Symptoms

Yeast infection symptoms range from mild to severe, including:

• Itching and irritation in the vagina and at that entrance to the vagina (vulva)
• A burning sensation, especially during intercourse or while urinating
• Redness and swelling of the vulva
• Vaginal pain and soreness
• Thick, white, odor-free vaginal discharge with a cottage cheese appearance

When to see a doctor
Make an appointment with your doctor if:

• This is the first time you've experienced yeast infection symptoms
• You're not sure whether you have a yeast infection
• Your symptoms don't go away after self-treating with over-the-counter antifungal vaginal creams or suppositories
• You develop other symptoms

Causes

A vaginal yeast infection is caused by the fungus candida. Candida is a microorganism that's normally present in your vagina, along with bacteria. Your vagina naturally contains a balanced mix of yeast and bacteria. Lactobacillus bacteria produce acid, which discourages overgrowth of yeast in the vagina. But disruption of the healthy balance can result in an overgrowth of yeast. Too much yeast in your vagina can lead to vaginal itching, burning, and other classic signs and symptoms of a yeast infection.

Overgrowth of yeast can result from:

• Antibiotic use, which leads to a decrease in the amount of lactobacillus bacteria in your vagina and a change in your vaginal pH that allows yeast to overgrow
• Pregnancy
• Uncontrolled diabetes
• Impaired immune system
• Anything that changes the type and amount of bacteria normally present in the vagina, such as douching or irritation from inadequate vaginal lubrication

Most often, yeast infection results from a type of candida fungus known as Candida albicans. Sometimes, however, a different type of candida fungus might be the cause of symptoms. Candida albicans responds well to typical treatments for yeast infections. Other types of candida, however, sometimes respond poorly to conventional therapies and may require more aggressive treatment.

A yeast infection can be sexually transmitted, especially through oral-genital sexual contact. However, yeast infection isn't considered a sexually transmitted disease because it happens in celibate women and the candida fungus is naturally present in the vagina.

Risk factors

Among the things that increase your risk of developing a yeast infection are:

• Antibiotic use. Yeast infections are common in women who take antibiotics. Broad-spectrum antibiotics kill healthy bacteria in your vagina, which can lead to the overgrowth of yeast.
• Increased estrogen levels. Yeast infections appear to occur more frequently in women with increased estrogen levels, for instance, in women who are pregnant, those taking high-dose estrogen birth control pills or those taking estrogen hormone therapy.
• Uncontrolled diabetes. In women who have diabetes, those with poorly controlled blood sugar levels are more likely to develop yeast infections than are women who have diabetes under control.
• Impaired immune system. In women who are immunocompromised — such as by corticosteroid therapy or by HIV infection — yeast infections are more likely to occur.
• Being sexually active. Although yeast infections aren't considered sexually transmitted diseases, one way the candida organism can be introduced into your vagina is through sexual contact.

Preparing for your appointment

If you've been treated for a yeast infection in the past, your doctor may not need to see you and may prescribe a treatment over the phone. Otherwise, you'll likely see your family doctor or gynecologist to treat your condition.

What you can do
So that your doctor can observe and evaluate any vaginal discharge you have, avoid using tampons and don't douche before your appointment.

Also make a list of medications or supplements you're taking and any allergies you have. Write down questions to ask your doctor. Some basic questions include:

• Can I do anything to prevent yeast infections?
• What signs and symptoms should I watch out for?
• Do I need to take medicine?
• Does my partner also need to be tested or treated?
• Are there any special instructions for taking the medicine?
• Are there any over-the-counter products that will treat my condition?
• What can I do if my symptoms return after treatment?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

Questions your doctor may ask
Be prepared to answer questions your doctor may have, such as:

• What vaginal symptoms are you experiencing?
• Do you notice a strong vaginal odor?
• How long have you had your symptoms?
• Have you ever been treated for a vaginal infection?
• Have you tried any over-the-counter products to treat your condition?
• Have you recently taken antibiotics for any reason?
• Are you sexually active?
• Are you pregnant?
• Do you use scented soap or bubble bath?
• Do you douche or use feminine hygiene spray?
• What medications or vitamin supplements do you regularly take?

