Also called: Yeast Infection (Genital)
David Slotnick, M.D.
Genital candidiasis (also called a yeast infection) is an inflammation of the vagina, prepuce (foreskin) or glans penis (the rounded head of the penis). It is caused by an overabundance of Candida, a microscopic fungus that normally inhabits the human body. There are four types of Candida. However, a variety called Candida albicans (C. albicans) causes the vast majority of genital yeast infections.
Several factors can promote the overgrowth of Candida albicans in the genitalia, including, but not limited to uncontrolled diabetes, certain medications (e.g., steroids, antibiotics), weakened immune system and pregnancy.
In women, symptoms of yeast infection are not always apparent, but may include:
- Thick, white, cottage cheese-like discharge
- Itching, burning or irritation of the vagina
- Pain during sexual intercourse (dyspareunia)
- Burning during urination (dysuria)
Symptoms are rarer in men, but may include genital itching and irritation among others. Men who experience these symptoms should contact their physician.
Patients with recurrent yeast infections are often able to diagnose and treat themselves. However, women exhibiting first-time symptoms of infection should immediately consult their obstetrician-gynecologist (ObGyn, a physician who specializes in treating disorders of the female reproductive system). Women who are (or may be) pregnant should also be seen by their ObGyn prior to beginning any treatment for yeast infections.
Yeast infections are typically diagnosed based on symptoms and, for women, a complete pelvic examination conducted by a physician. In some cases, a slide test may be administered by the physician. This test can analyze the genital secretions of men and women for the presence of yeast organisms.
Yeast infections can be treated with prescription or over-the-counter (OTC) medications. They come in various forms including creams and ointments for the vagina or penis, and suppositories that are inserted directly into the vagina. Oral medications may also be used, but these are available only through prescription.
Treatment options range from one to 14 days in duration although relief from the symptoms usually occurs within the first few days. Yeast infections cannot always be prevented but people can reduce the likelihood of developing them by avoiding risk factors involving clothing and personal hygiene. Left untreated, symptoms of yeast infection may persist and can cause more serious conditions in both women and men, including a lethal blood infection called sepsis.
About genital candidiasis
Genital candidiasis is an inflammation or infection of the vagina, the glans penis (the rounded head of the penis) or the foreskin (prepuce). It is often described as a yeast infection because the fungus that causes it is a type of yeast. Genital candidiasis is very common in women – during a lifetime, almost 75 percent of all women will experience at least one yeast infection and up to 45 percent will experience two or more, according to the U.S. Centers for Disease Control and Prevention (CDC). Yeast infection is believed to be much less common in men, although it can be carried by men or transmitted to men through sexual intercourse.
In both men and women, small numbers of Candida, a single-celled fungus, are always present. Normally, the acidic environment of the genitalia prevents the yeast from growing. When the environment becomes disturbed and the acid level is too low, too many organisms can grow, resulting in a yeast infection.
Candida albicans (C. albicans), which also grows normally in the mouth (thrush) and digestive tract, can spread to other parts of the body, including the skin, mucous membranes, esophagus and other areas. It can cause life threatening systemic infections, such as sepsis, especially in individuals with a weakened immune system. This population includes individuals with diabetes, HIV and pregnant women.
Approximately 5 percent of women with vaginal yeast infections develop a condition called recurrent vulvovaginal candidiasis (RVVC). RVVC is classified as more than three symptomatic vaginal yeast infections over the course of one year. Patients who experience RVVC should notify their obstetrician-gynecologist (ObGyn, a physician who specializes in treating disorders of the female reproductive system) who will attempt to identify the underlying cause of the condition.
Patients with a diagnosed yeast infection who use latex condoms or a diaphragm for birth control should discuss treatment with the physician. Some common medications used to treat yeast infections can weaken latex, and potentially compromise the birth control method and protection from sexually transmitted diseases. Proper diagnosis is important for the correct treatment of yeast infections. The symptoms are similar to other conditions and must be diagnosed correctly to rule out other illnesses or diseases. Left untreated, symptoms of yeast infection – which can be very uncomfortable – may persist and lead to more serious conditions.
Risk factors and causes of genital candidiasis
Several factors can promote the overgrowth of Candida albicans (C. albicans), the most common cause of genital candidiasis (yeast infection), in the vagina and penis. For instance, yeast infections are very common among pregnant women because the hormonal changes associated with pregnancy may increase the amount of sugar in the vaginal secretions. This in turn provides nourishment to the yeast.
Similarly, people with uncontrolled diabetes have an increased risk of developing yeast infections because elevated blood sugar levels impair immune function. When blood sugar levels rise, body secretions contain increased amounts of sugar. In addition, body tissues stop functioning properly. Therefore, normal bodily defenses against intrusion by yeast and other outside substances are diminished.
