Vaginal Yeast Infection Treatment

How To Treat Recurrent Bacterial Vaginosis, According To Ob-Gyns

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Imagine this: You're on a tropical getaway…but between the persistent vaginal itching and irritation you're feeling, you're in sweatpants instead of a bikini. Recurrent bacterial vaginosis doesn't care about your plans, whatever your life looks like at the moment. If you're dealing with symptoms like fishy odor, watery gray discharge and burning, pain, or irritation of the vulva, and this isn't the first time you've experienced these issues recently, it's likely you have a bacterial vaginosis (BV) infection that won't quit.

BV can commonly recur, especially if you never really treat the underlying cause, which is an overgrowth of the bacteria Gardnerella vaginalis. It's naturally found in the vagina and doesn't always cause problems—but sometimes, it can get too feisty.

Here, ob-gyns share everything you should know about recurrent BV and how to kick it to the curb for good.

What causes recurrent BV?

If you tend to have three or more BV infections in a year, that's the threshold for recurrent bacterial vaginosis, Suzanne Bovone, MD, a board-certified ob-gyn at Pediatrix Medical Group in San Jose, California, tells SELF. For the infections to warrant an official diagnosis of recurrent BV, they all need to be confirmed by a lab or your doctor, Dr. Bovone says.

There are a few reasons BV infections can recur, but it's not unusual for BV to come back a few times. One study found that 58% of cases among the 121 participants recurred even after treatment. Stubborn cases along those lines are often not the person going through them's "fault," Kameelah Phillips, MD, a board-certified ob-gyn based in New York City, tells SELF: You can follow all the courses of treatment and take all the precautions, and BV can still come back. But why?

Whatever the cause, recurrent BV comes from a consistent imbalance of "good" and "bad" vaginal bacteria.

It might make more sense to think of BV as a "state of affairs" rather than an infection, Mary Jane Minkin, MD, clinical professor of obstetrics, gynecology, and reproductive sciences at Yale University School of Medicine, tells SELF. It's ideal to have a balance of "good bacteria," or lactobacilli (a common bacteria found naturally in the vagina and found in probiotics) and "bad bacteria," or Gardnerella vaginalis. (While it may seem counterintuitive, an overgrowth of lactobacilli can also lead to a yeast-infection-like condition called cytolytic vaginosis. It's a delicate dance down there!) "The good lactobacilli make acid, which tends to keep the bad bacteria away," explains Dr. Minkin. When there's not enough acidity, it can throw off your vaginal pH and cause an overgrowth of harmful bacteria, a.K.A. A BV infection. Here's what might be throwing things out of whack and contributing to your stubborn BV.

Washing your vagina

Certain products used around or inside the vagina, like douches or cleansers (and especially ones that contain fragrance), can alter your vaginal pH and contribute to BV. They tend to strip away the lactobacilli that help maintain a balanced, acidic pH in the vaginal microbiome and might allow infection-causing bacteria to flourish.

So put down the soap—you don't need anything fancy to wash with, given that your vagina is self-cleaning. One of the most important things to remember: "The vagina does have a natural odor, and many products try to make you think any odor is bad," says Dr. Bovone. Using products to mask that natural scent could give you the illusion of making the vagina "cleaner" or "healthier," but the opposite ends up being true. And if it leads to a BV infection, you might ultimately have to deal with a pungent scent that's way more pronounced—and unpleasant.

Sex (sorry!)

While BV is not a sexually transmitted infection (STI), the bacteria that sometimes causes it can be passed between sexual partners. Sex can lead to BV when the natural chemistry or pH balance of a partner's genitals is different from what your vagina is used to, and so, contact between the two changes your vaginal microbiome. Annoyingly, you might encounter (and get BV from) the bacteria that causes issues every single time you have unprotected sex with even one partner whose pH isn't gelling with yours: "The BV-associated bacteria can be passed back and forth," Dr. Phillips says. "Having a consistent sexual partner can increase the risk for recurrent BV." Sex-related BV can also arise when you have a new sexual partner, or multiple partners, especially ones whom you're having unprotected sex with.

Other lifestyle factors

There are some other less-expected habits that might have something to do with BV that won't leave you alone. For instance: Smoking cigarettes can also up your chances of getting BV more frequently, says Dr. Phillips. According to research published in Nature, smoking can alter the vaginal microbiome and contribute to deficiencies in lactobacilli bacteria. It could be that cigarettes cause a continuous bacterial imbalance that makes you vulnerable to infections, making it an even better idea to quit if you smoke.