Tests and diagnosis

To diagnose a yeast infection, your doctor may:

• Ask questions about your medical history. This might include gathering information about any past vaginal infections or sexually transmitted diseases.
• Perform a pelvic exam. During the exam, you lie on your back on an exam table with your feet resting in supports called stirrups. Your doctor visually examines your external genitals for signs of infection. Next, your doctor places an instrument (speculum) into your vagina to hold the vaginal walls open so that he or she can examine the vagina and cervix. Your doctor may collect a sample of any vaginal discharge for examination under a microscope or to perform a vaginal culture test, if needed. After the speculum is removed, your doctor inserts gloved fingers into your vagina and, while using the other hand to press on your abdomen, examines your other pelvic organs for signs of disease.
• Send a sample of vaginal secretions for testing. For uncomplicated yeast infections, your doctor probably won't perform any sort of laboratory tests. However, if you have recurrent yeast infections, your doctor may be able to prescribe more effective treatment if he or she knows the specific type of yeast that's causing the infection.

Treatment and drugs

Yeast infection treatment depends on whether you have an uncomplicated or a complicated infection.

Uncomplicated yeast infection
For mild to moderate symptoms and infrequent episodes of yeast infection, your doctor might recommend:

• Short-course vaginal therapy. A one-time application or one-to-three-day regimen of an antifungal cream, ointment, tablet or suppository effectively clears a yeast infection in most cases. The medication of choice is from the class of drugs called the azoles; these include butoconazole (Gynazole), clotrimazole (Lotrimin), miconazole (Monistat) and terconazole (Terazol). Your doctor might prescribe one of these medications, or some preparations are available over-the-counter. The oil-based nature of these agents in cream and suppository form could potentially weaken latex condoms and diaphragms. Side effects of these topical medications are few, including a slight burning or irritation during application.
• Single-dose oral medication. Your doctor might prescribe a one-time single dose of the antifungal medication fluconazole (Diflucan) to be taken by mouth.

Make a follow-up appointment with your doctor if you've finished your treatment and your symptoms haven't gone away or if your symptoms return within two months of being treated.

Many topical treatments for a yeast infection are available over-the-counter. If you've tried one of these and your symptoms don't go away, see your doctor.

Complicated yeast infection
You might have a complicated yeast infection if:

• You have severe signs and symptoms, such as extensive redness, swelling, and itching that leads to the development of sores or fissures
• You have recurrent yeast infections — four or more in a single year
• Your infection is caused by a type of candida other than Candida albicans
• You're pregnant
• You have uncontrolled diabetes or your immune system is compromised from medication use or a condition such as HIV infection

Treatment for a complicated yeast infection might include:

• Long-course vaginal therapy. Vaginal treatment for complicated yeast infections includes an azole medication in the form of a vaginal cream, ointment, tablet or suppository. The duration of treatment is usually seven to 14 days.
• Multidose oral medication. Instead of vaginal therapy, your doctor might prescribe two or three doses of fluconazole to be taken by mouth. However, this therapy isn't recommended for pregnant women.
• Maintenance regimen. For recurrent yeast infections, your doctor might recommend a medication regimen to keep yeast overgrowth in check and prevent future infections. Maintenance therapy starts after the initial treatment clears the yeast infection and usually includes fluconazole tablets taken by mouth once a week for six weeks. Some doctors prescribe topical clotrimazole to be applied vaginally once or twice a week in lieu of an oral medication.

Usually, your sex partner doesn't also need to be treated for a yeast infection. However, for problems with recurrent yeast infections, your doctor might also recommend treatment for your partner or use of condoms with intercourse.

Lifestyle and home remedies

A number of natural products purport to prevent or cure vaginal yeast infections without prescription medication. Some popular yeast infection home remedies include:

• Vinegar douches
• Tea tree oil cream
• Garlic or boric acid vaginal suppositories

Anecdotally, some women report success with these home remedies. However, well-designed, randomized, controlled trials are needed to investigate the safety and effectiveness of these therapies before any reliable clinical recommendations can be made.

One exception may be lactobacillus, bacteria normally found in the vagina, but scientific evidence of benefit is limited. Some studies show that lactobacillus — available in some types of yogurt — taken orally or used intravaginally successfully reduced the amount of vaginal yeast cultures and provided symptom relief. But the studies were in a small number of women, with no control groups, and other studies haven't been able to corroborate those findings.

Prevention

To reduce your risk of vaginal yeast infection:

• Avoid douching.
• Don't use scented tampons, pads, bubble baths or feminine hygiene sprays.
• Wear cotton underwear and loosefitting pants or skirts.
• Avoid tightfitting underwear or pantyhose.
• Change out of wet clothes, such as swimsuits or workout attire, as soon as possible.
• Stay out of hot tubs or very hot baths.