Vaginal Infections: It's Not Always Yeast

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Vaginal Infections: It's Not Always Yeast

Sexual And Reproductive Health
Vaginal Infections: It's Not Always Yeast
Vaginal Infections: It's Not Always Yeast
They're common but don't assume that yeast is always to blame. They can be caused by a fungus or a virus.
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Reviewed by the Faculty of Harvard Medical School

Vaginal Infections

Don't assume that yeast is always to blame.

Preparing For The Office Visit

A gynecologic visit is a time for your health care professional to examine your genital area, evaluate the symptoms you may have and make an accurate diagnosis. Many women douche or use vaginal deodorant sprays or powders before their check-up because they feel cleaner. But sprays, powders or douching can cover up, alter or temporarily wash away signs of infection, so you may not receive an accurate diagnosis, and you may not get the help you need.

To help your doctor get the most accurate picture of what's going on, don't put anything in the vagina for 48 hours before your visit. So, no douching, no sex and no tampons. This applies to a  Pap test as well.

Vaginal yeast (also called candida or Monilia) infections are common, but not all vaginal itching and discharge is caused by an overgrowth of yeast. Vaginal infections can also be caused by Trichomonas (a microscopic parasite) or bacteria. Don't use an over-the-counter yeast medication until you're sure of your diagnosis. In most cases that don't have obvious features of a yeast infection, this usually requires a visit to your doctor.

Here are some guidelines for recognizing, preventing and treating common vaginal infections:

Yeast Infection

Symptoms:: A thick, curd-like white discharge, itching in and outside the vagina, and sometimes a burning sensation when urine comes in contact with irritated skin of the external vaginal area (vulva).

Causes And Prevention: It is normal for all women to secrete moisture and mucus from membranes that line the vagina. It is also normal for a mixture of bacteria and a small amount of yeast to grow in the vagina of a healthy woman. If the usual bacteria mixture is disturbed, the vagina's chemical environment can encourage yeast to multiply and cause yeast to change its form. In its new form, yeast develops thread-like "hyphae," allowing it to adhere to and irritate the vagina. Taking antibiotics can change the normal vaginal bacteria and lead to a yeast infection.

In some women, birth control pills change the normally acidic environment of the vagina and yeast can multiply.

Yeast can also cause an infection on the skin surrounding the genitals. Moisture on the skin can make it easier for a yeast infection to start. To keep this area dry, change out of damp or sweaty clothing such as a bathing suit or workout clothes quickly; avoid tight-fitting pants and choose underwear that is made of cotton so that air can circulate.

Douching is not a necessary part of healthy hygiene. In fact, douching increases the chance that yeast will cause an infection because it washes away normal bacteria in the vagina. Do not douche unless it is recommended by a physician. Instead, take a bath or shower daily and gently wash the outer genital area with nonirritating, mild soap.

Treatment: If you have vaginal symptoms such as itching and discharge but have never had a yeast infection, see a health care professional for a vaginal exam and to get a proper diagnosis. Your doctor can diagnose a yeast infection by inspecting the discharge and in most cases by checking for yeast with hyphae in vaginal mucus, under the microscope. If you've experienced a yeast infection and can recognize the symptoms, it's fine to self-treat with an over-the-counter vaginal cream or suppository medication such as clotrimazole (Lotrimin, Mycelex-G), miconazole nitrate (Monistat), butoconazole nitrate (Femstat), terconazole (Terazole) or tioconazole (Vagistat-1). All are effective for most vaginal yeast infections. Depending on the brand and strength, treatments last one, three or seven days. If this does not take away symptoms, see your health care professional.

The vaginal tissues are more sensitive just prior to menstruation. So a little itching at that time of the month may just be part of your body's normal fluctuations. If it goes away after menstruation, then it’s not likely due to yeast and there's no need to treat it. Severe or persistent itching or heavy discharge should always be treated. If you get recurrent yeast infections, your doctor will need to test you for diabetes. People with diabetes can easily develop yeast infections, particularly if their blood sugar levels are inadequately treated and controlled.

Bacterial Vaginosis (BV)

Symptoms: A strong, fishy odor and a grayish-white, non-irritating discharge.

Causes And Prevention: Bacterial vaginosis occurs when there is a slight change in the mixture of normal bacteria within the vagina. When certain varieties of "normal flora" dominate the mixture, the acidity of the vagina is different and bacteria can cause symptoms. The most common bacteria to cause BV is Gardnerella. Douching changes the balance of bacteria and should be avoided. BV is not always related to sexual activity, but women who have new partners or multiple partners are more likely to develop this form of vaginitis. It is not usually necessary for a sexual partner to be treated if you develop BV. However, having your sexual partner routinely use a condom or having your partner receive antibiotic treatment seems to help some women avoid repeated infections.

Treatment: Your doctor can diagnose BV by examining a sample of vaginal discharge under the microscope. Women with symptoms and a diagnosis of BV should be treated. Some obstetricians also recommend treatment for a pregnant woman who does not have any symptoms, if she has had preterm labor in a previous pregnancy. Prescription oral medication metronidazole (Flagyl) or clindamycin (Cleocin) is an effective treatment. Alternatively, metronidazole gel (MetroGel) clindamycin cream, or clindamycin ovules (vaginal tablets) can be inserted in the vagina.


Symptoms: A greenish-appearing, foul-smelling discharge that can be frothy and can be abundant and heavy in severe cases. The external vaginal area can be red and irritated, and there may be some burning when urinating, as the urine passes over the irritated genital skin.

Causes And Prevention: Trichomoniasis is a sexually transmitted infection caused by a one-cell parasite (Trichomonas). Since it's possible for people with trichomoniasis to have no symptoms, it can be spread from a sexual partner who is unaware that he is infected. Most women infected with trichomoniasis experience symptoms. You can prevent this infection if you practice safe sex. Using condoms can prevent infection. If you know that your partner is infected, abstain from sex until he has been fully treated.

Treatment: Prescription oral medication metronidazole (Flagyl), is given either in a large single dose or as a seven-day course of treatment. Because trichomoniasis is sexually transmitted, both partners need to be treated at the same time.

Vaginal Irritation

Allergies or sensitivities to fragrances, chemical sprays such as "vaginal deodorants," spermicides, and other powders or skin lotions are common. These products may cause itching, redness and irritation in or around the vagina. Perfumes in absorbent liners or menstrual pads can also be irritating to the genital area and the vagina. Use only unscented menstrual pads, panty liners and tampons, and avoid the use of vaginal sprays or powders.

Allergy to latex can cause vaginal irritation in some women. This is particularly problematic with condom use.

Many women experience atrophic vaginitis after they reach menopause. This is associated with the thinning of the vaginal lining and changes in the vaginal mucus, which occur when a woman makes less estrogen. Symptoms can be more noticeable during intercourse. Using lubrication such as K-Y Jelly or Astroglide can decrease irritation during sex. Estrogen supplementation (as a vaginal cream or estrogen pills or patches) can improve or eliminate symptoms.


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Last updated September 30, 2013

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