Vaginal Yeast Infection: Causes, Symptoms

A yeast infection of the vagina, also called vaginal candidiasis, vaginal thrush, vaginal mycosis, and candidal vulvovaginitis, is a fungal infection that causes itching of the vagina and female genitalia, irritation, swelling and discharge. 

It is an infection of the lower part of the female genitalia, specifically the vagina, and can occur in an acute or chronic form. 

Many women come to the gynecologist's office with just this problem

This kind of infection is among the most widespread and common problems in women. It is estimated that about 75% of women will experience such an infection at least once in their lifetime.  

It is not inflammation, it is the multiplication of microbes in the vagina on the basis of which the infection arises. 

The most common causative agent of yeast infection of the vagina is Candida albicans, which accounts for up to 80-90% of all cases. 

5-15% are Candida glabrata and approximately 5% are Candida tropicalis. Other species are less common but may occur. 

Co-infection with multiple species of candida causative agents is rare. 

Candida is also normally found inside the body, in the intestines, in the vagina, in the mouth, on the skin, without causing a problem. The problem only occurs when it overmultiplies. 

A healthy vagina under physiological conditions is colonized by certain species of yeast and bacteria. When their balance is disturbed, yeast cells multiply and a yeast infection develops, causing discharge, itching and swelling in the genital area. 

The occurrence of bacteria in the mail do not give rise to a yeast infection. 

The vagina has its own physiological vaginal ecosystem as a protection against infections. 

This is created by: 

• The mucosal immune system, which protects the lining of the vagina.
• Hormone levels during the menstrual cycle create favorable conditions for protecting the vagina from microbes.
• The vaginal flora, which is made up of microorganisms and are in balance with each other. The vaginal flora consists of Lactobacilli.
• Lactobacilli maintain the acidic pH of the vagina by producing lactic acid, which maintains its acidity, and by producing hydrogen peroxide, thereby limiting the growth of harmful bacteria and yeasts.

Candida, i.e. yeast, is found naturally in the vagina. Lactobacillus bacteria keep them in check. 

If there is an imbalance, it leads to infection. 

The most common causative agent of yeast infection of the vagina is Candida albicans, which is normally found in the vagina in small amounts with other yeasts. 

The vaginal flora, including lactobacilli, prevents yeast overgrowth. If there is an imbalance between them, their multiplication occurs and a yeast infection ensues. 

Yeast overgrowth can cause: 

• Higher levels of sex hormones that increase glycogen in the vagina, which increases the conditions for the growth and multiplication of candida. A frequent occurrence in pregnancy, the increased level of sweet environment in the vagina increases the multiplication of yeast.
• Diabetes mellitus. Yeast infection is common in diabetic women.
• Antibiotics. Some types of antibiotics reduce and disrupt the natural microflora of the vagina, thereby increasing the multiplication of yeast.
• Hormonal contraception. 
• Reduced immunity.
• Poor sexual and hygiene habits. 
• Stress 

Swimming in chlorinated water, wearing wet swimsuits for prolonged periods of time, hot baths also contribute to the occurrence of a yeast infection. 

Risk factors 

• Wearing tight, snug-fitting underwear that is impermeable, which increases local moisture and temperature around the genitals. 
• Too frequent vaginal hygiene with perfumed preparations.
• Use of perfumed toilet paper.
• Frequent swimming in public pools and visits to hot tubs. 

Yeast infection after sex 

A yeast infection alone is not classified as a sexually transmitted disease. 

But it can be transferred and settle in the vagina after use of sex toys, fingers or by a partner suffering from a yeast infection on the penis. 

Oral sex can disturb bacteria in the mouth, vagina and on the penis resulting in infection. 

Symptoms can be mild, moderate, and severe. 

A yeast infection can be recognised very quickly by its characteristic symptoms, which are mainly in the form of a whitish vaginal discharge and intense itching of the vagina and genitals.  

