Forty percent of all types of vaginitis are caused by candida, a yeast-like
fungus. When it multiplies in the vaginal tract, the disorder is called
vulvovaginitis. Women often refer to it as a "yeast infection." About 75 percent
of women get candida vaginitis at some time in their lives.
Signs and Symptoms
Itching in the vagina and vulva
Vaginal discharge (small amounts are normal, however)
Red, swollen, painful vaginal mucous membranes and external
Satellite lesions (tender, red, pus-filled bumps, which can spread to
thighs and anus)
What Causes It?
Candida is a yeast-like fungus that grows in the vagina. When there is too
much of it, it causes infection. The following increase your chance of getting a
Pregnancy—from increased heat and moisture
and hormonal shifts
Human immunodeficiency virus (HIV) infection
Taking birth control pills
High sugar intake
Wearing panty hose, tight clothing, or noncotton
What to Expect at Your Provider's Office
Your health care provider will give you a pelvic examination and swab your
vagina to check for candida. You probably will also have a Pap smear. Some women
have chronic yeast infections. If this happens, your provider may want to do
Usually topical treatments are started before oral medications. In the case
of chronic infection, the actual dosage and length of treatment may be
increased. If you have vaginitis, you should avoid excessive exertion and
sweating, keep vaginal area as dry as possible, and avoid sexual relations until
symptoms clear. Take showers instead of baths, use unscented soap, and always
wipe from front to back after bowel movements. Wearing cotton underwear and
avoiding pantyhose and tight-fitting pants can help prevent
Topical and oral therapies are considered to be almost equally effective.
Topical therapies—may initially cause burning
from inflammation: polyenes (nystatin)—one tablet twice
a day for two weeks placed high in the vagina with applicator; 70% to 80%
effective; no side effects on other parts of the body. Azole derivatives such as
imidazole (such as miconazole, butoconazole) and triazole (such as fluconazole,
terconazole)—vaginal cream one to five days, also may
be used externally; 85% to 90% effective; no side effects on other parts of the
Oral therapies: fluconazole—75% to 92%
effective; 150 mg once; often considered the treatment of choice; should not be
used during pregnancy; appears to help HIV infected women.
Ketoconazole—83% effective; 400 mg/day for five days,
or for two weeks with recurring infection. Oral nystatin helps reduce intestinal
Complementary and Alternative Therapies
Alternative therapies may help to treat acute and chronic vaginitis.
Use only one of the following douches at one time. Do not douche during
menstrual periods. For first time or acute infection try the vinegar douche or
boric acid capsules. For chronic vaginitis, use the herbal combination douche.
For recurrent vaginitis, use the Betadine douche. Stop douching if you are in
pain or your symptoms get worse.
White vinegar: 1 to 2 tbsp. to 1 pint of water. Douche daily for 10
to 14 days.
Boric acid: One capsule (600 mg) inserted daily for 10 to 14 days.
May cause irritation or problems from systemic absorption.
Herbal combination: Mix equal parts of oregano leaf (Oreganum
vulgare), goldenseal root (Hydrastis canadensis), and coneflower
(Echinacea purpurea). Steep 1 heaping tbsp. of herbal mixture in 1 pint
of water. Cool and douche daily for 10 to 14 days.
Povidone iodine (Betadine): Douche with one part iodine to 100 parts
water twice daily for 10 to 14 days. Prolonged use can suppress thyroid
Avoid simple and refined sugars (breads, pasta, baked goods, sweets),
dairy products, alcohol, peanuts, fresh or dried fruit, fruit juice, and food
allergens. Eat plenty of protein, vegetables, and grains.
Lactobacillus acidophilus reestablishes normal bacteria in the body
and prevents the overgrowth of candida. Take one capsule orally two to three
times per day. Insert one capsule into the vagina nightly during treatment (not
to exceed 14 nights).
Vitamin A (10,000 IU per day) or beta-carotene (50,000 IU per day)
enhances the integrity of the vaginal lining. Remember to avoid high doses of
vitamin A in pregnancy or if you may become pregnant within the next three
Zinc (30 mg per day) and vitamin E (400 to 800 IU per day) are
essential for immune function.
Vitamin C (250 to 500 mg two times per day) enhances immunity and
helps restore the integrity of vaginal
Herbs may be used as dried extracts (capsules, powders, teas), glycerites
(glycerine extracts), or tinctures (alcohol extracts). Unless otherwise
indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep
covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots.
Drink 2 to 4 cups per day.
Pau d'arco tea has antifungal effects.
Garlic (Allium sativum) has antimicrobial, antifungal, and
immune-stimulating properties. Prepare a tea with two cloves of garlic. May add
fresh lemon and honey for flavor.
Some of the most common remedies for vaginitis are listed below. Usually, the
dose is 3 to 5 pellets of a 12X to 30C remedy every one to four hours until your
symptoms get better.
Calcarea carbonica for intense itching with thick white or
yellowish discharge that is worse before you start your period
Borax for burning pains with egg-white colored
Sepia for burning pains with milky white discharge and
pressure in vaginal area, especially if you feel depressed and
Graphites for backache with thin white discharge that is worse
in the morning and when walking
Arsenicum album for when you have burning,
Homeopathic combinations are available as creams to apply
Acupuncture may be helpful in improving immune
To prevent recurrence of infection, take showers instead of baths, use
unscented soap, and always wipe from front to back after bowel movements.
Wearing cotton underwear and avoiding pantyhose and tight-fitting pants can help
Yeast infections occur twice as often during pregnancy.
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based on antioxidant and health effects in humans. Am J Clin Nutr.
JAMA Patient Page. How much vitamin C do you need? JAMA.
Johnston CS. Recommendations for vitamin C intake. JAMA.
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and
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Review Date: August 1999
Reviewed By: Participants in the review process include: William Manahan, MD, University
of Minnesota Medical School, Family Practice and Community Health, Mankato, MN;
Anne McClenon, ND, Compass Family Health Center, Plymouth, MA; David Perlmutter,
MD, Perlmutter Health Center, Commons Medical and Surgical Centre, Naples,
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regarding dosage, precautions, warnings, interactions, and contraindications
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