All women are probably going to have at least one yeast infection in their lifetime. So says Dr. Jo-Anne Hammond, a professor in family medicine at Western University. ‘Yeast loves to grow in the vagina’s hot, moist environment.’ Infections seem to be more common in the summer; steamy temperatures, synthetic fabrics and wet bathing suits can all increase the risk of this type of fungal infection.
Also known as vaginal candidiasis, the infection happens when there is an overgrowth of candida, a yeast-like fungus that is naturally present in the vagina. Normally, it’s kept in check by the presence of lactobacillus, bacteria that secrete an acid that discourages the growth of yeast. But when the balance is disrupted, the candida rapidly multiply, resulting in the symptoms of an infection: itch, irritation and discharge (typically white or yellow).
‘Anything that changes the bacteria count or suppresses the immune system can be a cause,’ says Hammond. That includes stress, a cold or lack of sleep. Antibiotics are the most common culprit, since they kill good bacteria along with bad; douching can also change the type and amount of bacteria in the vagina. Hormones, too, are a factor; some women get more yeast infections when pregnant, ovulating or taking the pill.
It is possible, but uncommon, for the infection to be transmitted through unprotected sex. Usually, the yeast transfers from the vagina to the penis; the male may experience a rash, redness, itching or burning. Both partners should get treated and refrain from sex until symptoms disappear.
To prevent a yeast infection, it helps to wear cotton underwear and loose-fitting pants or skirts, and change out of damp or sweaty clothes as soon as possible.
The Mayo Clinic advises avoiding scented feminine hygiene products, which can irritate the vagina. And Alana Shaw, a naturopathic doctor at Port Moody Health in Port Moody, B.C., says you should look at your diet. ‘High-sugar diets can feed yeast, so eliminate refined sugars and carbohydrates,’ she says. ‘Taking probiotics or eating yogurt and other fermented foods, as long as they don’t have added sugar, can also help maintain your healthy bacteria population.’
There’s no risk from not treating a yeast infection, says Hammond. But if you are experiencing symptoms for the first time and think it is a yeast infection, you should see your doctor for a diagnosis, because it is important to rule out a more serious condition. The symptoms can be similar to those of chlamydia, gonorrhea, trichomoniasis and bacterial vaginosis (the first two of which can result in serious complications if not treated), or may signal a disease such as diabetes. If you have been diagnosed with yeast infections before and are not pregnant or immune-compromised, it is safe to treat it with over-the-counter remedies, such as the ones mentioned below, for up to seven days. If the infection still bothers you after a week of treatment, or you suffer from recurrent infections’more than four per year’talk to your doctor.
Examples: Canesten 1-Day Cream; Canesten 1-Day Combi-Pak Cream; Life Brand Clotrimazole Vaginal Cream USP 2%; Monistat 7 Vaginal Cream
How they work: These treatments consist of an antifungal medicine in cream form that you insert in the vagina using an applicator similar to a tampon; the Canesten Combi-Pak also includes a tube of the cream to treat external itching and tenderness. The active ingredient in Canesten is clotrimazole, while in Monistat it’s miconazole. Says Cindy Chen, a clinical pharmacist at Rexall in Victoria, ‘Both stop the growth of the fungus as opposed to killing it. They’re dependent on the person’s immune system to then get rid of the infection.’ So these remedies may not be effective for people who are immune-compromised due to certain medications or conditions. Treatments come in one-, three-, six- and seven-day doses; the shorter the duration, the higher the concentration of active ingredients and the more potential for irritation. One- and three-day treatments are usually suitable for people who don’t get yeast infections often, says Chen. She recommends the seven-day treatment to women who get recurring infections. Do complete the whole treatment.