While this is what we know so far about common BV culprits, exactly why some people have recurring cases more so than others, in terms of the root causes, isn't an open-and-shut case just yet. "We need additional research to pinpoint exactly which other lifestyle factors are most likely to contribute to recurrent BV," Dr. Phillips explains.

How to take care of yourself in a recurrent BV cycle Don't self-diagnose.

A lot of the time, people with BV might not be familiar with it, and so mistake it for a yeast infection or urinary tract infection (UTI), which have similar symptoms—think itchiness and irritation. But trying to self-diagnose sometimes leads people to start taking OTC yeast infection treatments while their BV bacteria is raging, which doesn't help—and sometimes leads to a more uncomfortable infection, for a longer time, or one that just keeps coming back. This means you have to be sure of what you're actually dealing with.

It is a possibility that you can have both infections at once, but it's best to see an ob-gyn or go to a sexual health clinic to confirm what's going on. "While BV is the most common cause of abnormal vaginal discharge, it's possible that people may have a co-infection with yeast or other bacteria that can complicate diagnosis," Dr. Phillips adds.

Get evaluated by a health care provider to get the most accurate diagnosis, says Dr. Phillips—and find a new one if you're not getting good answers or helpful treatment as things stand.

Give health care providers all the info they need to make a complete diagnosis.

Bacterial STIs can also be strikingly similar to BV, symptom-wise. The condition can look a lot like trichomoniasis, which usually comes with funky-smelling discharge and itchiness, or Mgen, which causes unusual or smelly discharge, burning when you pee, and vulvar pain or discomfort. To avoid a misdiagnosis, Dr. Bovone recommends that providers test for all STIs, especially those with bacteria and parasites as vectors, or which come with symptoms of vaginal itching and discharge with an off odor (like gonorrhea and chlamydia). "We see it all, and can reassure you what is normal. And if anything is off, we can help," says Dr. Bovone.

Ask a doctor to test you for BV specifically, too. Dr. Phillips starts appointments with a verbal screening to clarify her patients' symptoms, then takes a vaginal swab sample to send out to a lab for analysis. Once she knows what's actually going on, she's able to devise a treatment plan.

When a doctor prescribes you treatment, follow their instructions and stick with it for the whole time you're supposed to—even if your symptoms get better.

Depending on the infection and the clinic, you might be given the option of oral or vaginal antibiotics (often, clindamycin or metronidazole) to treat BV. To target recurrent BV, Dr. Bovone explains that doctors might prescribe a longer course of treatment than they would for a one-off case, such as using an antibiotic for seven to 10 days, plus a weekly dose of a vaginal antibiotic gel for four to six months afterward to prolong the treatment. There are also newer treatments, including a clindamycin vaginal gel called Xaciato that can be applied like a tampon to deliver a strong single dose of medication.

BV can come creeping back if you veer off course with a prescribed treatment, such as not taking all of the antibiotics every day or stopping before the intended date, even if it seems like your symptoms are clearing up. "Inadequate treatment is a setup for a recurrence: BV is a disruption of the normal vaginal flora, and that flora needs to be re-established," says Dr. Bovone. It can become unclear whether the recurrence is a reinfection, or if the infection never really cleared in the first place. So, even if you're feeling better, don't stop taking medication before the set end date, or else you might risk a BV infection creeping back.

Keep things moisturized.

One way to keep your vaginal pH as close to acidic (and infection-free) as possible is to make sure there's enough lubrication on a day-to-day basis. Vaginal dryness, which can happen due to lower estrogen levels during menopause or during a period of breastfeeding, among other things, can lead to a less acidic pH, according to Dr. Minkin. She recommends a vaginal moisturizing gel like Replens to help with dryness.

Get a doctor's opinion before you use OTC suppositories, like those containing boric acid.

You may have heard of boric acid suppositories and other over-the-counter treatments that purportedly balance the vaginal microbiome. No matter what, you should speak with your health care provider to confirm you have BV before trying these out, Dr. Phillips says. From there, you should know that boric acid supplements are not FDA-approved, and that the jury's still out about whether boric acid on its own can help with BV. (SELF has a full rundown of how boric acid affects your vagina, including if you have a bacterial or yeast infection.)