Older girls may also develop yeast infections, often just before they get their menstrual periods. This is due to the hormonal changes in the body that accompany menstruation.
Certain medications can increase the risk of developing a yeast infection. Oral contraceptives (birth control pills), hormone therapy and corticosteroids can alter the hormone balance in women and increase the growth of yeast. Antibiotics are also considered a risk factor for yeast infections. Antibiotics can kill the “good” bacteria that live in the body. These bacteria normally keep the Candida in the genitalia in check. When they are destroyed, Candida can grow and cause a yeast infection.
Tight fitting clothing, especially undergarments, and synthetic materials can also increase yeast infections. These items can trap heat and moisture and create an optimal environment for the growth of Candida. Damp or wet clothing may contribute to the growth of organisms as well. Experts often recommend cotton undergarments.
Research has indicated that the use of irritating soaps, deodorants, douches and sprays may contribute to yeast infections. The products may change the alkaline levels in the genital area and promote yeast growth. Deodorant tampons may be a risk factor for women, as well as sanitary pads and panty liners. These items can trap moisture in the genital area and promote bacteria growth. Some studies suggest that oral sexual intercourse may also increase the risk of developing genital candidiasis.
People with genital candidiasis can sometimes transmit a yeast infection through sexual intercourse. In addition, yeast infections are more common in men who have not been circumcised.
Other risk factors for yeast infections include:
- Weakened immune system
- Excessive alcohol use
- Use of hot tubs and saunas
- Stress from poor diet, lack of sleep or illness
Signs and symptoms of genital candidiasis
People with genital candidiasis (yeast infection) may not exhibit any symptoms of the condition. Women are more likely to be symptomatic than men. For women, the signs and symptoms may include:
- Thick, white, cottage-cheese-like discharge
- Itching or irritation of the vagina
- Erythema (redness of the vulva or area that surrounds the vagina)
- Rash surrounding vagina
- Pain during sexual intercourse (dyspareunia)
- Burning during urination (dysuria)
Symptoms of yeast infection are generally the same in all women. However, there can be variations from one individual to the next. For instance, one patient may experience more discharge whereas another patient may experience more irritation and redness.
The vaginal tissues are often more sensitive prior to menstruation. Feelings of itchiness during this time may simply be a part of the body’s normal fluctuations. If itchiness subsides after menstruation, treatment for yeast infection is not usually necessary. If symptoms are experienced by men, they often include a burning sensation and/or a rash on the penis. Irritation or pain after intercourse may also occur. In some cases, men may experience thick discharge from the penis similar to that exhibited by women with genital candidiasis. Rarely, a man may develop a swollen foreskin (prepuce) that may cause constriction and pain (phimosis).
Diagnosis methods for genital candidiasis
Genital candidiasis (yeast infection) is one of several types of genital disorders, many of which exhibit similar symptoms. Proper diagnosis is essential to effective treatment. Many people diagnose themselves with a yeast infection based on the symptoms and past experience with the condition. However, the misdiagnosis of yeast infections is common. A study conducted by the American Social Health Association found that 70 percent of women self-treated vaginal infections before calling a healthcare provider. Most often, the women mistook a bacterial infection for a yeast infection. Other problems that people may assume are yeast infections may be irritation from sexual intercourse or tampons (in women), or an allergic reaction.
Following self-diagnosis, people may choose to use over-the-counter (OTC) medications for treatment. Roughly two-thirds of all OTC medications sold to treat yeast infections were used by people who did not have the condition, according to the U.S. Centers for Disease Control and Prevention (CDC). For this reason, people should consult their physician the first time symptoms of a possible yeast infection occur or if they are unsure if they have a yeast infection. In addition, all women who are (or may be) pregnant or breastfeeding must consult their obstetrician-gynecologist (ObGyn) before beginning any treatment. There are some medications that cannot be used by these women.
To diagnose a yeast infection, physicians usually first rely on the symptoms described by the patient. It is important to pay close attention to the symptoms, particularly the time when they first occurred, type of discharge and location of irritation. Women are advised not to douche prior their physician’s appointment as it may mask the symptoms or make accurate testing more difficult.
The physician will obtain the patient’s medical history, including current symptoms. For women, the physician will conduct a pelvic examination. The examination will focus on signs of inflammation or irritation in and around the vagina as well as any vaginal discharge.
The physician may conduct a slide test to analyze the vaginal discharge in women or fluid from the penis in men. In a slide test, the physician will obtain a sample of the genital secretions for a quick examination under a microscope for the presence of yeast organisms, such as Candida. This test is sufficient for diagnosing yeast infection in first-time patients and those with occasional infections. However, in both women and men, cases of recurrent or resistant yeast infections may require further analysis with a genital culture, which is used to identify the presence of other disorders as well as sexually transmitted diseases. The analysis can also aid in diagnosing yeast infections caused by less typical fungi that are often resistant to common yeast therapies.
