Vaginal yeast infections, also calledcandida vaginal infections or candidiasis, are common and easily treated in most women. Candida is a fungus. It commonly exists in small amounts in the vagina, mouth and gastrointestinal tract. When the fungus overgrows in the vagina, a yeast infection develops. This causes uncomfortable symptoms such as vaginal itching, burning and discharge.

1. YeastInfections
Vaginal yeast infections, also calledcandida vaginal infections or
candidiasis, are common and easily treated in most women. Candida is a
fungus. It commonly exists in small amounts in the vagina, mouth and
gastrointestinal tract. When the fungus overgrows in the vagina, a yeast
infection develops. This causes uncomfortable symptoms such as vaginal
itching, burning and discharge. Uncontrolled diabetes and the use
ofantibiotics,the contraceptive sponge, thediaphragm and spermicides are
associated with more frequent yeast infections. Women who use hormonal
birth control—birth control pills, the birth control patch or the vaginal
ring—may also have more yeast infections.
Characteristics of Yeast Infections
Most women––as many as 75 percent––will have at least one
diagnosis of vaginal yeast infection during their lifetimes. Yeast infections
(also called yeast vaginitis or vaginal candidiasis) are one of the most
commoncauses of vaginitis, an inflammationof the vagina characterized by
discharge and irritation.
Yeast infections are more common during pregnancy. It seems that the
higher levels ofestrogen in pregnancy cause the vagina to produce more
glycogen(sugar), which feeds the yeast. Similarly, people with diabetes get
yeast infections more frequently.
Recurrent Yeast Infections
About 5 to 8 percent of women develop recurrent vulvovaginal candidiasis
(RVVC), defined as four or more symptomatic vaginal yeast infections
during a 12-month period.Although RVVC is more common in women who
have diabetes or problems with their immune system, most women with
RVVC have no underlying medical illness that would predispose them to
recurrent candida infections.
Conditions Mistaken for Yeast Infections: Bacterial Vaginosis and
Trichomoniasis
Vaginal infections can also be caused by bacterial vaginosis (BV), the most
common cause of vaginitis in women of childbearing age, and
trichomoniasis, a sexually transmitted infection. BV and trichomoniasis are
associated with more serious reproductive health concerns, such as
premature birth and increased risk of contracting sexually transmitted
diseases.Because these infections can have symptoms similar to those of
yeast infections, yet can have more serious reproductive effects, it’s
important to see a health care professional to evaluate and diagnose any

2. vaginal symptoms.A variety of medications can treat vaginal infections, but
proper diagnosis is key.
Diagnosis
Possibly because they are so common, women often self-diagnose yeast
infections and self-treat with over-the-counter products.
But self-diagnosis may be a misdiagnosis. In one study, only 11 percent of
women accurately diagnosed their yeast infections, and among women
who had previously had a yeast infection, only 35 correctly diagnosed the
condition. A handful of other vaginal infections, such as bacterial vaginosis
(BV) and trichomoniasis cause similar symptoms.
Vaginal yeast infections may cause the following symptoms:
Vaginal itch and/or soreness.
A thick cottage cheese-like vaginal discharge, which may smell like yeast.
A fishy odor is a symptom of BV, not of a yeast infection. The vagina
normally produces a discharge that is usually described as clear or slightly
cloudy, non-irritating, and having a mild odor. There may also be no
discharge with a yeast infection or a discharge that is thin and watery.
A burning discomfort around the vaginal opening, especially if urine comes
into contact with the area.
Pain, dryness or discomfort during sexual penetration.
Redness and swelling of the vulva and vagina
Contact your health care professional if you have any of these symptoms.
During the normal menstrual cycle, the amount and consistency of vaginal
discharge varies. At one time of the month, you may have a small amount
of a very thin or watery discharge, while another time of the month the
discharge may be thicker. These variations are normal. The normal mid-
cycle discharge is slippery.
However, a vaginal discharge that has an offensive odor with irritation is
not normal. The irritation can be described as itching or burning or both and
often worsens at night. Sexual intercourse typically makes the irritation
worse.
To diagnose your vaginal symptoms, your health care professional will
perform a gynecological examination and check your vagina for
inflammation and abnormal discharge. A sample of the vaginal discharge
may be taken for laboratory examination under a microscope,or for a yeast
culture, test to see if candida fungi grow under laboratory conditions.
Looking under a microscope also helps rule out other causes of discharge
such as BV or trichomoniasis, which require different treatment.

