You just got through it, or thought you did, and then the itching is back. Sounds familiar? You are absolutely not the only one. Up to 75% of women will experience a vaginal yeast infection at least once in their lifetime, and for some of them, it keeps coming back. In this article we explain what's actually happening in your body, where the symptoms come from, and why some women just can't seem to shake it.
What is a vaginal yeast infection, exactly?
A fungus called Candida naturally lives in and around your vagina. That's normal and usually harmless, because the good bacteria in your vaginal flora keep its growth in check. When that balance is disrupted, Candida can multiply out of control. That's what we call a yeast infection, or in medical terms: vulvovaginal candidiasis.
In 85 to 95% of cases, the species Candida albicans is the culprit. But there are other Candida species too, such as Candida glabrata, Candida krusei, and Candida tropicalis. These so-called non-albicans species are becoming more common and are harder to recognize and treat, because they respond less well to standard medication.
The symptoms
The most common signs of a yeast infection are:
- Itching or a burning sensation in and around your vagina
- Thick, white discharge that resembles cottage cheese
- Redness and swelling of the labia
- A burning feeling when you pee
- Pain during sex
Itching is the most characteristic symptom, present in about 90% of women with symptoms. Important to know: not every woman with Candida in her vagina notices anything at all. Especially with non-albicans species, colonization without symptoms is fairly common.
What causes it
A number of factors can disrupt the balance of your vaginal flora and increase the risk of a yeast infection:
- Antibiotic use. Antibiotics don't just kill the bacteria making you sick, they also kill the good bacteria in your vagina that normally keep Candida in check.
- Hormonal changes. Pregnancy, the birth control pill, and even the normal fluctuations of your cycle can affect the balance. Symptoms are more common during the luteal phase of your cycle, when estrogen and progesterone are higher.
- Diabetes. With poorly regulated blood sugar, your urine (and possibly your vaginal tissue) contains more sugar, which feeds Candida growth.
- A weakened immune system. This makes you more susceptible to Candida overgrowth.
- Tight, non-breathable clothing, staying in wet clothes too long, or scented products used around your vagina.
Why it keeps coming back for some women
Doctors define a recurrent yeast infection as three or more symptomatic episodes per year. Why can't some women get rid of it for good? A few explanations from the research:
- Maintenance treatment isn't always enough. Maintenance fluconazole improves quality of life for 96% of women, but is not always durable: one study found that more than 63% of women still had an ongoing infection after completing maintenance therapy.
- Self-diagnosis is harder than it looks. The symptoms of a yeast infection overlap heavily with other causes of vaginal complaints. Research shows that only a portion of women who self-treat for a presumed yeast infection actually have one. That means some women may be using the wrong remedy, while the actual cause of their symptoms goes untreated.
- Candida doesn't only live in the vagina, it's also found in the gut. Standard vaginal treatments work locally and don't address a possible overgrowth in the gut. If that overgrowth is present, it can keep causing reinfection, even after the vaginal treatment seemed to have "worked." This could help explain why some women see their symptoms come back faster than others. Breaking that pattern means supporting the body from the inside too, not just treating locally.
- Non-albicans species are harder to treat. These species respond less well to standard azole treatment (such as fluconazole). The acidity of your vagina plays a role too: at the pH normally found in your vagina, some yeast species turn out to be significantly less susceptible to antifungal medication than at the pH used in standard lab testing.
- Other, not yet fully understood factors. Researchers also point to possible genetic predisposition and under-dosing or incorrect use of medication as factors that may contribute to recurrence, though more research is needed here.
What can help alongside medical treatment
A yeast infection won't go away on its own, antifungal treatment is needed for that. But a few habits can help reduce the risk of new episodes:
- Don't douche: this washes away the protective bacteria
- Avoid scented tampons, sprays, or soaps around your vagina
- Wear breathable, cotton underwear
- Change out of wet clothing (swimwear, gym clothes) quickly
- If you have diabetes: keep your blood sugar as well-regulated as possible
There are also indications that diet plays a role in the health of your vaginal flora. Sugary drinks and meat appear to have a less favorable effect, while fish, nuts, and vegetables are associated with a healthier flora.
When to see your doctor
Contact your doctor if:
- Your symptoms return three or more times a year
- You're pregnant
- You have diabetes that isn't well controlled
- Your symptoms are severe: extensive redness, swelling, or small tears in the skin
- This is your first time and you're not sure what's going on
Getting an accurate diagnosis matters. What works for one woman may not work for another.
Wondering if your symptoms fit a yeast infection?
We got you! Our yeast infection self-test can give you a first, reliable indication at home of whether your symptoms fit a yeast infection. For recurring or persistent symptoms, or if you're pregnant or have diabetes, seeing a doctor or gynecologist remains important.
