The Call-On-Doc Guide to Vaginal Yeast Infections

Every woman maintains a microbiome in the vagina that includes microorganisms, including bacteria and fungi. A yeast infection is caused by an imbalance in the microbiome, specifically when the bacteria cannot maintain the acidic environment and allow the fungi to grow out of control. Whereas it's called bacterial vaginosis when the bacteria runs rampant, a vaginal yeast infection or vaginal candidiasis occurs when naturally occurring fungi grow beyond what is natural or when the organism is allowed to go deeper into the vaginal cell layers. (3)

• Antibiotic Use: Antibiotics are designed to target and eliminate harmful bacteria. However, they can also affect the beneficial bacteria, like Lactobacillus species, that normally keep yeast in check. When these beneficial bacteria are reduced in number, the balance of the vaginal ecosystem is disrupted, allowing yeast to grow unchecked and potentially leading to an infection.
• Hormonal Changes: Hormonal fluctuations can significantly impact the vaginal environment. During pregnancy, for instance, hormonal changes can lead to increased glycogen (a type of sugar) in vaginal secretions, which yeast can feed on. Similarly, fluctuations in hormone levels during the menstrual cycle or when using hormonal contraceptives can alter the pH and moisture levels in the vagina, creating conditions favorable for yeast overgrowth.
• Weakened Immune System: An immune system that is compromised due to factors such as HIV infection, chemotherapy, or immune-suppressing medications can struggle to regulate the growth of yeast. Normally, a healthy immune response helps keep yeast levels in check, but a weakened immune system can allow yeast to proliferate.
• Uncontrolled Diabetes: Yeast, particularly Candida species, thrive in environments with elevated sugar levels. People with uncontrolled diabetes may have higher levels of sugar in their bodily fluids, including vaginal secretions, creating an environment that supports yeast growth.
• Douching and Irritants: Douching, or the practice of using water or other solutions to clean the vaginal area, can disrupt the delicate pH balance of the vagina and wash away the beneficial bacteria that control yeast. Additionally, using harsh soaps or hygiene products can irritate the vaginal tissues, making it easier for yeast to take hold and grow.
• Tight Clothing and Non-Breathable Fabrics: Tight-fitting clothing and synthetic fabrics can trap heat and moisture, creating an environment where yeast can thrive. This is why wearing breathable cotton underwear and avoiding overly tight clothing is recommended for maintaining a healthy vaginal environment.
• Sexual Activity: While yeast infections are not considered sexually transmitted infections, sexual activity can introduce foreign substances and potentially disrupt the vaginal ecosystem. The friction and potential irritation from sexual activity might also make it easier for yeast to overgrow.
• Personal Hygiene: Good hygiene practices are important for maintaining a healthy vaginal environment. Failing to keep the genital area clean and dry can create an environment where yeast can flourish, especially in warm and moist conditions.

Vaginal yeast infections are seen much more commonly in pregnant women than those that are not. The condition can occur at any point during pregnancy due to hormonal changes, shifts in vaginal pH, changes in diet, and potential immune system fluctuations. While there's no specific time frame when yeast infections are more likely, they can occur in the first, second, or third trimesters.  (3)(4)

Yeast infections are not considered an STD. However, it is possible for a man to indirectly contribute to a woman's yeast infection through sexual activity, particularly if the man has a condition like balanitis. Even if a man does not have the condition, sexual intercourse still contributes to the development of a yeast infection due to how it disrupts the vaginal microbiome. More specifically: 

• Yeast Introduction: During sexual activity, friction and movement can potentially introduce yeast from the genital area of one partner into the vaginal canal of the other partner. While this alone might not directly cause an infection, it can increase the yeast population and create an environment where overgrowth is more likely.
• Vaginal pH Disruption: Sexual activity, including penetration and ejaculation, can introduce substances that might temporarily alter the vaginal pH. Any changes to the vaginal pH can impact the balance of the vaginal microbiota, potentially promoting yeast overgrowth.
• Irritation and Microtears: Friction and physical irritation during sexual activity can create small microtears in the vaginal tissues, providing entry points for yeast and potentially increasing the risk of infection.