3. Treatment
Antifungal medications are used to treat yeast infections. These
medications are available in various over-the-counter (OTC) preparations
and in one-, three- and seven-day doses. They include:
butoconazole (Gynazole, Femstat 3)
terconazole (Terazol)
tioconazole (Vagistat-1)
miconazole (Monistat)
clotrimazole (Gyne-Lotrimin)
Differences among the various OTC medications include the length of
treatment indicated, preparation type and cost. The shorter course of
treatment is more convenient but often more expensive. The one-, three-
and seven-day durations of treatment appear to be equally effective.
Prescription antifungal treatments also are available.
In general, it’s acceptable to use OTC antifungal medication to self-treat
your symptoms if you’ve had a yeast infection diagnosed by a health care
professional before and you are now experiencing the same symptoms.
However, if you meet any of the following circumstances, do not self-treat.
Instead, contact a health care professional for guidance.
You’ve never had a yeast infection.
You have a fever and/or abdominal pain.
Your vaginal discharge is foul-smelling.
You are diabetic, HIV-positive, pregnant or nursing.
You used an over-the-counter yeast treatment but your symptoms have not
gone away or they returned almost immediately.
If you take medication to treat a yeast infection—OTC medication or
prescriptionmedication—be sure to take the full course of the prescription.
Don’t stop using it, even if you begin to feel better.
If your symptoms don’t respond or return shortly after they’d cleared up,
consult your health care professional. Don’t just try a different over-the-
counter treatment; your symptoms may not be caused by yeast.
Studies find up to an 89 percent error rate in self-diagnosis of yeast
infections. Thus, if you think that you have a yeast infection, there’s a high
chance you’re wrong. If your symptoms don’t ease after a few days of self-
treatment with OTC medicine, or if they return promptly, see your health
care professional. Keep in mind, however, that vaginal and vulvar irritation
may persist for two weeks.
Yeast infections also may clear up without any treatment. However, there is
a very small chance that a yeast infection may lead to a serious infection

4. known as systematic candidal disease. This complication usually only
occurs in women with compromised immune systems.
Side effects of OTC medications for yeast infections are generally minor
and include burning, itching, irritation of the skin and headache. However,
as with any medication,more serious side effects are possible,though rare,
and may include hives, shortness of breath and facial swelling. Seek
emergency treatment immediately if any of these symptoms occur.
Antifungal medications may damage condoms and diaphragms, so if you’re
using such a medication, take other precautions to protect against
pregnancy and sexually transmitted diseases. Also, don’t use tampons
while treating yeast infections with medication inserted into the vagina.
If you see a health care professional, he or she may prescribe a single
dose of oral fluconazole (Diflucan) or a generic equivalent, although this
treatment is not recommended during pregnancy. Also, do not take
fluconazole if you are taking cisapride (Propulsid) because this drug
combination could cause serious,even fatal, heart problems.In rare cases,
fluconazole has also caused liver damage, sometimes resulting in death.
Also, notify your health care professional immediately if you develop a rash
while taking fluconazole. Other, less serious side effects may be more likely
to occur. These include:
diarrhea
headache
dizziness
stomach pain
heartburn
There have been reported drug interactions between warfarin, an
anticoagulant (blood thinner) medication and topical miconazole nitrate
products (such as Monistat) and oral fluconazole (Diflucan). Additionally,
fluconazole may cause liver damage in rare instances, particularly in
conjunction with alcohol use. Discuss all the medications you may be
taking when you discuss your symptoms with your health care professional.
If you have a yeast infection, your sexual partners do not need to be
treated. However, if a male sex partner shows symptoms of candida
balanitis-redness, irritation and/or itching at the tip of the penis-he may
need to be treated with an antifungal cream or ointment.
Medications cure 80 to 90 percent of vaginal yeast infections within two
weeks or less, often within a few days with less severe infections.
About 5 to 8 percent of women experience recurrent vulvovaginal
candidiasis (RVVC), defined as four or more yeast infections per year.
Treatment involves a longer course of treatment—between 7 and 14 days

5. of a topical cream or suppository or oral fluconazole followed by a second
and third dose three and six days later. Your health care professional may
also recommend a preventative treatment after the infection has resolved.
This treatment may involve a 150 mg dose of fluconazole or 500 mg of
topical clotrimazole once a week.
Prevention
Among the strategies that may prevent vaginal yeast infections are:
Keep the external genital area clean and dry.
Avoid irritating soaps (including bubble bath) and vaginal sprays.
Avoid scented soaps, powders or toilet tissue.
Avoid daily use of panty liners, which can trap moisture and prevent good
airflow.
Change tampons and sanitary napkins frequently.
Wear loose cotton underwear that doesn’t trap moisture.
After swimming, change immediately into dry clothing instead of staying in
your wet bathing suit.
If you have diabetes, try to maintain stable blood sugar levels.
Take antibiotics only when prescribed by your health care professional and
never for longer than directed. In addition to destroying bacteria that cause
illness, antibiotics kill off the “good” bacteria that keep the yeast in the
vagina at a normal level. If you tend to get yeast infections whenever you
take an antibiotic, ask your doctor to prescribe a vaginal antifungal agent at
the same time.
Wipe from the front to the rear (away from the vagina) after a bowel
movement or urination.
Don’t use douches.Douching with vinegar or other chemicals increases the
rate of vaginal yeast infections because it alters the vaginal bacterial
balance.
Facts to Know
Seventy-five percent of women are likely to have at least one yeast
infection during their lifetime; nearly half have two or more.
Vaginal yeast infections are the second most common cause of abnormal
vaginal discharge in the United States (the first is bacterial vaginosis).
Yeast infections are quite common during pregnancy. It seems that the
higher levels of estrogen in pregnancy cause the vagina to produce more
glycogen (sugar), which feeds the yeast. Yeast infections are also more
common in women with diabetes.