Need to know: Regardless of which you choose, it takes three days to notice an improvement, and seven for a full recovery. Since these products can leak out of the vagina, insert them at bedtime and wear a panty liner. If the pack does not contain an external cream, Chen says it is safe to use some of the internal cream to treat and soothe irritation around the opening of the vagina. The creams are oil-based, and can weaken latex condoms; spermicides, lubricants and tampons should also be avoided during treatment. Adds Chen, it’s best to avoid sex when you have a yeast infection to avoid passing the infection on to your partner.
Vaginal ovules and tablets
Examples: Life Brand Miconazole 3-Day Ovule Therapy; Canesten 3-Day Combi-Pak ComforTab; Monistat 1 Vaginal Ovule; Monistat 3 Dual-Pak
How they work: These treatments are also inserted into the vagina with an applicator, but in an ovule or tablet form. Monistat ovules (which contain miconazole) are available in one-, three- and seven-day formats, and in combination packs that contain the ovules as well as external cream and soothing wipes. ‘Like the creams, ovules are oil-based, so they can result in a bit of leakage and be a little messy,’ says Chen. Tablets are powders, not oil-based, so they are drier and cleaner. Canesten tablets (which contain clotrimazole) come in one- and three-day treatments, and come with a cream for external vaginal itching.
Need to know: Choose the tablet form if you are sensitive to mineral oil. These products should be used at bedtime, and not in combination with latex condoms, spermicides, lubricants or tampons. Expect three days before symptom relief and a week to fully clear the infection.
Examples: Diflucan One; CanesOral; Monicure; Rexall Fluconazole
How they work: These non-prescription medicines provide a single oral dose of fluconazole. ‘It has the same antifungal action [as the vaginal products], except you take it orally,’ says Chen. ‘It’s no faster in terms of results, but can be more convenient because you don’t have to insert anything and can take the medication at any time of day.’ CanesOral also comes with an external cream, while Monicure comes with wipes containing aloe and lanolin.
Need to know: Talk to your pharmacist before taking these, since fluconazole can interact with certain pain relievers, cholesterol drugs, blood thinners and other medications. Take it after food to minimize the chance of stomach irritation. Do not use these products vaginally. It’s best to abstain from sex for the duration of treatment to avoid passing the infection on to your partner. You will still need to wait three days for symptom relief and seven days for symptoms to disappear.
Examples: Provacare Probiotic Vaginal Care Ovules; Aura Cacia Lavender Milk & Oat Bath; Bio-K+ Probiotic Capsules; Boric acid tablets (available behind the counter at compounding pharmacies); Candigen by Seroyal garlic suppositories; Nature’s Harmony Treemenda Tea Tree Oil
How they work: Provacare is a vaginal suppository containing lactobacillus bacteria; although both Shaw and Chen say it probably will not clear an infection on its own, it may help treatment and prevent future infections. Or try it in combination with oral probiotics for a more potent dose of live lactobacillus; look for products that need to be refrigerated such as Bio-K+ (Bio-K+ has between 12.5 billion and 50 billion live bacteria per capsule, depending on the strength, while each Provacare suppository has 300 million). Shaw says, ‘In studies, garlic has been seen to be effective against the most common strain of yeast. Boric acid also works well [as an antimicrobial].’ The tablets that are inserted vaginally can be useful against resistant or chronic yeast infections, but may be irritating. Says the U.S. National Institutes of Health, there is also evidence tea tree oil, a natural antifungal, can help; Shaw recommends two to three drops diluted in at least triple that amount of water, applied to a tampon and inserted. To soothe irritation, add dried herbs such as lavender and oats (found in Aura Cacia) to bathwater.
Need to know: Talk to your doctor before trying any of these. Tea tree oil and probiotic suppositories can be used twice daily for up to seven days. Boric acid capsules (of 600 mg each) can be inserted once daily, but check with your doctor if you plan to use them for longer than a week. (Keep boric acid away from children; it is toxic when swallowed.) Shaw recommends oral probiotics at a dose of 50 billion active bacteria a day for one month, and then 10 billion a day as maintenance. It’s best to avoid intercourse during any treatment, and to seek medical attention if your symptoms do not resolve within seven days.