Yes, dirty fingers can potentially contribute to the development of a yeast infection. If hands are not properly cleaned before touching the genital area, they can introduce harmful bacteria or foreign substances that may alter the vaginal pH and microbial balance. This disruption can create an environment where yeast can overgrow. Additionally, improper hygiene practices or introducing dirt and bacteria can cause irritation and microtears in the delicate vaginal tissues, providing entry points for yeast and increasing the risk of infection.

Certain foods, particularly those that are high in sugar and simple carbohydrates, can potentially contribute to the development or exacerbation of yeast infections. Yeast, such as Candida, thrive on sugar, so consuming excessive amounts of sugar and foods that break down quickly into sugar can create an environment where yeast can overgrow. Here are some foods that might contribute to yeast infections: 

• Sugary Foods: Consuming high amounts of sugary foods like candies, pastries, and sweetened beverages can provide yeast with a ready source of nutrients to grow and multiply. High sugar intake can also lead to spikes in blood sugar levels, which can promote yeast overgrowth.
• Refined Carbohydrates: Refined carbohydrates, such as white bread, white rice, and pasta, are quickly broken down into sugar in the body. These foods can lead to rapid spikes in blood sugar levels, creating an environment where yeast can flourish.
• High-Glycemic Index Foods: Foods with a high glycemic index cause rapid increases in blood sugar levels. This can contribute to elevated levels of sugar in bodily fluids, providing yeast with the opportunity to grow. Opting for foods with a lower glycemic index, like whole grains and legumes, can help regulate blood sugar levels.
• Alcohol: Alcoholic beverages can contain sugars, and some alcoholic drinks like beer and wine may also contain yeast residues. Consuming alcohol can disrupt blood sugar levels and provide yeast with an additional source of nutrients. It's advisable to moderate alcohol consumption and choose lower-sugar options when possible.
• Processed Foods: Highly processed foods often contain hidden sugars and additives that can encourage yeast growth. These foods can contribute to an imbalanced diet that promotes yeast overgrowth. Opt for whole, minimally processed foods to support a healthier microbial balance.
• Dairy: While dairy products can be part of a balanced diet, excessive consumption of dairy, especially those with added sugars, can contribute to higher sugar intake. Additionally, excessive dairy consumption may lead to increased mucus production, which could potentially affect the vaginal environment.
• Fruit: While fruits offer essential vitamins and nutrients, some fruits are higher in sugar than others. Consuming large amounts of high-sugar fruits can provide yeast with more sugar to feed on. Opt for lower-sugar fruits like berries and incorporate a variety of fruits into your diet.

Yeast infections do not always come with symptoms, with an estimated 20% of women that get the condition remaining asymptomatic. (5) However, for those that do, yeast infection symptoms typically include: 

• Vaginal Itching: Itching is often the most noticeable and persistent symptom of a yeast infection. The itching can vary in intensity, ranging from mild discomfort to an intense urge to scratch. It may be localized to the vaginal area or extend to the vulva and surrounding skin.
• Abnormal Discharge: Yeast infections typically lead to changes in vaginal discharge. The discharge becomes thicker, resembling cottage cheese in texture. It's usually white or whitish-gray and might not have a strong or unpleasant odor. The increase in discharge is due to the overgrowth of yeast in the vaginal environment.
• Burning Sensation: Many individuals with yeast infections experience a burning or stinging sensation, particularly during urination. This discomfort can be caused by the irritation of the vaginal tissues and the presence of excess yeast.
• Redness and Swelling: The vulva and the tissues around the vaginal opening might become red, swollen, and visibly irritated. This redness and swelling are often accompanied by itching and discomfort.
• Soreness and Discomfort: The vaginal area can feel sore, tender, and generally uncomfortable. The constant irritation can lead to a sensation of discomfort even when not actively scratching or touching the area.
• Pain During Intercourse: Yeast infections can cause pain or discomfort during sexual intercourse, which is often attributed to the inflammation and sensitivity of the vaginal tissues.
• Rash: In some cases, a red rash might develop on the skin outside the vaginal area, including the labia. This rash can be a result of the irritation caused by the yeast overgrowth.
• Discomfort with Clothing: Wearing tight clothing or underwear might exacerbate the itching, burning, or discomfort associated with a yeast infection. Loose-fitting, breathable clothing can help alleviate these symptoms.

