doctor’s orders: when to get help for a yeast infection
dr. vanessa poliquin, obgyn and infectious disease expert at the university of manitoba, explains why antibiotic use, sexual activity, and washing 'up there' with soap can increase the risk of a yeast infection or vaginal irritation — and what to do if you think something's not right.
7 minute read
dr. vanessa poliquin, obgyn, is an infectious disease expert at the university of manitoba and co-chair of the society of gynecologists of canada’s infectious diseases committee.
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yeast is a fungus that lives in your body normally without causing any problems, but a yeast overgrowth can lead to infection. a vaginal yeast infection affects up to three out of every four women at some point, according to the mayo clinic, causing the irritation, discharge and intense itchiness of the vagina and the tissues at the vaginal opening.
while a vaginal yeast infection isn’t a sexually transmitted infection, there is an increased risk of contracting it at the time of first regular sexual activity. intercourse introduces bacteria into your vagina’s ecosystem that may be disruptive and trigger a yeast infection.
healthing spoke with dr. vanessa poliquin, an obgyn and infectious disease expert at the university of manitoba and co-chair of the society of gynecologists of canada’s infectious diseases committee. her research is investigating how bacteria and immune function can impact the vagina and the female reproductive system.
what is a yeast infection?
dr. poliquin: yeast infections are one of the most common causes of vaginal discharge and itching. it’s a fungal infection. in north america, the most common species of fungus that causes these infections is candida albicans. that’s not necessarily the same throughout the world. basically, candida albicans lives in our gut. so, if there’s contamination into the vagina, it’s usually from the rectum. and truthfully, if you swabbed and looked for candida in many women’s vaginas you’d probably find it in low quantities. in low levels it’s not a problem — it’s called a colonizer at that point in time. but the problem of a yeast infection occurs when there’s a relative increase in the proportion of micro-organisms in our vagina that is candida and it out-competes the optimal bacterial makeup.
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what are the signs of a yeast infection?
dr. p.: some women might become symptomatic at a very low level of candida and some have a different kind of environment within their vagina that would require a lot more of a shift to become symptomatic. the whole concept of where the candida goes from colonizer to a problem is different for each person. but it becomes a problem when somebody develops symptoms — typically itching inside the vagina and vaginal discharge. many women describe the vaginal discharge as being white and clumpy, although some women have also described green discharge that is still consistent with a yeast infection. also, women can have pain when they urinate or pain when they’re having intercourse. some women even can have a candida fungal infection on the outside of their labia, like a red rash that kind of looks like a diaper rash. i see that more in women with diabetes, for instance, where they have high levels of sugar in their urine. so, if there’s a spill of that urine onto the skin around the vagina, i see more of the external skin affected rather than just an infection inside the vagina.
how does someone develop a yeast infection? what are the risk factors?
dr. p.: about three out of four women at some point in time in their life, typically in their reproductive years, would have a yeast infection. and many of those women would have had two yeast infections. it’s particularly common in a few situations. the first is antibiotics. many women will experience their first yeast infection sometime after taking a course of antibiotics. and that kind of gets back to that concept that yeast being there isn’t the problem. it’s their relative abundance compared to the rest of the normal flora. when you take antibiotics, even though you might be trying to treat strep throat, that antibiotic has the potential to really knock down some of your good bacteria inside your vagina. that’s what allows the imbalance and the movement as a colonizer to a problem. so, women who are taking antibiotics more often are susceptible.
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when we get sick, we tend to want something to make us feel better. sometimes there’s an important role for antibiotics and sometimes, especially for viral infections, there’s not. what i really try to emphasize is if you’re going to put antibiotics in your system, make sure that you’re taking it for a really good reason. because we know whether it be the good flora in your gut or the good flora in your vagina, when you put a pill of antibiotics into your mouth, you can’t control that it’s going to affect the bacteria that’s in your throat and not the bacteria that’s in your vagina or gut.
dr. poliquin explains the vagina is self-cleaning, so using soap or other cleaning products inside the vagina isn’t encouraged.
