Getting to the Root Cause of Recurring Vaginal Yeast Infections
by Naturopathic Doctor Pamela Frank, BSc(Hons), ND
Most women experience it at least once in their lifetime: that itching, burning, irritated and white chunky discharge that signifies a vaginal yeast infection. A one-off yeast infection is no big deal, you just head to the nearest pharmacy, grab some over the counter yeast infection treatment and Bob’s your uncle. But, there are many women for whom the OTC treatments just plain don’t work or they only work temporarily and the yeast infection recurs within a few weeks or months. If you are one of these unfortunate ones that yeast is driving batty, here are some ways to get at the root of the yeast problem for good:
First off, is it really yeast?
If yeast treatments don’t work, this is the first thing we have to ask ourselves. Did vaginal swabs show yeast or come back clear? If they came back clear then here are some options:
a) Repeat the swab. Lab tests aren’t fool proof, sometimes mistakes are made and sometimes yeast fails to show up on a particular swab but does show on the next one.
b) Itching, burning, irritation and discharge signify vaginal irritation, but not necessarily from yeast. Such vaginal irritation and inflammation can also be caused by bacterial overgrowth (bacterial vaginosis), food sensitivities, allergies to latex condoms or spermicides, vaginal dryness, hormone imbalances and even allergies to semen. Of these, food sensitivities are extremely common and often something that women don’t realize they have. Vaginitis, inflammation of the vagina, may be the only obvious symptom. Gluten and dairy are common triggers for this.
It is a Yeast Infection
Vaginal swabs did show yeast and symptoms improved with yeast treatment but the yeast infection came back. Then we have to ask, why is your system so receptive to yeast?
a) Pregnancy1 – Since hormones influence yeast susceptibility and pregnancy is an altered hormonal state, you might be more susceptible to yeast infections while pregnant. Also during pregnancy, immune function is somewhat lower in order to protect the developing baby from rejection by the immune system.
b) Birth control pills1 and HRT2 – Many of my patients have told me that they got frequent yeast infections while on birth control pills. Estradiol (estrogen), down-regulates the immune system response to Candida albicans.9
c) Antibiotics1 – antibiotics kill not only the bacteria that is causing your infection (bladder infection, strep throat etc), but also the beneficial bacteria that reside in the digestive tract and in the vagina. These good bacteria create an environment that is inhospitable to yeast growth and produce a vaginal biofilm that hinders persistent yeast infection7. This is why we always recommend taking a good quality probiotic any time that you have to take antibiotics.
d) Inadequate progesterone production3 – Progesterone has been demonstrated to reduce the capacity of C. albicans strains to form biofilms and to colonise and invade vaginal epithelium.
e) Disordered glucose metabolism6and diabetes4 – What would diabetes have to do with Candida? Lots. Higher blood sugar levels mean that sugar is being transported via the blood stream to the vagina and feeding yeast. Sugar also suppresses the immune system. So if you’re consuming lots of sugary or refined carbs, you make a perfect environment for yeast to thrive.
f) A weakened immune system – HIV positive women have been found to be at much greater risk of vulvovaginal Candidiasis5, which would be expected given their low resistance to infection. You may not be as extremely immune compromised as an HIV patient, but if you’re under high amounts of chronic stress, not sleeping enough, not exercising and eating junk, your immune system will be weak and incapable of fending off yeast.
g) Use of vaginal hygiene products, such as douches and bubble bath that alter the vaginal pH6. The normal vaginal pH in menstruating women is about 4.0, rising to 4.5 at menstruation. Beneficial bacteria like Lactobacillus acidophilus produce and thrive in an acidic environment. When the pH is shifted even slightly toward a more alkaline state, Candida converts from a mild yeast form into a more virulent, infection-causing form.10
h) Iron Deficiency Anemia – Some research suggests that iron deficiency anemia shifts the balance of the two arms of the immune system, Th1 (the microbe killing portion) and Th2 (the allergy portion), away from Th1 and more toward Th2. Meaning the immune system defenses don’t work as well to kill the yeast and create more of an allergic response.8
i) Anti-fungal resistance – the anti-fungal treatment worked to reduce the yeast numbers temporarily; however, some of the yeast was resistant to the treatment and bounced back once the course of treatment was complete.
j) Changes in vaginal pH throughout the menstrual cycle. Some women will get a yeast infection around their period every month. The vaginal pH does increase around your period and may be allowing yeast overgrowth. Probiotic bacteria help maintain a healthy vaginal pH and balancing hormones will also help maintain a normal vaginal pH throughout your cycle.
k) Sexual transmission – If a woman suffers from repeated vaginal yeast infections, the possibility of transmission from her partner needs to be considered. Research on recurrent vulvovaginal Candidiasis has suggested no association between recurring infection and Candida infection in her sexual partner, however, the limitation of this research is that yeast culture was obtained superficially11, where yeast infection has been found in males as high as the prostate12.