Treatment options for genital candidiasis
Genital candidiasis (yeast infection) may be treated with either prescription or over-the-counter (OTC) antifungal medications. If a yeast infection is diagnosed by a physician, prescription medication is likely to be given in the form of a cream, suppository or oral pill. Since most people rely on self-treatment, however, OTC medications are more commonly used to treat the condition. Because men are more likely to experience mild symptoms, if any, OTC medications are usually sufficient to clear up a yeast infection in men.
The OTC medications for yeast infections are antifungal drugs that work to break down the wall of the Candida organism until it disappears. The drugs also inhibit the ability of the fungus to multiply and form new membranes. OTC medications for yeast infections contain one of four active ingredients:
- Butoconazole nitrate
The medications for treatment are available in two forms: topical and oral. Topical medications are available by prescription and OTC. They include vaginal creams and ointments that are inserted by the woman into the vagina using a special applicator, or creams that can be applied to the penis. Vaginal suppositories that dispense medicine as they dissolve can also be placed directly into the vagina for treatment. Treatment with these medications can range from several days to two weeks.
Oral medications are only available by prescription and come in the form of tablets or capsules. The dosage and frequency depends on the severity of the yeast infection. People with mild infections may only require a single dose or daily doses for a short duration.
The use of oral or topical forms of medication depends on a number of factors, including the severity of the yeast infection and whether or not the infection is recurrent. A patient’s personal medical history also affects the type of medication that should be used. For example, certain medications should not be used by pregnant women or individuals with a comprised immune system or diabetes. People with these conditions must consult with their physician before beginning treatment for yeast infections.
Some drug regimens may include a combination of treatments, such as an oral agent followed by topical application of a cream. Severe or recurrent infections may require changing the type of medicine or remaining on a medicine for maintenance treatments.
Drug or food interactions may occur with several types of oral medications. Antacids or other drugs that decrease stomach acidity may decrease the effectiveness of oral antifungal drugs. In addition, creams and suppositories may contain oil that can weaken latex condoms. Patients should check with their physician or pharmacist if they are taking other medications before starting yeast infection treatment.
The most common side effects experienced with topical medications include burning or itching of the vagina or penis. Less common side effects include contact dermatitis, inflammation and pain during urination or sexual intercourse. Common side effects with oral medications include fever, dizziness, mild itching and nausea.
Yeast infections generally respond to treatment within a few days. However, individuals are instructed to complete the entire course of treatment, even if symptoms subside before treatment has concluded. It is important to note that although these treatments have an 80 percent to 90 percent success rate, frequent or prolonged use can reduce their effectiveness, according to the U.S. Centers for Disease Control and Prevention (CDC).
If an infection clears up for a period of time but the same symptoms reappear, the patient may be advised by a physician to use a different type of treatment. A new type of medication may be able to completely cure the infection. People should contact their physician if:
- All of the symptoms do not go away completely
- The symptoms return immediately or shortly after completion of treatment
- They have any serious medical problems such as diabetes or immune disorder
- They are pregnant or breastfeeding
Prevention methods for genital candidiasis
Genital candidiasis (yeast infection) cannot always be prevented. However, adhering to the following guidelines may reduce people’s risk of developing a yeast infection:
- Wear loose-fitting undergarments and avoid garments that trap heat and moisture.
- Wear only undergarments composed of cotton or natural fiber or those that have a cotton panel.
- Avoid hot tubs, whirlpool spas and bubble baths.
- Immediately change out of a wet clothes (e.g., bathing suit, exercise apparel).
- If diabetic, monitor and regulate blood sugar.
Women are encouraged to take the following precautions:
- Do not wear panty liners every day and avoid deodorant tampons.
- Avoid use of vaginal sprays, deodorants or douches.
- Exercise proper toilet habits (e.g., wipe from front to rear).
- If menopausal, discuss hormone pills or creams to keep the vagina lubricated and healthy.
Women who experience three or more yeast infections per year may want to speak with their gynecologist about taking boric-acid capsules or eating yogurt with lactobacillus acidophilus cultures. Studies indicate that using these capsules in the vagina and consuming yogurt with live acidophilus cultures daily help “good” bacteria grow and balance the growth of Candida.
Questions for your doctor on genital candidiasis
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to genital candidiasis (yeast infection):
- What may have caused my yeast infection?
- What are common signs and symptoms of yeast infections?
- What steps can I take to prevent getting another yeast infection?
- Can I pass my yeast infection to my partner?
- Can I get a yeast infection if I am postmenopausal?
- What is the best treatment method for a yeast infection?
- What are the chances of yeast infections recurring?
- Are there any vitamin or herbal supplements that can help prevent yeast infections?
- I am pregnant. Will a yeast infection harm my baby?
- What treatment methods are safe to use while pregnant/breastfeeding?