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people who have diabetes, especially if it’s not controlled, and those who are immunocompromised are the other big risk groups for yeast infections. in terms of diabetes, it’s oftentimes the urine that has a high sugar content in it that tends to allow the candida species to flourish. in the immunocompromised, it’s the fact that our immune system is functioning inside of our vagina as well. and if you are immunocompromised, your body’s ability to maintain a normal homeostasis where the good bacteria prevail is altered compared to somebody that has normal immunity.
are there lifestyle choices that can help prevent or treat a yeast infection?
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dr. p.: a lot of women come to my clinic and they’ve read about dietary changes, like avoiding bread and flour. and truthfully, the evidence for dietary avoidance as a way of preventing a yeast infection is not really robust. so, it’s really a lifestyle choice — if you want to stay away from gluten, then do that. but don’t do that only because this is what you think is going to control a yeast infection. i don’t have the right evidence to suggest that’s a good idea.
i think the biggest thing for me is education about vulvar and vaginal hygiene. the vagina is like a self-cleaning oven. you don’t need to put anything into it to make it clean. really, it’s just water in the shower. nothing needs to go up inside the vagina. and in fact, even if you use sensitive soaps, they still are alkaline. in an optimal vagina, the healthy lactobacillus bacteria are working so hard to keep the vagina a little bit more acidic. if soap gets up there, then we’re throwing off the acidic environment that is optimal in the vagina. so that’s the other thing that i really emphasize is just having a very hands-off approach to vaginal hygiene. then cotton underwear if there’s an issue. i encourage people to go without underwear at night to let everything breathe.
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how is a yeast infection generally treated?
dr. p.: there’s over-the-counter options and then there’s prescribed options. the vast majority of the yeast infections that we see can be treated with over-the-counter preparations in two varieties. there’s either the variety that comes as a gel or cream that goes inside the vagina, and depending on different concentrations is dosed for one night or up to seven nights, or there’s an oral pill that you can take. we like to try to direct the antifungal, so the first line is always the topical or intravaginal. but if someone doesn’t like putting a medicine in their vagina, we do have the antifungal pill.
i really encourage — especially if it’s your first time, if you feel like it’s not getting better, or if you feel like it’s coming back all the time — to see a doctor or nurse. so many times people come to my office and they feel like they’ve had a yeast infection forever and ever, and then we find out that it’s actually not a yeast infection at all. sometimes it’s a dermatologic condition, sometimes it’s a different infection. so, if something is not responding right away to an over-the-counter medicine, go and see a doctor and make sure they’re doing an exam for you.
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i think it’s worthwhile letting people know that if they have recurrent yeast infections and they go see their doctor, not to be surprised if their doctor puts them on a maintenance regimen for six to 12 months. the reason for that is because the yeast itself has an active phase and then a dormant phase where it exists as a little spore that’s really hard to get rid of. and so we do more of a prolonged treatment for people that have recurrent yeast infections to get the yeast when it moves out of its sleeping dormant phase and becomes active, because we can’t kill it during its dormant spore phase. we may need to apply treatment for a very long time — six to 12 months if somebody truly has recurrent yeast where they might have spores living in multiple layers of the skin of their vagina.
what’s one piece of advice for someone with a yeast infection?
dr. p.: if you’re struggling, the big thing is really not to self-diagnose. see your doctor and see your nurse if it’s either not getting better or if it just keeps coming back because it might be something different.
what’s most rewarding about the work you do?
dr. p: when i see someone in clinic and they feel they can finally talk about something or finally get an answer to something that has really not felt appropriate to talk about. that’s the space that i like to create in my clinic. and i feel like i’m succeeding, creating a safe space. coming to our clinic is value-added because it’s that space where we can uniquely and openly talk about things.
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for more information about yeast infections, visit healthlinkbc and the cleveland clinic.
karen hawthorne is a toronto-based writer.
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