Vaginal Yeast Infections

Vaginal yeast infections can be extremely uncomfortable and significantly impact the quality of a woman’s life. At least 75% of women will experience a yeast infection once in their lifetime, with 45% experiencing two or more episodes, and 5–8% experiencing frequently recurring infections over the course of their life.^[5] Vaginal yeast infections are not classified as a sexually transmitted infection (STI), but can be transferred during intercourse between partners and to babies through the birth canal.^[1] Although they are generally not life-threatening, the sudden onset and quick progression of vaginal yeast infections can leave women to deal with an itchy, burning, painful mess, with little knowledge of how to successfully prevent a recurrence. Furthermore, recurrent vaginal yeast infections may negatively affect a woman’s self-esteem and confidence and contribute to a decrease in desire for sexual intimacy.^[9]

Most vaginal yeast infections are caused by one of several species of Candida, and are medically referred to as vulvovaginal candidiasis (VVC). In a healthy immune system, Candida yeast species normally colonize the microflora of the mouth, intestines, vagina, skin, nose, and ears, without causing any harmful effects.^[2] They live in a symbiotic relationship with friendly bacteria, such as Bifidobacteria bifidum and Lactobacillus acidophilus, and help to maintain balance within the ecological terrain of the individual. However, if this fine balance is disrupted, bacteria such as yeast can grow out of control, creating dysbiosis and wreaking havoc on the system.^[2] An overgrowth in a specific strain of Candida, C. albicans, has been linked to the primary cause of VVC. Other species of Candida (C. glabrata, C. tropicalis, and C. krusei) can also cause vulvovaginal symptoms and may be resistant to conventional forms of treatment.^[5] Although both men and women can be affected by yeast infections, women are more prone to them primarily due to their anatomy; a woman’s urethra (the tube leading from the urinary bladder to the outside) and the distance between the anal opening and the vulva and vagina are shorter, which increases the chance of vaginal infections.^[2] Furthermore, yeast species thrive in warm, dark, and moist areas of the body, making the vagina a primary hospitable home.^[1] Recurrent episodes of VVC may signal immune dysfunction, hormonal imbalance, and/or intestinal dysbiosis, and should be monitored closely by a health-care professional.^[2]

Signs, Symptoms, and Diagnosis

VVC is most prevalent in women between the ages of 15 and 50.^[7] Infections tend to be rare after the age of 50, except for in women on hormone replacement therapy (HRT). Symptoms range from mild to very severe, and can include, but are not limited to, the following:^{[1, 2, 5, 7]}

• Intense vulvar itching.
• Pain with urination (dysuria).
• Pain with vaginal sex (dyspareunia).
• Redness, burning, and swelling of the vagina and vulva, which may become raw and fissured.
• Symptom aggravation before menses.
• Watery to thick white or yellow discharge like “cottage cheese” which is adherent to the vaginal walls. Discharge may be odourless or have a mild yeast-like odour. Many women may have no discharge at all.
• Normal vaginal pH between 4.0 and 4.5.

Diagnosis of VVC is generally based on a combination of a thorough medical history, visual inspection of the vagina externally and internally through a pelvic examination, vaginal pH testing, microscopy, and if necessary, a vaginal culture.^[10] Self-diagnosis of VVC is not recommended, as the symptoms can easily be confused with other forms of vaginitis, such as bacterial vaginosis, trichomonas vaginalis, and STIs.^[2] Self-diagnosis and self-treatment of recurrent VVC, defined as four or more episodes of infection per year, is especially dangerous because an underlying immune, digestive, or hormonal condition can go undiagnosed.^[5]

Causes and Risk Factors

When the ecological balance of the normal flora is disrupted, the chances of manifesting a yeast infection increase dramatically. One of the main causes of VVC is recent or repeated antibiotic use.^[7] Antibiotics directly decrease the Lactobacilli population, but have no effect on the Candida population in the microflora.^[2] This results in a relative overgrowth of Candida species, which can attach to the vaginal wall, normally covered in Lactobacilli.^[5] Furthermore, frequent antibiotic use can depress the immune response, predisposing individuals to recurrent infections.^[2] Other causes and risk factors of VVC include, but are not limited to:^{[1, 2, 5, 6, 7]}

• Chronic stress.
• Excess sugar and simple carbohydrate consumption.
• Increased vaginal intercourse and/or multiple sexual partners.
• Recent/repeated corticosteroid use.
• Multiple pregnancies.
• Diabetes mellitus and hyperglycemia.
• Intestinal candidiasis, food sensitives or leaky gut.
• HIV, AIDS, Cushing’s or Addison’s disease.
• Hypothyroidism or hyperthyroidism.
• Chemotherapy and radiation.
• Lowered immunity and autoimmune disorders.
• Use of oral contraceptives, diaphragms, spermicides, IUDs, latex-condom allergy.
• Hormonal imbalance, primarily due to HRT and/or estrogen dominance and progesterone fluctuations during the menstrual cycle.
• Smoking.
• Use of nylon underwear and pantyhose.
• Partner infected with Candida.

