Is It a Yeast Infection? - Common Vaginal Infections and Their Prevention

Vaginal infections are a common cause for women to either seek help from their doctor, or to self-medicate with over-the-counter preparations. It’s hard not to self-prescribe with so many easy applications available for yeast infections. We’ve gone from the 7‑day treatment in our mother’s or grandmother’s time, to more simple and “clean” versions of a “one-tablet treatment” both orally and vaginally. Thinking you have a yeast infection because of new vaginal itching, possibly odour, and discharge could be misleading.

We’ve become so accustomed to these quick fixes for vaginal infections that many women go straight to their pharmacy without being properly assessed. In reality, these symptoms may not be a yeast infection at all, but one of many other types of vaginal infections that may not resolve with a typical antifungal treatment. Three of the most common vaginal infections in women of reproductive age are bacterial vaginosis, vaginal candidiasis (yeast infection), and trichomoniasis (a sexually transmitted infection). Due to the nature and cause of each infection, it’s important to have a proper assessment and testing done. This is especially true as women can experience these infections differently, exhibiting unique signs and symptoms, or may be completely asymptomatic altogether.

Bacterial Vaginosis

Bacterial vaginosis (BV) is a very common case of vaginal dysbiosis that has led to an infection. Because it involves a change in the bacterial species that occupy the vagina, it may not respond to classic antifungal / yeast-infection treatments. In the case of a dysbiosis, the vaginal environment becomes overgrown with anaerobic bacteria instead of the protective Lactobacilli species that naturally would occupy this area.[1] This change in the microenvironment causes the degradation of mucus membrane, leading to irritation and discharge.[2]

As the vaginal tissue becomes more raw and sensitive, and without its protective mucous layer, it becomes more vulnerable to other pathogens. The occurrence of this type of bacterial infection can create abnormal discharge in addition to unfamiliar or fishy odours.[3] With these changes, the pH of the vaginal environment is also modified and becomes less acidic than in cases of vaginal candidiasis, which is one way to test for BV versus a yeast infection.[3] A vaginal pH of 4.5 or less would indicate an adequate level of healthy Lactobacilli bacteria, and therefore is unlikely to be BV.

There are many factors that influence the development of a vaginal microdysbiosis. Using douching products or taking broad-spectrum antibiotics can both deplete the healthy Lactobacilli species from the vaginal environment.[2] Additionally, frequent unprotected intercourse can also change the bacterial flora, as sperm alkalinizes the vaginal environment.[2] For this reason, it’s important to abstain from intercourse during a vaginal infection: unprotected, sperm changes the vaginal pH and leads to a decline in healthy bacteria; protected, friction from intercourse may cause discomfort and further irritation.

Vaginal Yeast (Candidiasis) Infections

Symptoms that we typically associate with a classic yeast infection include itching and a characteristic “cottage-cheese” discharge. However, many women can experience symptoms differently, and may actually have discharge that varies from a watery consistency to a thicker, less fluid consistency.[2] Other symptoms may include swelling, redness, and irritation. Because symptoms can be vague and different between individuals, it is common for women to misdiagnose themselves. This often leads to improper treatment—a potential cause of recurrent vaginal infections, among many others.[2] Vaginal Candida can be easily treated medically with oral fluconazole or vaginal clotrimazole (ovule or cream); however, it’s important to include natural treatments and/or lifestyle changes to properly reestablish a healthy vaginal environment and to prevent recurrence of infection. Preventative care is important for many vaginal infections and includes wearing underwear made of breathable fabrics like cotton. Also important is the avoidance of thong underwear which can act (literally) as a bridge for microbes like bacteria between the vagina and the anus.

Trichomoniasis

Trichomoniasis is a sexually transmitted infection, more common than gonorrhoea and chlamydia.[2] Women with this type of infection often experience vaginal itching, discharge, and irritation, quite similar to other vaginal infections; however, discharge colour may appear yellowish or green, or even frothy.[4] Unlike BV and candidiasis, it’s not uncommon to experience pain with sexual intercourse (dyspareunia) and painful urination (dysuria).

The Vaginal Exam

The importance of a vaginal exam here cannot be overstated. It’s not something we as women look forward to, but your doctor can gain a vast amount of information from these exams. First, your doctor will inspect the vaginal tissue, looking for any skin lesions that you may not be able to visualize. They should also be checking for any lumps or bumps which could indicate cysts or warts. After an inspection of the outer tissues, your doctor will obtain swab samples and may use a speculum to visualize the cervix and to take any additional appropriate swabs from the area. Your doctor can test the pH of vaginal secretions and discharge very easily (often without needing to insert a speculum), which could help to differentiate between different types of infections as listed above. Although not commonly run for a vaginal infection, a Papanicolaou test, also known a “Pap smear,” may be conducted. During a pap test, your doctor will obtain a sample of the cells from the cervix as a way to screen for any abnormal cells. In part of the speculum exam, your practitioner is able to see what exactly is happening inside the vaginal canal. This is one way to investigate the type of infection you may be experiencing. For example, in some cases of trichomoniasis, the cervix can display a characteristic “strawberry” appearance, as caused by the small hemorrhages from the infection. In one case study of a vaginal infection, a speculum exam was able to illuminate a retained foreign object that was unbeknown to the patient.[5] In this case, an old tampon had been retained and forgotten about, later causing the patient’s symptoms. It was only upon a speculum exam that the practitioner was able to locate the fibrous mass that had completely deformed and had caused her infection.[5]

Prevention and Treatment

Vaginal health, for the most part, is affected by our lifestyle, diet, and immune function. Probiotic use orally and/or vaginally has been used to prevent recurrences of infections such as bacterial vaginosis, but is especially important after any antibiotic use.[6] Simple ways to help avoid vaginal infections, and to reduce the risk of recurrence include:

• Avoidance of tampons and insertion of other foreign objects
• Avoidance of irritants such as spermicides and douches, as well as irritating soaps and detergents (especially those with added fragrance)
• Avoidance of hot tub use
• Wearing underwear made of breathable fabrics such as cotton, and refraining from wearing thong underwear
• Eat a diet rich in whole foods, with little to no refined sugars
• Increase intake of probiotic foods
• Avoid sexual intercourse while experiencing a vaginal infection
• Condom use with male sexual partners

Talk to your naturopathic doctor about your treatment options. Proper assessment and testing is crucial in order to receive proper treatment, as there are many natural options available.