The onset of yeast infection symptoms can bring about sensations that often include vaginal itching, discomfort, and a burning sensation. You might notice persistent itching in and around the vaginal area, which can be accompanied by feelings of irritation. As the infection progresses, you may experience changes in vaginal discharge, such as an increase in thickness and a texture resembling cottage cheese. The vulva and surrounding tissues might appear red, swollen, and visibly irritated. Alongside this, a sore and sensitive sensation can be present in the vaginal area, which can be intensified during activities like urination or sexual intercourse.

Yeast infections themselves typically do not directly cause bleeding. However, yeast infection symptoms that cause a person to itch around and in the vagina might lead to minor abrasions of the vaginal tissue. 

In some cases, a medical professional will provide a clinical evaluation, physical examination, take a swab for microscopic examination, and review symptoms with the patient. (6) However, typically, the doctor will only need to review the symptoms in discussion with the patient before providing a prescription, like in the case of CallonDoc. 

• Observe Symptoms: Pay attention to any symptoms you might be experiencing, such as persistent vaginal itching, abnormal discharge, burning during urination, redness, swelling, soreness, or discomfort.
• Check Discharge: Examine your vaginal discharge. If you notice a thick, white, cottage cheese-like discharge that lacks a strong odor, it could be a sign of a yeast infection.
• Examine External Area: Gently check the external genital area for redness, swelling, or any visible signs of irritation.
• Monitor Discomfort: Take note of any discomfort or pain you might be feeling, especially during urination or sexual intercourse.

• Bacterial Vaginosis: Bacterial vaginosis (BV) and yeast infections share common symptoms like vaginal itching and discomfort. However, BV typically presents with a thin, grayish discharge that has a fishy odor, while yeast infections cause a thick, white, cottage cheese-like discharge without a strong odor. Both conditions can cause irritation, but the nature of the discharge and its odor are key differentiating factors. 
• Urinary Tract Infections: Yeast infections and urinary tract infections (UTIs) share some overlapping symptoms like discomfort and burning during urination. However, yeast infections primarily cause itching, abnormal discharge, and redness in the vaginal area. UTIs often result in frequent urination, urgency, and lower abdominal pain.
• Trichomoniasis: Yeast infections and trichomoniasis both involve vaginal discomfort and abnormal discharge. However, yeast infections produce a thick, white discharge with itching, while trichomoniasis leads to a frothy, yellow-green discharge with a strong odor. Additionally, trichomoniasis may cause discomfort during urination and sexual intercourse. 
• Chlamydia: Yeast infections and chlamydia infections can both cause vaginal discomfort and discharge. However, yeast infections produce a thick, white, cottage cheese-like discharge with itching, while chlamydia often causes a clear or cloudy discharge with less pronounced itching. Chlamydia may also lead to lower abdominal pain and discomfort.
• Contact Dermatitis: Yeast infections and contact dermatitis both involve itching and discomfort in the vaginal area. However, yeast infections also lead to abnormal discharge and redness, while contact dermatitis results from an allergic reaction to irritants like soaps or hygiene products and may cause redness, swelling, and a rash.

Most often, doctors will prescribe antifungal medications specifically designed for yeast infection treatment. The following medications are known to treat and clear yeast infections within a few days of taking them:

• Diflucan: Diflucan, the brand name for fluconazole, is an oral antifungal medication that treats yeast infections by inhibiting the growth of the Candida yeast responsible for the infection. It targets the fungal cell's ability to produce ergosterol, a key component of the cell membrane, weakening the yeast and ultimately leading to its death and the resolution of the infection.
• Terconazole: Terconazole, available as a cream or suppository, treats yeast infections by disrupting the fungal cell membrane's integrity. As an antifungal agent, it interferes with the synthesis of ergosterol, a vital component of the yeast cell membrane, weakening the cell's structure and causing it to die off, thus effectively resolving the yeast infection.
• Clotrimazole: Clotrimazole, commonly found in creams and suppositories, treats yeast infections by targeting the cell membrane of the Candida yeast causing the infection. It inhibits the synthesis of ergosterol, a crucial component of the cell membrane, resulting in membrane disruption and subsequent cell death, leading to the resolution of the yeast infection.
• Nystatin: Nystatin, available in various forms like creams, ointments, and oral solutions, treats yeast infections by directly attacking the cell walls of Candida yeast. It binds to components within the cell wall, disrupting its integrity and causing the cell to leak and eventually die, effectively eliminating the yeast infection.