Conventional Treatment

Currently, there are over 100 prescription and over-the-counter preparations that are marketed to be effective in the treatment of VVC.^[2] The majority of these treatments are antifungal medications of varying strength and are usually administered orally, topically, or as vaginal suppositories.

Oral prescription antifungal medication: Azole-containing drugs are the gold standard in treating systemic fungal infections. Some examples of popular azole-containing prescription medication include ketoconazole, fluconazole (Diflucan), itraconazole, and nystatin.^[2] Although they are usually effective in treating 80–90% of VVC symptoms within a short course of oral treatment, they have a number of known side effects, and may promote yeast proliferation in the long run. Some side effects include nausea, dizziness, abdominal pain, rash, headaches, abnormal elevations of liver enzymes, and numerous drug interactions.^[10]

Topical over-the-counter antifungal medication: There are many OTC topical preparations to choose from, some of which include butoconazole (Femstat 3), clotrimazole (Lotrimin), miconazole (Monistat), and terconazole (Terazol 3).^[10] The duration of these treatments may last from one to seven days, and they are generally effective in alleviating symptoms. However, they tend to be ineffective in treating strains of Candida other than Candida albicans, can interfere with condom use, and may cause local burning and irritation.^[10]

Naturopathic Approaches

Although conventional methods are effective in treating the symptoms of VVC, they often have unwanted side effects and may not treat the underlying cause associated with recurrent infections. Furthermore, incorrect and frequent use can lead to immune depression and further Candida proliferation, which increases the chance of future infections. Naturopathic treatment of VVC is generally aimed at determining the imbalance within the body that may be predisposing the individual to frequent infections. Emphasis is placed on immune health, digestive health, and hormonal health, as dysfunction in these areas tend to be at the root of VVC infections. Naturopathic symptomatic treatment of VVC is generally side effect–free and effective against all strains of Candida, not just Candida albicans. Some of the most common naturopathic recommendations to treat and prevent recurrence of VVC are listed below. Please consult a naturopathic doctor before attempting self-treatment, especially if you are or may be pregnant.

Dietary Modifications

Avoid sugar: Sugar, especially refined sugar, feeds Candida and depresses the immune response. Many studies have linked spikes in blood glucose to increasing the risk of having a yeast infection in women susceptible to VVC. In one study, 90% of women with recurrent VVC who were consuming large amounts of sucrose remained yeast-infection-free for one year by restricting their daily sugar intake.^[4] Xylitol, in moderation, is an excellent and safe sugar substitute which does not feed yeast cells.

Eliminate food allergens: Avoid alcohol, yeast, fermented foods, mushrooms, peanuts, vinegar, refined carbohydrates, and dairy in the diet, as these have been linked to causing an allergic response and vaginal irritation in women with recurrent VVC.^[7] Food allergens can also contribute to Candida overgrowth in the gut, which directly increases the risk of VVC.^[2] Following an anti-Candida diet short-term may also be beneficial, especially during an acute infection.^[2]

Lifestyle Modifications

• Wear loose cotton underwear and avoid tight pants, synthetic underwear, and pantyhose. Synthetic fabrics prevent proper air circulation, which increases heat and humidity, favoring growth of Candida.^[7]
• Avoid using bubble baths as well as artificially scented soaps or scented tampons, pads, or toilet paper, as these can amplify vaginal irritation.^[7]
• Avoid the oral contraceptive pill and favor nonlatex condoms in replacement, because frequent hormonal fluctuations promote the proliferation of yeast.^[6]
• If you have an infection, use condoms and have your partner treated for infection as well, so you don’t keep reinfecting each other.^[5]
• Avoid douching when you have an infection. It disturbs your healthy vaginal flora and can make you more susceptible to vaginal infections and cervical dysplasia.^[7]
• Explore and address emotional causes to recurrent VVC. Anger towards you partner, guilt, shame, and past sexual abuse may perpetuate recurrent infections.^[7]