A naturopathic physician can help balance hormones, restore healthy vaginal and digestive tract flora, correct iron deficiency and improve immune function for lasting improvement from recurring yeast infections.
- Anis Ahmad, Asad U. Khan “Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India” European Journal of Obstetrics & Gynecology and Reproductive Biology, Volume 144, Issue 1, May 2009, Pages 68–71.
- Fischer G1, Bradford J., “Vulvovaginal candidiasis in postmenopausal women: the role of hormone replacement therapy”. J Low Genit Tract Dis. 2011 Oct;15(4):263-7.
- Alves CT, Silva S, Pereira L, Williams DW, Azeredo J, Henriques M, “Effect of progesterone on Candida albicans vaginal pathogenicity Int J Med Microbiol. 2014 Jul 25. pii: S1438-4221(14)00086-1.
- Gunther LS, Martins HP, Gimenes F, Abreu AL, Consolaro ME, Svidzinski TI “Prevalence of Candida albicans and non-albicans isolates from vaginal secretions: comparative evaluation of colonization, vaginal candidiasis and recurrent vaginal candidiasis in diabetic and non-diabetic women.” Sao Paulo Med J. 2014;132(2):116-20.
- Apalata T, Longo-Mbenza B, Sturm A, Carr W, Moodley P, “Factors Associated with Symptomatic Vulvovaginal Candidiasis: A Study among Women Attending a Primary Healthcare Clinic in Kwazulu-Natal, South Africa” Ann Med Health Sci Res. 2014 May;4(3):410-6.
- Donders GG1, Bellen G, Mendling W., “Management of recurrent vulvo-vaginal candidosis as a chronic illness.” Gynecol Obstet Invest. 2010;70(4):306-21.
- Murina F1, Graziottin A, Vicariotto F, De Seta F, “Can Lactobacillus fermentum LF10 and Lactobacillus acidophilus LA02 in a Slow-release Vaginal Product be Useful for Prevention of Recurrent Vulvovaginal Candidiasis?: A Clinical Study”, J Clin Gastroenterol. 2014 Nov-Dec;48 Suppl 1:S102-5.
- Naderi N1, Etaati Z, Rezvani Joibari M, Sobhani SA, Hosseni Tashnizi S, “Immune deviation in recurrent vulvovaginal candidiasis: correlation with iron deficiency anemia”, Iran J Immunol. 2013 Jun;10(2):118-26.
- Lasarte S, Elsner D, Guía-González M, Ramos-Medina R, Sánchez-Ramón S, Esponda P, Muñoz-Fernández MA, Relloso M., “Female sex hormones regulate the Th17 immune response to sperm and Candida albicans” Hum Reprod. 2013 Dec;28(12):3283-91.
- C Monteagudo, A Viudes, A Lazzell, J P Martinez, J L Lopez-Ribot, “Tissue invasiveness and non-acidic pH in human candidiasis correlate with ‘‘in vivo’’ expression by Candida albicans of the carbohydrate epitope recognised by new monoclonal antibody 1H4” J Clin Pathol 2004; 57:598–603
- Lisboa C, Costa AR, Ricardo E, Santos A, Azevedo F, Pina-Vaz C, Rodrigues AG. “Genital candidosis in heterosexual couples.” J Eur Acad Dermatol Venereol. 2011 Feb;25(2):145-51.
- Mayayo E, Fernández-Silva F. “Fungal prostatitis: an update”. Anal Quant Cytopathol Histpathol. 2014 Jun;36(3):167-76.
DISCLAIMER: The information provided here may not apply precisely to your individual situation. Diagnostic and therapeutic choices must always be tailored to the individual patient’s circumstances, and consultation with a licensed naturopathic physician should be undertaken before following any of the treatment strategies suggested in this web site.