6. About 5 to 8 percent of women develop recurrent vulvovaginal candidiasis
(RVVC), defined as four or more symptomatic vaginal yeast infections in a
12-month period. Most women with RVVC have no underlying medical
illness that would predispose them to recurrent candida infections.
A woman’s vagina normally produces a discharge described as clear or
slightly cloudy, non-irritating and odor-free or having only a mild scent.
During the normal menstrual cycle, the amount and consistency of
discharge may vary.
Douching disrupts the balance of normal bacteria in the vagina and can
cause more frequent vaginal infections.
Vaginal yeast infections can clear up without treatment. However, if you
don’t treat a yeast infection, there is a very small chance you may develop
a serious infection.
If you have a yeast infection, treatment of sexual partners is usually not
generally recommended, since it’s not clear if vaginal yeast infections are
transmitted sexually. However, if a woman has recurrent infections and her
male sex partner shows symptoms of candida balanitis—redness, irritation
and/or itching at the tip of the penis—he may need to be treated with an
antifungal cream or ointment.
Medications cure 80 percent to 90 percent of vaginal yeast infections within
two weeks or less, often within a few days.
Take antibiotics only when prescribed by your health care professional and
never take them for more or less time than directed. In addition to
destroying bacteria that cause illness, antibiotics kill off the “good” bacteria
that normally live in the vagina. Stopping treatment early, even when
symptoms have improved, can cause infections to return and make them
resistant to the medication.
Key Q&A
I think I might have a yeast infection, but I’m not sure. Should I go ahead
and try one of the over-the-counter preparations to see if my symptoms go
away?If you’ve had a yeast infection before and now have the same
symptoms—vaginal discharge that has a yeast-like smell,with burning,
itching and discomfort—self-treatment with an over-the-counter antifungal
treatment is generally acceptable. However, many vaginal infections,
including some that can cause serious reproductive health conditions, such
as premature birth or increased risk of sexually transmitted diseases, have
similar symptoms. If you’re not sure, have never had a yeast infection
before, are pregnant or have a health condition, consult a health care

7. professional for an evaluation of your symptoms before treating yourself
with OTC medications.
I’m on the third day of a seven-day treatment and my symptoms are all
gone. Can I stop using the medication?No, you need to use all of the
medication as directed.Your symptoms can disappear before your infection
is completely treated. If you stop using the medication now, the yeast
infection could recur.
I have vaginal itching and a discharge with a fishy odor. Is this a yeast
infection?No, a discharge with a fishy odor is not a symptom of a yeast
infection. It’s a symptom of bacterial vaginosis (BV), another common, but
more serious, vaginal infection. BV requires a different treatment than that
used for yeast infections. Contact a health care professional for additional
guidance.
What is the risk of self-treating yeast infection for women who are pregnant
or nursing or those who have diabetes or HIV?First, women who are
pregnant or have diabetes or HIV have a higher risk of developing a yeast
infection. Second, and most important, these woman, as well as nursing
mothers, should always see their health care professional if they suspect a
yeast infection rather than self-treat because yeast medications may
interfere with medications needed for their other health problems (HIV,
diabetes) or pose risks for the baby.
If I’m pregnant, can a yeast infection hurt my developing baby?No, but you
do need to see your health care professional for treatment. Also, some
treatments currently on the market, such as fluconazole (Diflucan), are not
recommended during pregnancy. Be sure your health care professional
and pharmacist are both aware that you are or may be pregnant.
I keep getting recurrent yeast infections. Should my sexual partner be
treated?It’s not clear whether vaginal yeast infections can be transferred
during sexual intercourse. However, if your sexual partner has the
symptoms of candida-redness, irritation and/or itching at the tip of the penis
in a male-he may need to be treated. In rare cases,treatment of partners of
women with recurrent yeast infection is recommended. Additionally,
recurrent yeast infections may be representative of a different problem.
Thus, it is important to see your health care provider for an evaluation.
I thought douching helped keep a woman clean. What is the risk in
douching?The healthy vaginal ecosystem requires just the right balance of
bacteria flora. The vaginal mucosa, which protects against pathogens, is
made up predominantly of healthy bacteria called lactobacillus. These
bacteria make hydrogen peroxide, which keeps unhealthy bacteria from
getting out of hand. This, in turn, keeps the amount of yeast at a normal

8. level. Too much douching can disrupt the bacterial balance and lead to
infection.
My health care professional has prescribed antibiotics to treat an unrelated
illness. What precautions should I take to avoid getting a yeast
infection?Wear loose clothing and loose cotton underwear. Keep yourself
clean and dry. Avoid scented or irritating soaps, powders, and toilet tissue.
Avoid douching. Use a preventive dose of yeast medication.
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