Supplements and Botanical Herbs

Probiotics: Oral and vaginal probiotics are one of the most important treatments for preventing recurrent VVC. Several species of Lactobacilli populate the healthy vaginal canal. However, frequent use of antibiotics and douches can decrease Lactobacillus concentrations, making women more susceptible to vaginal infections.^[5] Repopulation of Lactobacillus species is essential in maintaining a healthy flora. Lactobacilli produce lactic acid, which naturally acidifies the pH of the vagina, protecting against infective organisms. Vaginal Lactobacilli also produce hydrogen peroxide, which is a known antibacterial agent, acting as a local immune stimulant to manage microbial levels in the vagina.^[3] Studies have shown that women with hydrogen-producing Lactobacilli in their vaginas are less likely to have Candida infections.^[3] Lactobacillus rhamnosus has been established as the most effective strain of Lactobacillus for both prevention and treatment of VVC and recurrent VVC, and is equally effective if taken orally or vaginally.^[3] Daily oral supplementation and vaginal insertion of high-dose probiotics for a period of 2–6 months is highly beneficial in treating VVC.

Zinc: Zinc plays a crucial role in supporting immune function. Therefore, a deficiency in zinc may predispose women to VVC. In one study, plasma zinc levels were found to be significantly lower in women with recurrent VVC than in controls.^[8]

Boric acid: Boric acid is one of the most successful treatments for VVC. Laboratory tests and human trials support its use for both Candida glabrata and albicans, even in cases of resistance to antifungal prescription drugs.^[5] Several studies confirm its success in ranging from 64 to 98% effective. In one study comparing boric acid to Nystatin, boric acid cured 92% after 10 days and 72% after 30 days, while Nystatin cured 64% and 50%, respectively.^[5] The only side effect noted is a slight burning during urination in cases where the infection has already irritated the tissue. This can easily be managed through the use of topical coconut oil or vitamin E.^[5] Boric-acid powder can easily be obtained in most pharmacies and as a prepared suppository. It is extremely effective in managing symptoms and preventing recurrence of VVC. Vaginal suppositories twice a day for 2–4 weeks were found to be most effective in curing acute infections. For preventing recurrence, suppositories used for four days per month during the menses, for four consecutive months, were found to be most effective.^[5]

Garlic (Allium sativum): Garlic extracts have been shown to inhibit the growth of Candida albicans by blocking lipid production. Allicin is the primary inhibitory substance found in garlic, and is effective in VVC for its antibacterial and antifungal actions.^{[5, 10]} Ensure garlic products are high in standardized allicin for effective treatment purposes. Garlic cloves can be taken orally or peeled and threaded to create an overnight vaginal garlic suppository.

Goldenseal (Hydrastis canadensis) and Oregon-grape (Berberis vulgaris): Goldenseal and Oregon-grape root contain a substance called berberine that acts as both an antibacterial and immune enhancer, specifically in epithelial mucous membrane tissue found in the vagina, mouth, and stomach. Berberine is an effective antimicrobial and has been shown to be effective orally and vaginally in treating Candida albicans.^{[5, 10]}

Asian Medicine and Acupuncture

In Asian medicine, VVC can be caused by excess heat in the liver and dampness in the spleen.^[7] Working with a naturopathic doctor or Asian-medicine practitioner to release liver heat and spleen dampness through a specific Asian-medicine diet, Asian-medicine herbs, and acupuncture can be effective in controlling symptoms of VVC and its recurrence.

Homeopathic Remedies

There are a variety of homeopathic remedies that are indicated to aid in the treatment of VVC and recurrent VVC. See a homeopathic doctor or naturopathic doctor to determine the best remedy for you.

Conclusion

Vulvovaginal candidiasis (VVC) affects millions of women around the world. Although numerous over-the-counter and prescription antifungals are available and effective in alleviating symptoms, they do little to deal with the underlying cause of the infection, especially if it is recurrent. Recurrent VVC infections can signal a dysfunction in another system of the body and should not be overlooked. Naturopathic approaches provide safe and effective symptom management for VVC and treat the underlying cause, so that Candida can be conquered once and for all. Please see a naturopathic doctor for more information or to create a treatment plan for vulvovaginal candidiasis that is unique to your needs.