It’s enough to drive you mad, that recurring, chronic yeast infection, with its annoying symptoms. Some people may be susceptible to frequent yeast infections but there are steps you can take to prevent them – if you know what triggers them...
You’re doing your best to prevent chronic yeast infections, wearing cotton panties and changing out of your swimsuit as soon as you get home from the beach. But there it is again — the maddening itch that signals another vaginal yeast infection. If you have 4 or more vaginal yeast infections a year, you have a chronic yeast infection problem, says Erin Nelson, MD, assistant professor of obstetrics and gynecology in the School of Medicine at the University of Texas Health Science Center at San Antonio. About 5% to 8% percent of women fall into this category, she says. Chronic yeast infections can be frustrating for patients and doctors, says Linda Masini, a nurse practitioner at Advocate Medical Group in Chicago.
“Patients keep calling and saying, ‘My treatment isn’t working,’” she says.
Why do yeast infections keep coming back, no matter what you do? According to experts, it might be a cause you’d never suspect. Read on for common triggers of chronic vaginal yeast infections.
1. Your DNA might be working against you.
Two genetic mutations might make some women more susceptible to Candida albicans, the fungus most responsible for chronic vaginal yeast infections, according to a 2011 French study conducted by the National Institutes of Health and Medical Research and the University Paris Descartes. A healthy immune system will recognize excess Candida growth and launch a defense — but immune systems in women with these genetic defects can’t create key proteins to make that defense possible. The genetic link might explain why frequent yeast infections seem more common in some families than in others. In a 2011 study, researchers at Radboud University in the Netherlands examined the genetic profiles of 11 patients from 5 families who had chronic yeast infections and identified an inherited genetic mutation that made members of those families more susceptible.
2. Your boyfriend might be part of the chronic yeast infection problem.
Yes, men can get yeast infections, which are called balanitis, according to the US National Library of Medicine. It makes the head of the penis red, sore and itchy. Uncircumcised men are more susceptible to balanitis. Twelve percent to 15% of men report getting an itchy rash on their penis after having sex with a woman with a yeast infection, reports the US Department of Health and Human Services Office on Women’s Health. Even after a woman’s yeast infection clears up, her partner can re-infect her. Vaginal yeast infections aren’t considered sexually transmitted diseases because the Candida fungus is naturally present in the vagina, and even celibate women can get infections. “Treating the sexual partner is not generally part of our protocol,” Nelson says. But Candida can be passed between sexual partners, according to the Mayo Clinic.
- Condoms: The American Congress of Obstetricians and Gynecologists (ACOG) lists spermicide — including the kind found on condoms — as a leading cause of vaginal irritation, which can lead to vaginal yeast infections. Also, beware of using condoms if you’re already treating a yeast infection: Some medications make condoms more likely to break, ruining their effectiveness at preventing disease and pregnancy, according to Planned Parenthood, a nonprofit organization that runs sexual health and family planning clinics.
- Oral sex: A 2003 study by the University of Michigan-Ann Arbor showed that a woman’s risk of contracting yeast infections greatly increased after receiving oral sex. Candida albicans is found in the mouths of one-third to one-half of all adults, researchers say.
- Lubricant: In her column on the Stanford School of Medicine Women’s Health site, Leah Millheiser, MD, a clinical assistant professor of obstetrics and gynecology, writes that glycerin can contribute to chronic yeast infections. “If you are prone to developing yeast infections, switch to the glycerin-free version of your favorite lubricant,” she writes.
If you’re sexually active and think you might have a yeast infection, “see a gynecologist and have a proper exam,” Nelson advises. The symptoms of yeast infection are similar to those of trichomoniasis, the most common, curable, sexually transmitted disease in young, sexually active women, according to the Centers for Disease Control and Prevention (CDC). The federal agency estimates 7.4 million men and women get it every year. Trichomoniasis is caused by a parasite and must be treated with an antibiotic — not an anti-yeast medication. Left untreated, the parasite can cause problems in pregnancy and can make a woman more susceptible to infection with HIV and other sexually transmitted infections, according to the National Women’s Health Resource Center, an independent, nonprofit women’s health education organization funded by the US Department of Health and Human Services.
