Ask the Pharmacist

Q. I repeatedly seem to be experiencing vaginal yeast infections. What can I do about it?

A. Vulvovaginal candidiasis (VVC) is the medical term for yeast infections and what you are describing is recurrent vulvovaginal candidiasis (RVVC). VCC appears to affect 75% of women in their childbearing years at least once. About 10% find themselves having four or more symptomatic infections within a year which is termed RVCC. The prevalence of RVCC is thought to increase significantly over the next decade because of the high numbers of antibiotic misuse, our aging sexually active population using hormone therapy and an increase of certain conditions such as diabetes.

Of RVVC cases, 85-95% are caused by azole-sensitive Candida albicans. For those that might be concerned that your VVC is a result of your sexual activity, you can rest assured it is not. Some factors that may predispose you to VVC are:

· Alterations in the normal vaginal microbiome which ultimately leads to Candida overgrowth. The most common reason for this is antibiotic use.
· Obesity
· Diabetes
· Immunosuppression
· Psychological stress
· Genetic polymorphisms
· Estrogen may increase risk of RVVC but studies are still trying to confirm that statement
· Intrauterine devices
· Condoms/spermicide use
· Poor personal hygiene
· Wearing tight fitting clothes
· Humid weather
· Vaginal douching
· Genetic factors

The signs and symptoms specific to VVC are vaginal itchiness, irritation, redness and swelling of the vulva, external painful urination and painful sexual intercourse.

There is often a vaginal discharge that is white and thick and best described as “cottage cheese” like. A surprising fact is that only 30% of women were able to correctly self-diagnose VVC and a past confirmed diagnosis did not change their ability to self-diagnose.

Treating your symptoms of your vaginal yeast infections will help you feel better in the short term but does not appear to reduce your risk of recurrent infections. This is not surprising since the many risk factors listed above likely have not changed.

As with many conditions, there are changes you can make to reduce your risk of acquiring a yeast infection. First off, you should opt to wear cotton underwear or, at the very least, ensure that the crotch is made of cotton. Secondly, make sure your underwear is not tight-fitting. On that same note, avoid tight-fitting pantyhose and pants as well. This is all to ensure that the vaginal area will be able to breathe.

Other habits that should be avoided include douching (that removes some good bacteria we want in the vaginal area), scented feminine products, hot tubs and very hot baths and unnecessary antibiotic use. Lastly, since yeast/fungi thrive in a moist environment, be sure to remove wet clothing such as swimsuits and workout attire as soon as possible after you are done.

Though Candida albicans is the most common cause of VCC, there are others that may be the culprit such as Candida tropicalis, Candida parapsilosis, Candida krussei, Candida glabata or azole-resistant Candida species. Most RVCC will respond well to fluconazole taken orally every day for 10 to 14 days followed by a maintenance treatment taken once weekly for six months.

During the maintenance phase, only about 5% will have a breakthrough vaginal yeast infection. If this happens, it is important to confirm that this is indeed a VVC infection (recall only 30% of women can correctly diagnose themselves) by a vaginal swab from their health care practitioner and then treat with another 10 to 14 days of daily fluconazole dosing and then resume the weekly maintenance phase. Once the maintenance phase is completed, about 50% will find themselves experiencing more recurrent infections. There are some women that continue taking weekly fluconazole for years but there are no case studies to support its efficacy.

There are some alternative remedies that some women have tried but do not have enough backing to prove its worth. They are boric acid vaginal suppositories and also probiotics.

There is a new oral anti-fungal that might soon be available in Canada called oteseconazole which has been approved in the United States last spring specifically for RVVC. What’s nice about oteseconazole is it has fewer drug interactions and appears to combat more Candida species than fluconazole.

For more information on this or any other health topic, contact the pharmacists at Gordon Pharmasave, Your Health and Wellness Destination.