Vulvovaginal candidiasis, commonly referred to as a yeast infection, is a prevalent condition affecting women globally. It results from the overgrowth of Candida, a type of fungus, in the vaginal area. In this article, we’ll delve into the causes, symptoms, and treatment options for VVC.

VVC is predominantly caused by the yeast species Candida albicans, although other species can also be responsible. Candida normally lives harmlessly in the body, but certain conditions can trigger an overgrowth, leading to an infection.

First things first: The Vaginal Flora

The bacteria that live naturally in the vagina are called Lactobacilli and they stabilize the vagina’s acidic PH. Nevertheless, sometimes due to certain conditions the number of Lactobacilli is decreased and other atypical bacteria get the chance to multiply and cause Bacterial Vaginosis (also known as BV). The most common ones are Gardnerella vaginalis, Mycoplasma hominis, Ureaplasma spp. Mobiluncus spp, Bacteroides spp, Prevotella spp which normally live in the vagina in small numbers.

Risk factors of Vulvovaginal Candidiasis

Several factors can increase a person’s risk of developing VVC:

• Antibiotic Use: These can reduce the number of protective bacteria in the vagina, allowing Candida to multiply.
• Hormonal Changes: Hormonal shifts during pregnancy, menstruation, or due to hormone therapy can create favorable conditions for yeast.
• Diabetes: Elevated blood sugar levels can provide a conducive environment for yeast to thrive.
• Immune System Suppression: Conditions like HIV or medications that suppress the immune system can increase the risk.
• Unprotected Sex: While VVC isn’t considered an STI, it can spread through sexual contact.
• Vaginal douching
• Soap that is not suitable for vaginal washing
• Frequent change of partners
• Intrauterine contraceptive devices (IUD)
• Smoking

Common Vulvovaginal Candidiasis Symptoms

50% of Bacterial Vaginosis cases are asymptomatic. The most common symptom, though, is malodorous or unusual smell in vaginal discharge.

Common signs and symptoms include:

• Itching and irritation in the vagina and vulva
• A burning sensation during urination or intercourse
• Vaginal pain and soreness
• Vaginal rash
• Thick, white, odor-free vaginal discharge with a cottage cheese appearance
• Redness and swelling of the vulva

Vulvovaginal Candidiasis Diagnosis

VVC is diagnosed based on the symptoms, a physical examination, and laboratory tests of the vaginal discharge.

The diagnosis is made via vaginal cultures. If you want to test yourself at home, you can find a hometest for Vaginal smear culture in our shop.

They cover the most common atypical bacteria (Gardnerella Vaginalis, Mycoplasma spp, Ureoplasma sp).

What Medicine Should I Take for Vaginitis?

VVC is typically treated with antifungal medications. These can be:

• Topical: Applied directly to the affected area. Examples include clotrimazole, miconazole, and terconazole.
• Oral: Fluconazole is a commonly prescribed oral medication for VVC.

Some women with recurrent VVC might need longer courses of treatment or multi-dose medications.

1. Yeast Infections: These are usually treated with antifungal medications, either in the form of a cream, vaginal suppositories, or oral tablets.
2. Bacterial Vaginosis: Treatment typically involves antibiotics, either applied locally (creams, suppositories) or taken orally.
3. Atrophic Vaginitis: Often related to a decrease in estrogen levels after menopause, it can be treated with hormonal creams or suppositories.

Classic antibiotic treatment includes Metronidazole and Clindamycin which are prescribed by a gynecologist.

Alternative Treatment Options for VVC

If you want to choose a more holistic or alternative treatment you can combine classic antibiotics with probiotics and prebiotics that help stabilize vaginal acidic PH. You can find probiotics and prebiotics in tablets or naturally in foods such as yogurt, kefir, kombucha, pickles, miso, and kimchi.

How common is Vulvovaginal Candidiasis?

25.7% in queer women
14.4% in heterosexual women

Why is it more common for lesbian, bisexual, homosexual women and people with vaginas who have sex with people with vaginas?

The answer to this question is under investigation. Potential explanations for this increase of BV in VSV people may be because of genital hygiene behaviours or sexual practices. Certain vulval cleansing agents and vaginal douching may affect the vaginal ecology through alteration of pH,  or creating bacterial effects on the normal lactobacilli and so increasing the likelihood of BV.

It has been suggested that receptive oral sex could introduce abnormal flora or lactobacillus viruses into the vagina, or that a salivary mediator could cause alteration in the vaginal flora because saliva has less acidic PH that the vagina, so it alters it. A high concordance of vaginal flora between lesbian partners has led to the suggestion of a sexually transmissible factor, transmitted by exchange of vaginal secretions.

Stay tuned for more info in our next article, until then…take care of your vagina!

Ressources

Bacterial vaginosis: Standard treatments and alternative strategies MarianaTomás
Bacterial vaginosis:[Epidemiology and risk factors], A Georgijević
Prevalence of bacterial vaginosis in lesbians and heterosexual women in a community setting Amy L Evans
Prebiotics – A Review Paiboon Thammarutwasik

“Ask your Gyno” with Dr Amalia Savvidi

This article is part of the series “Ask your Gyno” with Dr Amalia Savvidi, omgyno’s very own resident queer gynecology guru. If you have a question, write to us and we’ll make sure that you are heard and that your questions are answered.

I am referring to people with vaginas who have sex with people with vaginas, as VSV (Vaginas who have sex with Vaginas, also known as lesbians). I will use this term for all my articles, because I think it is the most inclusive, but I am open to your opinion about it. So, VSV have the same chance of getting STIs as heterosexual women. This is a fact you maybe didn’t know, because most of the information online is targeted towards heterosexual women. At omgyno, we believe in informing people of all genders and sexual orientations with the right information for better health.