If you don't have a yeast infection and you use an antifungal or yeast infection treatment, it's possible that the treatment might cause irritation or discomfort in the vaginal area. Antifungal medications are designed to target and eliminate yeast cells, so using them when yeast overgrowth isn't present can disrupt the natural balance of the vaginal microbiota and lead to irritation.

• Maintain Good Hygiene: Gently wash the genital area with water and mild, unscented soap. Avoid using douches or harsh cleansers that can disrupt the natural pH balance. Due to the vagina being a self-cleaning organ, DO NOT put soap or water inside of the vagina. 
• Breathable Clothing: Choose cotton underwear and loose-fitting clothing to allow air circulation and prevent moisture buildup, which can create an environment conducive to yeast growth.
• Irritants: Avoid scented products like soaps, powders, and tampons, as they can cause irritation and disrupt the vaginal environment.
• Moisture Management: Change out of wet clothing, swimsuits, or workout attire promptly to prevent moisture from promoting yeast growth.
• Blood Sugar Control: If you have diabetes, maintaining stable blood sugar levels can help prevent recurrent yeast infections.
• Dietary Choices: Reducing your intake of high-sugar and refined carbohydrate foods can help create an environment less favorable for yeast growth.
• Probiotics: Consuming foods with probiotics or taking oral probiotic supplements might help maintain a balanced vaginal microbiome.

Mild yeast infections might resolve on their own, but more often than not, yeast infections require treatment to fully clear up. The natural balance of the vaginal microbiome can sometimes help control yeast overgrowth, allowing mild infections to subside without intervention. However, many factors can affect this process, and untreated yeast infections can persist or even worsen over time.

To prevent yeast infections naturally, you can adopt a holistic approach that focuses on maintaining a healthy vaginal environment. Practice proper hygiene by gently cleansing the external genital area with mild, unscented soap and water. Opt for breathable cotton underwear and loose-fitting clothing to reduce moisture buildup. Adjust your diet by minimizing sugar and refined carbohydrate intake while incorporating probiotic-rich foods like yogurt to support beneficial vaginal bacteria. Avoid irritants such as scented products and promptly change out of damp clothing to prevent moisture accumulation. Manage underlying health conditions like diabetes and prioritize stress reduction techniques such as meditation or yoga to support a strong immune system. Overall, a balanced lifestyle with adequate sleep, regular exercise, and a nutrient-rich diet can contribute to optimal vaginal health.

In the instance that you do get a yeast infection, CallonDoc offers same-day consultations and yeast infection treatment for each patient. Not only are services affordable, but can be completed quickly and privately online from the comfort of your home.

1. “Vaginal Yeast Infection.” Harvard Health, 19 March 2019, https://www.health.harvard.edu/a_to_z/vaginal-yeast-infection-a-to-z.
2. Wray, Anton A., et al. “Balanitis - StatPearls.” NCBI, https://www.ncbi.nlm.nih.gov/books/NBK537143/.
3. “Yeast infection (vaginal) - Symptoms and causes.” Mayo Clinic, 11 January 2023, https://www.mayoclinic.org/diseases-conditions/yeast-infection/symptoms-causes/syc-20378999.
4. “Yeast Infections During Pregnancy.” American Pregnancy Association, https://americanpregnancy.org/healthy-pregnancy/pregnancy-complications/yeast-infections-during-pregnancy/.
5. “Vaginal Candidiasis | Fungal Diseases.” CDC, https://www.cdc.gov/fungal/diseases/candidiasis/genital/index.html.
6. “Vaginal Yeast Infection: Causes, Symptoms & Treatment.” Cleveland Clinic, 2 September 2022, https://my.clevelandclinic.org/health/diseases/5019-vaginal-yeast-infection#diagnosis-and-tests.