Your ob-gyn probably won't prescribe boric acid alone to treat acute BV, since it's a homeopathic remedy and has not been proven to be more effective than prescription antibiotics. That said, there's a chance your gyno might recommend it as a maintenance treatment for acidifying the vagina and keeping recurrent BV away. Studies show it can lead to some irritation of the vagina, though, so it may not work well for everyone. And you shouldn't use boric acid supplements if you're pregnant or trying to conceive, because there's not enough research to show that it won't cause harm to a fetus.

If you decide to give boric acid a try with your ob-gyn's blessing, a typical cycle of treatment is 30 days (you shouldn't use it for longer than that, which can lead to even worse irritation). To avoid contact irritation to your partner's skin or damage to condoms or diaphragms—both of which can be caused by boric acid—it's best to hold off on having penetrative or receptive oral sex while you're using it, Dr. Bovone advises.

Err on the side of not using products in or near your vagina.

Double-check with your gyno before trying any over-the-counter products that could alter your pH and send you into a BV spiral. "You don't need any vaginal wash. This will disrupt the normal bacteria and create more issues," says Dr. Bovone. The vagina is meant to be self-cleaning, thanks to vaginal discharge sweeping out any bacteria, and will regulate its own pH and natural odor, as SELF previously reported.

And, hate to say it, but…don't have sex until you get to the bottom of things, and use protection whenever possible when you do.

This might seem like a given, but don't have penetrative sex or receive oral sex, even with barrier protection, during your antibiotic treatment. If you do, it can throw things off course as your pH is settling back into its normal groove. Once you finish the whole course of medication and your vagina seems calm again, you're good to go.

If your partner's pH is potentially the X factor here: Whether your partner has a penis or vagina, using condoms or dental dams might be able to decrease spread of the bacteria until you get the overall imbalance under control.

Take a breath—and don't beat yourself up about this.

We know, BV is not a good time—especially when you have life events that involve bikinis! Wedding days! Beach vacations! Or simply getting laid! And it can be particularly difficult to get to the bottom of the recurrent cases. But don't be ashamed—this is SO common, and there are effective treatments available to you. It just takes a bit of trial and error—and patience. With the right help (and perhaps a thorough audit of the products you use near your vagina), you'll figure it out.

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Originally Appeared on SELF

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Vaginal Yeast Infections

The vagina normally contains a healthy balance of bacteria and yeast. The hormone estrogen helps bacteria called lactobacilli to grow. These bacteria kill harmful organisms in the vagina and keep you healthy. But when something happens to tip that balance, a fungus called candida can grow out of control and cause a yeast infection, also known as vaginal candidiasis.

They're itchy and uncomfortable, and no one really likes to talk about them. But vaginal yeast infections are very common. It's estimated that 75% of women will have at least one yeast infection in their lifetime.

Though yeast infections can happen to anyone at any time, certain things make them more likely. Most infections can be cleared up quickly and easily.

Yeast infection vs. Bacterial vaginosis

Yeast infections and bacterial vaginosis (BV) are both vaginal infections called vaginitis. While the conditions may have similar symptoms, they happen for different reasons and need different treatments. You can use an over-the-counter treatment for a yeast infection but will probably need prescription medicine for BV.

You can treat some vaginal infections with over-the-counter medicine, but others require a prescription. Your doctor can help you figure out which condition you have and the right treatment. (Photo Credit: DigitalVision/Getty Images)

Itchiness and discomfort are the main symptoms of a yeast infection, but there are others:

Burning, redness, and swelling of the vagina and the vulva (the outer part of the female genitals)

Pain or burning when you pee

Pain during sex

A thick, white, odorless discharge, similar to cottage cheese

Watery discharge

Vaginal rash

Small cuts or tiny cracks in the skin of your vulva

If you think you have a yeast infection, see your doctor before treating yourself. The symptoms of yeast infections are similar to other, more serious conditions, including sexually transmitted infections and bacterial vaginosis (bacterial overgrowth in the vagina). An accurate diagnosis is important so you can get the best treatment.

There are many reasons you could get a yeast infection, including:

Hormones. Changes during pregnancy, breastfeeding, or menopause (or if you're taking birth control pills) can change the balance in your vagina.

Diabetes. If your diabetes is not well-controlled, the increase in sugar in the mucous membranes of your vagina can create a place for yeast to grow.

Antibiotics. These drugs can kill off many of the good bacteria that live in your vagina.

Douches and vaginal sprays. The use of these products can change the balance in your vagina.

A weakened immune system. If you are HIV-positive or have another immune system disorder, the yeast may also grow uncontrolled.

Sex. Though a yeast infection is not considered a sexually transmitted infection, it can be passed from person to person through sexual contact.