The whitish discharge can often resemble the consistency of lumps of cottage cheese, and this vaginal discharge is also accompanied by burning sensations of the genitals. The burning and itching affects both the external and internal mucous membranes of the genitals and is accompanied by redness. 

Symptoms of yeast infection

• The discharge may be thick, lumpy, curd-like, or even watery. 
• The color of the discharge may be white to whitish-yellow.
• The discharge is odorless.
• A white coating appears on the outer lips.
• Irritation of the vagina and its surroundings. 
• Itching, sometimes burning of the vagina or vulva.
• A burning sensation during intercourse or when urinating.
• Pain in the vaginal area.
• Redness and swelling of the genitals. 
• With severe infections, cracks may appear in the wall of the vagina, followed by discoloration of the discharge to brownish or with an admixture of blood.

Table: characteristic differences between infections.

Learn more:

• Vaginal discharge: what does green, yellow, white discharge and itching mean?
• Vaginal discharge and change in colour, odour or consistency = problem?

Diagnosis is based on medical history (anamnesis) and examination. 

Your gynecologist needs to have the following information: 

• how long the problem has been going on
• when the problem first occurred  
• how the issue is connected/related to the menstrual cycle 
• what is the nature/character of the problem

The doctor needs to find out what is the type of discharge, its smell, and under what circumstances it arose. 

It is also important to inform the gynaecologist about your sex life, your contraceptive use, whether you use a condom and whether you have recently taken antibiotics or are taking them. 

Diagnosis is based on: 

Check with a vaginal mirror, when the quality and character of the discharge is assessed, whether there is blood in it and what is the condition of the vaginal mucosa. The extent and intensity of changes in the vagina, its colour and blood supply are monitored. 

Determination of the pH of vaginal secretions using an indicator paper. Under normal conditions, the pH in the vagina is 3.5 - 4.5. At elevated pH, a mixed infection is considered. 

The amine test is performed by adding a drop of 10% potassium hydroxide solution to the secretion. In yeast infection, a fishy smell is produced. 

Diagnosis can also be made by microscopic examination of vaginal secretions, in which a vaginal swab is taken and then applied to a glass slide. A saline solution is dripped onto the slide and covered with another slide. The slides are immediately placed under the microscope for evaluation. 

Another option is to send the vaginal swab directly to a laboratory for microscopic examination and evaluation. 

With a negative microscopic examination, it is necessary to perform a culture test and determine the type of Candida and bacteria found in the vagina. 

The disease starts with the yeast multiplying and attaching to the mucosa, and a suitable environment, such as an increase in the level of animal starch in the cells, is also needed for this to happen. 

Once the yeast takes hold, it starts to multiply and the first symptoms appear. 

It usually takes a few days, exceptionally a week or more, before the first symptoms from the infection break out. 

There is vaginal discharge and other symptoms, most commonly burning, genital itching and abdominal pain in the later stages. 

For a yeast infection to occur, the infection must go through a three-step process. 

This process includes adhesion, germination, invasion: 

Adhesion is crucial for fungal survival. Adhesion means stickiness, being glued or fused. When Candida ablicans is present, there is more increased adhesion than other yeast species have. 

The adherence of yeast infection includes differences that affect susceptibility to the development of infection.

It occurs more often in diabetes melitus, in pregnancy, with estrogen treatment, because the levels of the hormone estrogen increase the adherence of candida. 

Yeast infection is also very often triggered by antibiotic treatment.

It occurs less frequently during menopause and after menopause. 

Another reason for the development of infection may be a lack of lactobacilli in the vagina. 

Germination is the process of initial development where the growth and spread of yeast occurs. 

The invasion leads to the release of substances leading to swelling, itching and formation of discharge. 

The development of infection depends mainly on the vaginal flora and on immunity. 

Most important is the healthy presence of lactobacilli, which make up the normal vaginal flora. 

