What exactly is a vaginal yeast infection?
Yeast live in the vagina all the time in small, harmless numbers. But when these fungi grow out of control, the resulting itchiness, burning, and redness are extremely uncomfortable. In some cases, a thick, white, odorless discharge, resembling cottage cheese, also appears. Lactobacillus bacteria (a healthy type) normally keep the vagina’s pH and yeast levels in check. But the balance can be tipped by antibiotics, corticosteroids, uncontrolled diabetes, or raised estrogen levels from birth control or pregnancy. Yet, in many cases, there’s no easily identified culprit for the pesty yeast infection.
Here’s what’s new, what’s natural, and what’s tried-and-true in the battle to beat vaginal yeast infections:
1- Prescription Tablets
Certain vaginal yeast infections may require a more aggressive treatment than a cream. Your doctor can prescribe one to three doses of the oral antifungal fluconazole, which has a success rate of up to 90%, according to the CDC. If your infection is chronic, “your doctor can give you a standing prescription,” says Reinhold. Having a prescription at the ready may also be worthwhile when starting a course of antibiotics if on previous occasions the drugs prompted a yeast infection.
2- Drugstore Antifungals
The gold-standard treatment for most vaginal yeast infection cases is any one of the creams or suppositories lining drugstore shelves. These products use drugs called azoles, antifungals that have been proven to clear up 80 to 90% of yeast infections. The type of azole varies brand to brand (miconazole is used in Monistat; clotrimazole, in Gyne-Lotrimin), and treatment can span 1 to 7 days. Each is equally effective for a patient with an uncomplicated vaginal yeast infection, so buyers can choose the least expensive, says Reinhold.
One other factor: If you’re particularly itchy, you may prefer a soothing cream. Women with recurrent infections, which are harder to treat, should choose the 7-day option, says Reinhold. (We like Monistat 7 Vaginal Antifungal Cream, $12, amazon.com.) If the infection doesn’t abate, make an appointment: A doctor can determine whether it is yeast at all, and then match the strain to the most effective medication (prescribing Terconazole cream, for example, to thwart non-albicans strains).
3- Progestin-Only Birth Control
Estrogen-based contraception, such as combination birth control pills, may cause an uptick in yeast. “If a patient is very reliant on her method of birth control, we’ll work around it, but it is worth considering nonestrogen methods such as progestin-only mini pills and IUDs,” says Cullen. Spermicides, which can alter the vaginal environment, may also present problems. Birth control aside, Cullen recommends using a lubricant (water-based only, like Shibari Personal Lubricant; avoid yeast-friendly glycerin) during sex: “Friction can upset the ecology of the vagina.”
4- Cotton Underwear (or none)
A warm, moist environment may push a yeasty infection colony into overdrive, so the age-old advice—wear cotton-lined underwear, avoid panty hose and tight jeans, and change out of wet swimsuits and gym clothes right away—still stands. Or, if you’re up for it, go commando. “I’m a big fan of wearing long skirts with no underwear to let air get to the perineal area for women who have a history of chronic infections,” says Jill Rabin, MD, head of urogynecology at Long Island Jewish Medical Center and the author of Mind Over Bladder. She advises against using scented douches, body sprays, and the like, which can disrupt vaginal pH levels. Rabin also suggests showering with an unscented soap (like Dove Beauty Bar for sensitive skin) after sex, especially oral sex, to avoid letting someone else’s bacteria set up shop.
5- Boric Acid Suppository
“For uncomplicated yeast infections, my top-shelf treatment is boric acid,” says Cullen. The substance is a natural antifungal and antiseptic, and studies have shown that it inhibits the growth of Candida albicans, the strain of yeast behind most cases of the infection, as well as other kinds, such as Candida glabrata, an increasingly common cause of infection that tends to be more resistant to other treatments. The powder, an irritant, should never be applied directly; look for a suppository capsule that contains it, such as Vitanica Yeast Arrest ($24, amazon.com), and use for only 5 to 7 days.
6- Tea Tree Oil
The essential oil derived from tea tree leaves has been shown in several lab and animal studies to act as an antifungal against yeast. While more studies need to be done to prove the oil’s efficacy, some women report that they get yeast infection relief from inserting a tampon doused in tea tree oil at night. Try this with caution, Cullen advises: “The vagina is very sensitive, so I would hesitate to put something that might be irritating in an already irritated environment.” If you find this home remedy uncomfortable, discontinue it immediately. Also check in with your doctor first, and make sure to use a 100% pure oil.
7- Home Screening
While women often self-diagnose a vaginal yeast infection, in many cases, “they actually have bacterial vaginosis, which has similar symptoms but, unlike a yeast infection, needs to be treated with antibiotics,” says Jennifer Reinhold, PharmD. Urinary tract infections also have overlapping symptoms (pain and burning, though not discharge), but they, too, require different medications. A home vaginal swab that measures pH levels, taken with an OTC test such as the Monistat Vaginal Health Test ($38, amazon.com), can confirm a yeast infection diagnosis. But health experts recommend that women with complicating factors, such as pregnancy or recurrent infections, schedule a doctor visit.
Many yogurts contain the same type of probiotics that keeps the vagina healthy, yet studies have not been able to prove effectively that eating a daily cup offers any benefit for vaginal yeast infection treatment. But in a recent Italian study, women with chronic yeast infections who placed a probiotic tablet directly in the vagina (once a night for 7 nights, then every 3 nights for 3 weeks, and then once a week) saw their rates of yeast infection drop by 87%. Laurie Cullen, ND, a naturopathic physician and a professor at Bastyr University, suggests treating an infection with a conventional therapy first, and then trying a Lactobacillus pill (such as Jarrow Fem-Dophilus, $30, amazon.com) to maintain a healthy vaginal environment.
For 5% of women, vaginal yeast infections are chronic, returning at least 4 times a year. In a study at Wayne State University School of Medicine, women with a history of recurrent episodes took the oral antifungal fluconazole (Diflucan) weekly for 6 months; during that time, the rate of recurring infection dropped 90%. Six months afterward, 43% were considered cured, compared with 22% of those taking a placebo. (Maintenance therapy with OTC creams, although messier than pills, has also been found effective.)