Vaginal yeast (Candidiasis): causes, symptoms and prevention

Candida is a fungus, the most common species of which, albicans, usually lives in small concentrations in the oral cavity, in the intestines, on the skin, in the genital mucous membranes, without causing any disturbance, in constant equilibrium with the other host microorganisms in our organism

In the vagina, together with other (more numerous) bacteria, in particular Bacillus Doderlein, it forms the so-called ‘vaginal ecosystem’.

The right balance between the various components allows the maintenance of a normal pH (between 3.8 and 4.5) and proper lubrication of the vagina.

Alteration of the vaginal pH (increase or decrease in normal values), by breaking the balance of this ecosystem, favours the proliferation of pathogenic germs.

How candida vulvovaginitis develops

The development of candida yeast finds an excellent breeding ground in acidic environments such as the vaginal environment, where fermentative phenomena prevail.

A number of predisposing conditions have been identified that, through alteration of the ecosystem, favour the development and appearance of the typical symptoms of the infection:

  • certain physiological changes in which there is an increase in oestrogen (premenstrual phases, pregnancy, hormone replacement therapy in post-menopause). Oestrogens play a key role in the development of candida as they are responsible for the increase in vaginal glycogen, a sugar important for candida metabolism.
  • Metabolic diseases (such as diabetes), diets high in sugar, certain medications (such as cortisone and antibiotics) directly alter the vaginal bacterial flora. This type of infection is also frequently encountered when using oral contraceptives.
  • Personal habits can very often alter the vaginal ecosystem: dietary abuse, a diet rich in yeasts (pizza, bread, biscuits, crackers, leavened cakes) and sugars (wine and alcohol); a change in diet, physical exertion (frequent cycling or motorcycling), travelling, particular stressful situations and, finally, an individual propensity on a genetic basis.

Is candida yeast sexually transmitted?

Although some authors and numerous websites attribute an important role in the transmission of the disease to sexual intercourse, Candida yeast is not considered a sexually transmitted infection.

Its occurrence, as mentioned above, is linked to endogenous factors that alter the pH and balance of the vaginal bacterial flora.

Indeed, very often the infection develops in the absence of sexual intercourse.

However, it can occasionally be transmitted to the male partner, who manifests redness, the formation of shiny reddish patches located on the glans and foreskin, burning, itching, and sometimes pain in the inflamed area.

The reinfecting ability of men, the so-called ‘ping-pong’ effect, is not significant.

How to recognise the symptoms of candida yeast

The main and most characteristic symptoms are

  • intense and sometimes incoercible itching
  • white vaginal discharge with an appearance similar to cottage cheese or curdled milk, not smelling bad.

There is redness and swelling and sometimes abrasions from scratching are present.

The urinary tract may also be affected with pain and burning on urination.

In the case of clearly recognisable symptoms (especially in the case of women who have already suffered from candida vaginitis), a few initial remedies are advisable in order to alleviate the complaints while waiting for medical advice.

Candidiasis: behavioural tips and therapy

  • One of the easiest remedies to find and one of the most effective is sodium bicarbonate diluted in lukewarm water (one tablespoon in a quarter of a litre), which can be applied in the form of an external lavage or vaginal irrigation with an enema perette. Some commercially available antifungal douches are also effective.
  • The pharmacist may recommend an antifungal vaginal cream to be applied to the part only externally, thus not compromising the possibility, in the event of an uncertain diagnosis, that the doctor may subsequently perform vaginal sampling.
  • Diet is also very important in accelerating healing. Therefore, it is advisable to avoid excessive consumption of carbohydrates, sugars and foods particularly rich in yeast, as such foods tend to encourage yeast fermentation and the proliferation of candida yeast.
  • Good dietary rules against the fungus also include the avoidance of sweets, chocolate, alcohol, sugary drinks, bread and pizza with a concomitant increased consumption of protein foods such as eggs, meat and fish. Other healthy foods such as vegetables are recommended, especially spinach, broccoli and asparagus.

Very often, once the triggering causes have disappeared and the balance of the ecosystem has been re-established, the candida heals spontaneously; therefore, these modest remedies may be sufficient.

However, it is advisable to consult your doctor, who will be able to recommend a possible pharmacological therapy, usually based on antifungal creams or ova, or an oral antifungal therapy.

During pregnancy, local therapies, again based on creams or ova, can be used effectively and safely.

Recurrent candidiasis

Candida vulvovaginitis, after bacterial vaginosis, is the most frequent vulvo-vaginal infection.

It is estimated that acute episodes of candida affect about 70-75% of women of childbearing age at least once in their lifetime and that 30-40% experience a recurrence in the following months.

It can also occur many months after the first episode as well as not recurring later in life.

However, 5-10% of patients develop a recurrent form.

Recurrent vulvovaginitis is defined as vulvovaginitis that occurs with a frequency of at least 4 episodes in a year.

Such recurrent forms are particularly challenging to manage.

Prolonged prevention (for at least six months) with antimycotics, by mouth or in ova taken cyclically, is necessary.

Medications and treatment regimes vary according to the experience of individual experts.

However, medication is not enough: known risk factors, such as diabetes mellitus, oral contraception, poor hygiene, unsuitable clothing (tight trousers, jeans, pantyhose, panty liners, etc.), frequent cycling and motorcycling, must be identified and corrected.

A diet low in sugar and yeast, limiting foods with fructose and honey, one hour of aerobic activity every day in order to improve peripheral insulin utilisation should be adopted.

Some authors recommend the use of condoms in sexual intercourse and partner care.

The recurrence of inflammation can cause vulvar vestibulitis, also called ‘provoked vestibulodynia’, characterised by pain during intercourse and persistent burning, which can worsen and become chronic until it becomes independent of intercourse, affecting the entire vulva (vulvodynia).

Vulvodynia may persist for a long time even in the absence of Candida infection.

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