Because of hormone changes, the vaginal secretions of pregnant women contain more sugar, which can feed Candida albicans, according to the American Pregnancy Association. “As hormonal changes occur, sometimes women develop more yeast infection problems,” says Sangeeta Senapati, MD, clinical assistant professor in the division of Gynecologic Pain and Minimally Invasive Surgery at North Shore University Health System, a teaching affiliate of the University of Chicago. That’s because “shifting hormones can kill off more of the ‘good’ bacteria” that keep Candida in check. Pregnant women shouldn’t use high doses of fluconazole, a common oral medication for yeast infection treatments, for long periods because it can increase the risk of birth defects, the FDA warned in 2011. But that warning also says, “This risk does not appear to be associated with a single, low dose of fluconazole, 150 milligrams (mg), to treat vaginal yeast infection (candidiasis).”“There are lots of misconceptions that you can’t get treated for chronic yeast infections if you’re pregnant or breastfeeding, ”says Lisa Rogo-Gupta, MD, a urology fellow and clinical instructor in the division of Female Pelvic Medicine and Reconstruction at the University of California Los Angeles Medical Center. But topical treatments for frequent yeast infections are safe for pregnant and breastfeeding women, she says. “If it bothers you, ask your doctor.”
If moisture makes yeast grow, then keeping panties dry should help fight yeast infections, right? Yes — but not if you use panty liners. Women prone to chronic yeast infections shouldn’t use panty liners because they can trap moisture and prevent air flow, creating the moist conditions yeast loves, according to the National Women’s Health Resource Center. Another problem: Yeast can become concentrated on a panty liner, making the infection worse, Nelson says.
If you’re taking medication that suppresses your immune system — to treat autoimmune diseases like lupus, or because you’ve received organ transplants — you might be more susceptible to reoccurring yeast infections. Steroids also can make it hard for your immune system to fight a yeast infection, Nelson says, because they counteract the inflammation that is a necessary first step in your immune response. Diseases that attack the immune system, like HIV and leukemia, can let yeast grow wild, according to a 2010 University of Utah study. In fact, chronic yeast infections that don’t respond to any treatment might be an early sign of HIV, according to the National Institutes of Health (NIH).“Women with recurrent yeast infections should be tested [for HIV],” Dr. Senapati says.
Women with diabetes have a higher incidence of reoccurring yeast infections, Nelson says, “especially if they’re not controlling their [blood sugar levels] well.”
Even if you don’t have diabetes, bingeing on carbohydrates can set up conditions that yeast thrive in, according to Michael T. Murray, ND, author of Chronic Candidiasis: Your Natural Guide to Healing with Diet, Vitamins, Minerals, Herbs, Exercise, and Other Natural Methods (Three Rivers Press).“If you’re eating high-glycemic foods, it’s feeding this organism and can cause an overgrowth,” he says.
Many of the same conditions that cause vaginal yeast infections can also cause yeast to flourish in your intestines, Murray says. If you have low energy, depression, irritability, worsening PMS, and heightened sensitivity to foods, chemicals, and other allergens — in addition to chronic vaginal yeast infections — ask your doctor whether you might have an overgrowth of Candida albicans in your intestines.
In the years immediately before menopause, your hormones undergo some radical changes — and according to Dr. Senapati, hormonal shifts can cause an imbalance in your vaginal bacteria, which may boost Candida growth. But if you’re past menopause, the irritation and itch that feels like a yeast infection might be a symptom of vulvar cancer, Dr. Rogo-Gupta says. “High estrogen favors Candida overgrowth, so women who are no longer producing estrogen should not be getting frequent yeast infections.”
If you use a wheelchair, you are more at risk for recurring yeast infections. Sitting on a plastic wheelchair seat can create a “very moist environment, an excellent place for yeast to grow,” Dr. Senapati says. If you also have a problem with incontinence, you are even more likely to have yeast infections. According to information from the US National Library of Medicine, anti-fungal powders and skin-protective ointments can help women who use wheelchairs avoid yeast infections.
Your most recent yeast infection might be nothing new – in fact, it might be your old yeast infection reappearing. Researchers at the University of Leeds in Britain in 2010 followed 48 women diagnosed with vaginal yeast infections for 12 weeks. Although all the subjects were initially helped by medical treatment, about half had a subsequent yeast infection – and genetic testing showed that most of those women were actually experiencing a resurgence of the same infectious organism. Nelson says she sometimes prescribes “suppression therapy” for women with chronic yeast infections: 3 doses of cream followed by a weekly dose for 6 months, which she says is “effective 80% to 90% of the time. ”At the other end of the spectrum, if you have a vaginal yeast infection and need relief right now, use the vaginal cream rather than the pill, Dr. Rogo-Gupta suggests. She says creams are messier but they go to work about 2 days faster than pills do.
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