Although yeast infections are probably the most common type of vulvovaginitis, they rank second in office visits because many women never go to their doctor for this type of infection. Some recover spontaneously, others treat themselves with anti-fungal vaginal creams or suppositories available without prescription.
Classic symptoms of yeast infections include vulvar itching, redness, and irritation. If your urinary opening is inflamed, you may have to urinate somewhat more frequently than usual, and urination may be uncomfortable. If your infection is severe, your vulva may swell and fine breaks, called fissures, may appear. Your vaginal discharge will become thicker, whiter, and curd-like (similar to cottage cheese in texture and appearance). Inflammation of the vulva and vagina, combined with the dryness of your discharge, makes intercourse painful.
Yeast infections are the result of excessive growth of a family of fungi that normally live and thrive in the vagina. The most common of these infections is vulvovaginal candidiasis (VVC), which is usually caused by a fungus named Candida albicans. As many as three quarters of all women experience at least one episode of VVC, and about half have two or more episodes. There are two types of VVC: uncomplicated (a mild to moderately severe infection that responds well to therapy) and recurrent (an infection that tends to be more severe, particularly in women who have uncontrolled diabetes or are infected with less treatable forms of yeast, such as Candida glabrata). Recurrent VVC, defined as four or more episodes in a year, requires longer initial treatment (10 to 14 days) and follow-up therapy for at least 6 months.
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Another Potential Culprit
Not all vaginal irritation is the result of infection. Especially if you've passed menopause, the problem may be a condition called atrophic vaginitis. This disorder results from lack of hormonal stimulation to genital tissue. Deprived of hormones, your vulva and vagina take on a paler, smoother appearance and become drier and more easily injured or irritated by sexual activity. These changes are called "atrophy." Atrophy occurs normally after menopause due to a fall in hormone production by the ovaries. Breastfeeding and the use of anti-estrogen medications to treat endometriosis, uterine fibroids, and other conditions can also reduce your ovarian activity and result in atrophic changes. Birth control pill users may experience mild atrophic changes, too. The problem is easily remedied with a good personal lubricant (such as Replens or KY Lubricating Jelly), and through hormone replacement therapy. For more information, see "Hormone Replacement Therapy: Weighing the Pros and Cons." |
Certain factors such as recent use of oral or vaginal antibiotics, clothing (such as nylon and lycra) that traps heat and moisture, obesity, pregnancy, and diabetes tend to disrupt the normal balance of vaginal organisms, causing the fungi to reproduce rapidly and leading to the uncomfortable symptoms we associate with yeast infections. Other possible causes of these infections include suppression of the immune system during such chronic illnesses as AIDS, the use of oral contraceptives, and eating large amounts of sugars, starch, and yeasts.
Because yeasts also normally inhabit the intestine, it's important always to wipe front to back (vaginal area first; rectal area second) after a bowel movement. During sex you must take care to prevent your vagina from becoming contaminated with organisms from your bowel and rectum.
Your chances of catching a yeast infection from a male sexual partner are quite low. The fungus does not fare well on a man's sexual organs, where exposure to the air can dry it out. However, men can develop the disease through frequent sexual contact with an infected female partner. In this case, tiny tender, itchy red bumps appear on the penis. Among lesbian couples, sexual transmission is more common. In all cases, treatment is the same.
To diagnose these infections, the doctor will take a case history, perform a pelvic examination, and examine a few drops of vaginal discharge under the microscope. When the diagnosis is unclear, a vaginal culture may be taken. A good response to an antifungal medication confirms the physician's diagnosis.
If you do have a yeast infection, your doctor will ordinarily treat you with either prescription or nonprescription antifungal vaginal creams and suppositories (see the table nearby). These preparations usually provide substantial relief in a few days. You must finish all your medication even if you're feeling better. Otherwise, you run the risk of relapse. If you still have symptoms after you complete your medication, see your doctor. Several other skin conditions can mimic or coexist with yeast infections.
