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By the way, doctor: Why am I still getting yeast infections?

By the way, doctor

Why am I still getting yeast infections?

Q. I recently developed a vaginal yeast infection — a surprise, because I haven’t had one in many years. Aren’t these infections unusual in postmenopausal women?

A. About 75% of women will have at least one episode of vaginal yeast infection, or vulvovaginal candidiasis, at some point in their lives. Though yeast infections are not as common after menopause, they still account for some cases of vaginitis (vaginal inflammation) and are more common in women taking hormone therapy. The microorganism Candida albicans is usually responsible. Candida organisms are normally present in the vagina, mouth, and digestive tract. They usually coexist peacefully with bacteria and contribute to a healthful balance of vaginal microorganisms. Infection occurs only when there is an overgrowth of Candida.

One cause of yeast overgrowth is the use of antibiotics, which are helpful in treating urinary tract and other infections but can also kill bacteria that help keep yeast under control. It’s common to develop a yeast infection after completing a round of antibiotics.

Candida overgrowth tends to occur in women who are pregnant, take oral contraceptives containing high levels of estrogen, or have uncontrolled diabetes; and in women whose immune systems are suppressed by corticosteroids, HIV infection, or chemotherapy. Risk may also be increased by certain contraceptive devices such as sponges, diaphragms, or IUDs, perfumed feminine hygiene sprays or douches, and wearing tight, poorly ventilated clothing and underwear.

Vulvovaginal candidiasis is not considered a sexually transmitted disease, since it can occur in celibate women, and Candida is normally present in the vagina. But the risk increases after women begin regular sexual activity, though the reasons aren’t entirely clear.

Symptoms are the same in women of all ages — itching and soreness of the labia and other tissues surrounding the vagina, burning during urination, and pain during sexual intercourse. A white, clumpy vaginal discharge may also be present.

Since Candida is not the only organism that can cause vaginal infection, itching, and discharge, it’s important for a clinician to confirm the diagnosis. Several oral and vaginal treatments are available. The usual first choice is a vaginal cream used daily for three to seven days or a single oral dose of fluconazole (pregnant women should not take oral fluconazole). Yeast infection may take longer to eliminate in women with severe vaginal inflammation, uncontrolled diabetes, or immune suppression.

— Celeste Robb-Nicholson, M.D. Editor in Chief, HWHW

Last updated:	August 21, 2006