Vaginal yeast infection - few coping tips

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.