Pri zmnožení candidy prenikajú kvasinky do povrchu sliznice vagíny a tým spôsobujú infekciu. 

Yeast infection of the vagina is not considered a sexually transmitted disease, it is not transmissible like other infections. Although it can be spread through sexual contact, it also occurs in women who are not sexually active. 

A yeast infection can be passed from partner to partner. 

Transmission is also possible from mother to child at birth, during breastfeeding, if the yeast is overgrown in the breast area, and in children it is manifested by a white coating in the mouth, commonly known as thrush. 

Yeast infection and menstruation 

Yeast infection most commonly occurs a few days before menstruation. Before menstruation, hormones fluctuate and this often causes an imbalance of healthy bacteria in the vagina and an overgrowth of yeast. 

If you have a yellow or white discharge before your period, you don't have to worry right away that it is a yeast infection, as long as there are no symptoms such as itching or burning. 

It is best to start treatment at the first sign and not wait for symptoms to develop. 

Early treatment before menstruation at the very first signs can help you get rid of the infection. If problems persist after your period, see your gynaecologist. 

Treatment of yeast infection in pregnancy 

In pregnancy, vaginal mycosis can occur due to a change in hormone levels quite regularly and often. 

In pregnancy, the mucous membrane of the vagina is more susceptible to yeast infection 

Higher hormone levels, especially estrogen levels, cause an increase in glycogen, or sugar, which accelerates and allows yeast to multiply in the vagina. 

In this case, it happens that after childbirth, the level of hormones normalizes, and this also applies to infection.  

Treatment in pregnancy is the same as in non-pregnant. But their success rate is lower and treatment tends to be slower. 

However, topical use is preferred in treatment. 

Pregnancy must be taken into account, when possible damage to the fetus must be taken into account, especially in the first trimester of pregnancy. If treatment is necessary just at the beginning of pregnancy, boraxglycerin is used, which is fetal-friendly. 

Alternative treatment: Home remedies for mycosis fungoides in the vagina?

For an incipient yeast infection, the option is to reach for over-the-counter medications to treat the yeast infection or try an alternative natural/home treatment. 

• Garlic - it is effective against candida albicans. Oil, powder or extract can be prepared from it and used in a rubbed form.  Garlic extract kills the yeast within an hour.
• Leek – leek oil is useful. 
• Cloves – clove extract kills yeast within 5 hours. 
• Propolis – has antibacterial and antifungal effects.
• Lactobacilli – in tablet form have an effect against the multiplication of yeasts.
• Zinc – has a positive effect on treatment.

Treat yeast infection with a strict diet

Avoid the following foods:

• Sugar in any form, whether white sugar, brown sugar, sweeteners of maple syrup, honey or malt.
• White flour, white rice, pasta, noodles contain simple carbohydrates that do not contain fibre and are converted into sugar in the digestive system.
• Yeast. Foods containing yeast and fermented foods (breads and pastries). 

Please note that sourdough bread may be consumed.

• Alcohol, like wine, beer
• Vinegar, soy sauce, mayonnaise, mustard. 
• Mould - mould cheese, ermine
• Smoked, dried meat  
• Peanuts and pistachios 
• Dried fruit, or jarred, condensed fruit. 
• Fungi - can contribute to yeast overgrowth. 
• Fruit juices 

What diet is suitable? 

• White yoghurts containing lactobacilli.
• Proteins from animal sources, chicken, eggs, fish, legumes, nuts and seeds. 
• Fresh vegetables, especially leafy greens, cabbage, spinach, cabbage. 
• Use caution with potatoes as they can contain carbohydrates that turn into sugar. 
• Fresh fruit provides fibre, vitamins and minerals. 
• Complex carbohydrates contained in whole grain products. This includes brown rice, millet, buckwheat, barley, oats, quinoa. 
• Oils unrefined and cold pressed. Olive, coconut, sunflower, fish, linseed, avocado oil.