Vaginal Yeast Infections

Edited by Mirabella Chan



Vulvovaginal candidiasis (VVC), more commonly known as a vaginal yeast infection, affects up to 75% of women. Luckily, most VVC cases can be self-treated with over-the-counter medications available at the pharmacy.



What causes VVC?


Symptomatic VVC is caused by an overgrowth of Candida albicans and other Candida species. Under normal vaginal conditions, these organisms do not cause any discomfort. When these normal conditions are disrupted, we may see the development of VVC. Risk factors that may predispose someone to frequent vaginal yeast infections include vaginal douching, antibiotic or corticosteroid use, pregnancy, menses, uncontrolled diabetes, immunodeficiency, and stress. It is important to note that VVC cannot be sexually transmitted.


What symptoms are common with VVC?

  • Severe itchiness of vaginal area

  • Stinging and/or burning in vaginal area

  • “Cottage cheese” discharge with no odour

  • Vaginal pH < 4.5


When should a doctor be seen?


Before seeking treatment for VVC, other forms of vaginal infections or sexually transmitted diseases must be ruled out. A doctor should be seen if one is prepubertal, presenting with vaginal symptoms for the very first time, is diabetic, immunocompromised, pregnant, at risk of a sexually transmitted disease, had a vaginal yeast infection in the past 2 months, or experiences more than 3 yeast infections in a year. However, once diagnosed with VVC, women who have recurring symptoms characteristic of VVC may choose an appropriate treatment option. Pharmacists can be of great help when it comes to screening self-care candidates and tailoring the treatment options accordingly.



How can the risk of getting VVC be reduced?


Practicing good genital hygiene is key to preventing vaginal yeast infections. This includes washing the vaginal area once daily with warm water and mild unscented soap. Otherwise, the vagina cleanses itself naturally through its secretions and does not require further maintenance. Avoid vaginal douches, deodorants, and perfumed products as these can cause further irritation. It is also best to avoid tight-fitted clothing and synthetic underwear in an effort to reduce the development of a warm, moist, and irritated vaginal environment.



What treatment options are available?


There are several products available without a prescription for the treatment of uncomplicated vaginal yeast infections. It’s also important to note that treatment does not have to be stopped or delayed when menstruating. The most common and effective options are listed below, in no particular order.


Fluconazole (CanesOral)


An oral antifungal agent which requires a one-time ingestion of a 150 mg tablet. Some potential side effects with taking fluconazole include headache, nausea, and abdominal pain.


Clotrimazole (Canesten Vaginal)


A topical antifungal agent requiring vaginal application. Products exist as 1-, 3-, or 6-day treatments including a vaginal cream or a vaginal tablet. Some products may also include a medicated external cream to help soothe the external itching and burning. Clotrimazole is very well tolerated, with local irritation being a potential side effect.


Miconazole (Monistat)


A topical antifungal agent requiring vaginal application. Products exist as 1-, 3-, or 7- day treatments consisting of a vaginal cream or a vaginal ovule. Some products come with a medicated external cream to help with the external itching and burning. Miconazole is very well tolerated, with local irritation being a potential side effect.



Tips on Inserting Vaginal Products


It is best to do this while lying down at night as this reduces the risk of expulsion and makes the treatment more comfortable. Always wash your hands before getting ready to insert.


Vaginal Cream: To start, the pre-measured or manually loaded applicator should be placed as deep into the vagina as far as it will comfortably go. Next, the plunger should be slowly pressed until all of the cream is deposited into the vagina before removing the applicator.


Vaginal tablet or ovule: To start, the vaginal tablet or ovule should be placed into the end of the applicator. While standing, squatting, or lying on the back, the loaded applicator should be inserted deep into the vagina as far as it will comfortably go. Next, the plunger of the applicator should be fully pressed in order to release the tablet or ovule before removing the applicator.


For pre-filled applicators, discard after use. For resuable applicators, wash with soap and water following use. It is also important to refrain from using intravaginal products (e.g., tampons) or engaging in vaginal intercourse for the duration of treatment.



When should VVC symptoms improve?


Pharmacists are a great resource when it comes to helping guide VVC treatment. Regardless of which product is chosen to treat the vaginal yeast infection, the accompanying symptoms should start to improve within 3 days of starting treatment and resolve within 7 days. A doctor should be seen if treatment failure is experienced as persistent VVC cases may require longer courses of therapy or a change in the antifungal product.



To wrap up…


Vaginal yeast infections are a very common occurrence among women. Luckily, there are many treatment options available that have shown promising results. Pharmacists are an accessible and reliable source when it comes to assessing if over-the-counter products are right for you, helping choose evidence-based treatments, and sharing tips to reduce recurrence.



 


References

  1. Pollock L. Vaginal Symptoms, Hygiene and Infections. In: Compendium of Therapeutics for Minor Ailments. Canadian Pharmacists Association. Updated September 10, 2018. Accessed May 4, 2021. https://myrxtx-ca.proxy.lib.uwaterloo.ca/search

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