slowly as you do not want to push any air or yogurt into the cervix (which in true fact would be very hard to do even if you were trying, but be careful). If you have any level of concern about your ability to safely do this then do not do it, rather visit a healthcare provider and seek care.

Tea tree oil: This is effective but hard to get into the vagina and it will burn if not diluted or if the irritation is significant. Dilute it with any food grade oil: 1 tsp to ½ cup oil. If that is still irritating, add more oil. You can mix it with coconut oil warmed to liquid then make suppositories when it hardens, for easier insertion. For a mild imbalance you can put some on your finger and try and spread it inside. You can also soak a tampon in the oil and then insert it.

Coconut oil has mild anti-fungal as well as antibiotic qualities. You can use this alone or as a base for tea tree oil.

Garlic a clove of garlic inserted vaginally-peeled but not crushed in any way can treat yeast. You need to make sure you remove it after 8-10 hours. You can wrap it in gauze for easier removal. Use daily until symptoms go away, will take days to a week. Warning however, after a few days your sweat and body odor will take on a notable garlic tinge.

 Apple cider vinegar: You can use this diluted 1 part vinegar to 3 parts water, as a wash. But it is hard to get it inside without using a douche. Douching is not great as it washes out all your healthy vaginal flora with the bad. But some find relief from external use, though I doubt if you will get a full cure in this way, but maybe. Use it if you are strongly drawn to.

Boric Acid: I was very sad to discover that there are toxic concerns about boric acid. Due to this, I no longer recommend it as a treatment. The Environmental Working Group gives it an overall moderate to high overall toxicity rating with concerns specifically of it as an endocrine disrupter. https://www.ewg.org/skindeep/ingredient/700799/BORIC_ACID/

Over the counter medications:

You can find all kinds of creams and suppositories to treat yeast. From the pharmaceutical world we have products (monostat, gynelotrimin and others) I am partial to the 3 day creams as I find the cream disperses better than the suppositories. The one day treatments tend to burn-at times significantly, especially if you are very raw and irritated, and they have a lower cure rate. The 7 day products are a good choice if you are very raw, as they are milder, but you need to use them longer. They have the same cure rate as the 3 day products. Do not use any of these in the first trimester of pregnancy as they have been associated with miscarriage.

Anti-itch creams are generally safe in pregnancy, but are not specifically fungus killing (yes, yeast is a fungus). Some are homeopathically based and can work well. some  are acidifiers, which may help with symptoms in the short term, but do not cure.

In pregnancy natural treatments are the safest bet.

Prescription medications

Diflucan the name brand of fluconazole is an oral medication. One pill often will take care of a vaginal yeast infection. It has rare side effects at this low dose. Occasional GI upset. People who have digestive system yeast who have a low immune system (have advanced HIV or are getting cancer treatments) take this dose 3 times a day on-goingly so are at risk for significant side effects. Fluconazole has been associated with miscarriage in pregnancy, at any time in pregnancy, so I would avoid it if you are pregnant.

The fluconazole and all the over the counter creams are effective against ONLY candida albicans. Terazol is a prescription cream effective against a few other non albicans yeasts. So if you are not getting a full cure from your other treatments, you might want to see your Woman’s health provider and discuss a prescription for this. Terazol is not to be used in the first trimester of pregnancy.

Yeast Times: Recurrent Vaginal Yeast Infections

I find that sometimes we just have yeast times—months or years when we just keep getting yeast, then one day you will think—my I have not had a yeast infection in two months-oh now six months. Years will go by without one. Then maybe the yeast will happen again. These are the yeast times. Perhaps it happens every month before or after your menses, every few months randomly, or every time you have sex. If this is happening to you, then it is time to asses your diet and your environment. I intentionally put these under recurrent yeast. I do not think you need to worry about these issues if you get a random yeast infection every few years or less.

 If you have self diagnosed your yeast and have been doing home treatments that are not working, now is the time to go see a Women’s health provider to make sure it is yeast.

If you have yeast, and it just wont stay gone, here are some things to consider.

Diet

Yeast loves sugar, it is food for yeast. I have seen women who whenever they eat sweets, they get yeast. Not fun. But if you stop or significantly slow down your sugar intake and see a difference in the frequency of your yeast, then perhaps you might find it worthwhile to stop eating sugar. Alcohol of course is sweet, so also isn’t the best choice.

Yeasty foods. Some advocate removal of all yeast based foods from your diet. This would be all breads that are “raised” with yeast-most bread, except flat breads. All beer and wine.

 So those are the don’t, what about the do’s?

Probiotics in yogurt have been found to decrease recurrence of yeast. Eating a daily serving of an active culture plain yogurt is helpful. Try sweetening it with fruit or stevia. I find the liquid extract stevia more dose controllable—just a few drops works.

Fermented foods are another excellent source of probiotics.

Fem dophilus is a probiotic made by Jarrow Formulas. Taken orally it has been shown to reduce recurrent yeast.

Hair dryer

Dry your genitals, buttocks under your breasts and arms and in any other skin folds you might have with a hair dryer after your bath. This is an excellent way to limit recurrent yeast. The yeast live on your skin, when you stay damp after your bath, you are helping your yeast to thrive. A nice full drying with a hair dryer will destroy their moist home and they will die….Be CAREFUL and keep the dryer MOVING, it will burn you if you do not.

Hormones

It is very common for yeast to recur right before your period, so we know that there is a hormonal influence. For some women, birth control pills alter their hormonal balance such that they keep getting yeast infections while taking them. If this is your problem, then you might want to consider a different birth control option.

Sex

If every time you have sex you get yeast there are a few things to consider. First, perhaps your partner has yeast and is giving it to you. He might have a mild case and not know it. On light skinned men yeast looks like a slightly red rash with a slightly redder edge. On darker skinned men, the rash can be darker than their skin color with a darker edge to it. Men get “jock itch” or yeast by another name. They can be treated by over the counter creams such as Tinactin or Lamisil.

If you are using condoms, it is possible that you are allergic to the latex or to the lubricant/spermicide. Try a non-latex option to see if that helps.

How to deal with the Yeast Times

If you are plagued by the yeast times what is the best approach to treatment. I believe the best approach is to just treat it every time it happens. Looking at contributing lifestyle choices is helpful. Preventative treatment, advocated by some, do not limit the overall duration of the recurrences.

In the yeast times I think fluconazole is lovely—mostly because it wins the easy, quick and not messy award. Just take one pill as soon as you feel the yeast coming on, and that’s it.  I am not saying that it is “better”, but it is more convenient.

What acts like yeast but isn’t?

Trichomonas infection is a sexually transmitted infection that has very similar symptoms as yeast. This needs to be ruled out if you have any possible way of having been infected. If you have been treating your self diagnosed yeast with over the counter treatments and not having any success, then see a Woman’s health provider.

Another possibility is that you do not have yeast, rather you have a form of contact dermatitis—a reaction to an allergen in your environment. I have been seeing this much more over the last 15 or so years. Fragrances, dyes, and harsh chemicals that contact your genitals can cause itching that is very much like a yeast infection. Think vaginal lubricants, deodorant pads/tampons, some women react to the super absorbent chemicals in the thin highly absorbent sanitary pads. Then there are soaps, toilet paper, clothes washing detergents. If you are having recurrent symptoms pull out your inner detective and look at what chemicals you could stop using and see if that makes a difference.

I hope you have found this helpful.