The vaginal flora is a delicate balance between the bacterial
and fungal flora. A notable member of the bacterial flora is the lactobacillus
acidophilus which help maintain the acidic environment that helps maintain the
balance. Conditions that deplete the bacterial floral inadvertently allow the
fungal population to escalate.
Factors that predispose to vaginal yeast infection includes:
Injudicious use of antibiotics, immune suppression, prolonged steroid use,
diabetes mellitus, douching, pregnancy etc
Many women find yeast infection very upsetting especially as
it has a propensity for reoccurrence, it may become particularly distressing
during pregnancy. Elevated estrogen levels during pregnancy increases vaginal
production of glycogen on which yeast tends to thrive.
Over-enthusiastic douching or cleansing with antiseptic soap
reduces normal vaginal bacteria flora thus favoring escalation of yeast
population.
Vaginal yeast infection presents often as vaginal discharge,
creamy or cheesy in most cases. It is usually not foul smelling but with
associated vaginal itch which may be particularly distressing
Below are ways of managing vaginal yeast infections;
1. Avoid over-enthusiastic douching – Cleaning
up after visiting the urinals is a hygienic ritual, however urine is naturally
sterile thus overzealous cleansing with antiseptic soaps and liquid is not only
unnecessary, it may pose a health risk, as it depletes the vaginal bacteria
flora especially the lactobacillus acidophilus hence causing increased pH and
increased glycogen store with subsequent overgrowth of the yeast flora.
Cleaning up with ordinary clean water will suffice and will help maintain a
balance in the normal vaginal flora thus preventing a recurrence of vaginal
yeast infection.
Avoid
Moisture – The
perineum because of its anatomical and physiological make up, tend to be wet,
this makes it a favorable niche for Candida growth, therefore the perineum
should as much
1. as
possible be kept clean and dry. After using the toilet or urinals use a dry
swipe to clean up from front to backwards. If socially acceptable one may sleep
at night with a breathable night gown without panties.
2. Appropriate Underwear – Avoid tight
pants with nylon or synthetic fabrics e.g. panty hose. Use cotton underwears as
much as possible. Avoid tight synthetic dresses instead opt for light materials
that encourage aeration.
3. Antibiotic use – Avoid injudicious and
indiscriminate use of antibiotics especially without a doctor’s prescription as
this may deplete the bacteria flora of the vagina and increasing yeast growth.
If on prolong antibiotic prescription patient should inform their doctors of a
recurrent yeast infection so that an antifungal agent can be prescribed along
side.
4. Avoid prolong steroid use - Prolong use
of steroids should be avoided if possible as it may cause immune suppression
and subsequent yeast infection. Patients on prolong steroids may also be placed
on antifungal agents.
5. Antifungal agents – Several antifungal
creams and vaginal pessaries are available as over-the-counter medications. Common
antifungal agents like clotrimazole, nystatin and fluconazole are available as
oral agents, creams and vagina pessaries. It is however advised that antifungal
agents be used after seeing a General practitioner to properly diagnose vaginal
yeast infection and to determine the appropriate antifungal agent to use.
6. Laundry Care - When doing laundries,
separate the under wears. Soak and wash with warm water. This will kill the
yeasts on the fabrics and preventing re-inoculation.
7. Balanced diet and Fruits - healthy
feeding habits, with food and fruits rich in vitamins, amino acids and
essential minerals help in fortifying the immune system and thus prevent
opportunistic overgrowth of yeast. This is especially important in the
immunocompromised and patients suffering from debilitating or chronic
illnesses. Patients can consult their dietitian for advice on immune boosting
diets.
8. Glycemic control - Diabetics should
work closely with their physician for optimal glycemic control. This could be
achieved by strict dietary modification, use of oral hypoglycemic agents or
insulin injections and adequate monitoring of blood sugar, home or self
monitoring with a glucometer is encouraged. The diabetic state is immune
suppressing hence diabetics are prone to sepsis and vaginal yeast infections.
Hence the treatment goal in diabetic with recurrent yeast infection is to
achieve strict glycemic control. Podiatric care is an integral part of diabetic
care, ensure proper kind of foot wears, ensure dry and clean feet to prevent
mycotic foot disease e.g. Athlete’s foot disease.
9. Safe sex - Suggesting that vaginal
yeast is sexually transmittable is controversial however certain sexual
practices like oral and anal sex may be a predisposition. Appropriate use of
condom may be beneficial. Safe sex is advised for overall reproductive health
and wellbeing of every woman, as it will prevent other sexually transmitted
infections and unplanned pregnancy.
10. Oral Contraceptive Pills – Oral
contraceptive pills with high estrogen content has been implicated as a
predisposition to vaginal yeast infection. High estrogen level increases the
glycogen production in the female birth canal hence allowing the yeast
population to proliferate. Patients on oral contraceptives and having recurrent
vaginal yeast infections should discuss with their caregiver for other
appropriate contraceptive options.
1. Menopause – Menopause and its attendant
distressing symptoms may necessitate women to procure Hormone replacement
therapy to ameliorate the stress of menopause. Women on Estrogen replacement therapy may be prone to recurrent
vaginal yeast infections. This is also linked to increased vagina glycogen
causing Candida to proliferate. Patient on Estrogen replacement therapy should
compare the risk- to- benefit ratio and discuss with their physician on other
available coping strategies for distressing menopausal symptoms.
2. Pregnancy – Elevated blood estrogen
during pregnancy predisposes to yeast infection. Recurrent yeast infection with
discharge may raise anxiety in a pregnant woman. Treatment with oral antifungal
agents is not advised whereas vagina pessaries may be safely used. It is
however important to explain to and reassure patient to prevent unnecessary
medical intervention as discharge from yeast infection during pregnancy is
often harmless and self limiting. Cleaning the vagina with clean water may also
be helpful.
3. Yogurt – This common drink made from
bacteria fermented milk is rich in harmless bacteria especially the
Lactobacillus species. The bacteria are used to ferment milk as crucial step in
the manufacturing of yogurt. Lactobacillus in yogurt theoretically can be used
to effect a balance in the vagina bacteria flora. The capacity to effect
significant change in vaginal flora by drinking yogurt maybe difficult to
substantiate in evidence based manner, however home remedies with application
of yogurt in the vagina with the use of pads has offered some relieve and
appears theoretically feasible. There have not been reports of harm resulting
from this practice hence it can be tried if it is personally acceptable.
4. Vinegar – The application of apple
cider vinegar has provided symptomatic relieve from yeast infections. It
particularly relieves the itching. Lack of scientific evidence-based study to
support this home remedy makes its general acceptability difficult. However no
particular harm as been attributed to this practices, so if it works for you, I
guess it is okay.
Yeast infection in young girls
just after attaining menarche may be particularly distressing to the naïve
young individuals. It is important that parents understands that not all vagina
discharge results from sexually transmitted infections. The estrogen surge
associated with commencement of the menstrual cycle also makes the vagina a
fertile ground from growth of yeast; hence candidiasis may occur in girls just
attaining menarche even without prior sexual contact. Educate such young girls
against douching and overzealous cleaning up with antiseptic soaps especially
when menstruating.
The use of home remedies for cure
of vaginal yeast infection need to be carefully looked into so as not to fall
prey of charlatans taking advantage of patients for a quick buck. Certain home
remedies appear theoretically plausible but lack of scientific documentation to
back up such claims makes them to remain at best a hypothesis, however some of
these home remedies appear to give some symptomatic relieve.
The use of Estrogen replacement
therapy for menopausal symptoms remains controversial in terms of the overall
benefit needs to be weighed against the attending risk.
Certain medical conditions necessitate
prolong use of steroids, however steroid abuse by individuals is strongly
discouraged. Steroid prolong use inadvertently diminishes the strength of the
immune system, hence the body is prone to opportunistic infections, this
include yeast infections.
Patients suffering from chronic
debilitating illnesses and immune deficiencies e.g. HIV are particularly
susceptible to yeast infections, either as systemic mycoses or superficial
mycoses.
Geriatric populations and old
people institutionalized in care homes may also be prone to yeast infections.
This is particularly so because of the relative immune suppression associated
with extreme age groups. Such individuals become more and more incapable of
self hygiene hence they need care and assistance in terms of grooming and
hygiene to forestall yeast infections. Mycotic infections can be the cause of
atypical pneumonia in old people. Great
attention must be paid to podiatric care to ensure dry clean feet to avoid
athlete’s foot disease.
Prompt medical attention is
advised for such individuals, they should see their caregiver as soon as they
experience any strange symptoms.
The role of diet cannot be over
emphasized, vitamins and minerals acts as anti-oxidants, assist in re-epitheliazation
of membranes. They also boost the human immune systems thus mounting first line
of defense against infections including yeast infections.
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