Stress. Research shows that the candida fungus, like other organisms, responds to stress. Our knowledge of this response mostly comes from lab studies where scientists grow it in glucose. But in the human body, the fungus faces different conditions and is exposed to many stresses at once, which impacts its ability to cause disease.

Are yeast infections contagious?

You can get a yeast infection both through sex and without sexual contact, but it's not a sexually transmitted infection (STI).

Diagnosing a yeast infection involves your doctor or nurse examining your vulva and vagina. They'll also get a sample of discharge by swabbing your vagina, then send the sample to a lab to be examined.

The most common way to treat yeast infections is with over-the-counter antifungal creams, ointments, or suppositories (with clotrimazole or miconazole). Treatment can take 1 to 7 days. Your doctor may also prescribe an oral antifungal medication, such as fluconazole (Diflucan) or ibrexafungerp (Brexafemme). 

If you're pregnant, it's safe to use creams or suppositories, but avoid oral medications. 

It's important for you to know that some yeast infection medications weaken condoms or diaphragms. That makes it easier for you to get pregnant or contract a sexually transmitted disease. Be sure to read instructions and warnings before using.

Recurrent yeast infections

If you have diabetes or a weakened immune system, you may get yeast infections over and over again. It's a condition called recurrent vulvovaginal candidiasis (RVVC). If you get yeast infections at least four times a year, your doctor may recommend that you take a weekly fluconazole pill for 6 months to fight them. Oteseconazole (Vivjoa) has been approved for those with recurring problems with infections who do not want to have children (or have more children).

Some studies have shown that eating probiotic yogurt or taking Lactobacillus acidophilus supplements may slow the growth of yeast in the vagina, lowering the risk of infections. More research is needed before a clear connection can be made. Other ways of avoiding a yeast infection include:

Wear cotton underwear.

Keep your skin dry.

Don't douche.

Avoid feminine deodorants.

Use scent-free tampons or pads.

Use water-based sexual lubricants.

Keep your blood sugar in check if you have diabetes.

Vaginal yeast infections are common, with symptoms including itchiness, redness, swelling, pain during urination or sex, and a thick, white discharge. Treatments range from over-the-counter antifungal creams or oral medications to prescription options. Infections that continue to come back may require long-term treatment. Probiotics like yogurt or supplements containing Lactobacillus acidophilus might help prevent yeast overgrowth, but more research is needed to confirm how well they work.

Oh, Great: You Can Get Eczema On Your Vulva

Lots of things can irritate your nether regions, however, so sometimes it can be tough to know what you're dealing with. Though a derm or ob-gyn can make the final call (and help you find the right treatment), here are three other common culprits to consider:

Yeast infections

This happens when there's a disruption of your normal, healthy microorganisms, and an overgrowth of certain kinds of yeast, in your vagina. Alongside itchiness, you'll probably have white, chunky, odorless discharge and sometimes feel a burning sensation while peeing or having sex. While Dr. Kenkare says this *likely* means your issues aren't eczema-related, a yeast infection can sometimes trigger a flare-up of eczema symptoms or increase discomfort if you're in the throes of one. But in both cases, "it is not contagious, nor is it a sign of bad hygiene," Dr. Smith says.

Contact dermatitis

Atopic dermatitis is a chronic condition, meaning it might recur repeatedly. So if this is a one-off scratching situation and you haven't been diagnosed with eczema in the past, you might have contact dermatitis, which happens when your skin reacts to something specific, like a new type of laundry detergent or a "cleansing" wipe loaded with fragrances. In this case, identifying what's bothering you and getting rid of it should solve the urge to scratch, Chris G. Adigun, MD, FAAD, a board-certified dermatologist at Dermatology & Laser Center of Chapel Hill in NC, tells SELF.

STIs

While gonorrhea and chlamydia can both cause itchiness around the genitals, they may result in an unusual discharge, sometimes with an odor that eczema wouldn't cause. You might also experience other problems, like pain during sex, abdominal aches, or a fever. (Although STIs often cause no symptoms at all.) If you've been sexually active, particularly with new or multiple partners, and your vulva suddenly feels inflamed, it's probably a good idea to get tested for STIs just to be 100% sure you aren't dealing with something that requires antibiotics, Dr. Kenkare advises.

Fortunately, there are treatments for eczema flare-ups, and the best way to get relief on your vulva isn't too far off from how you'd deal with itchiness on other body parts, Dr. Adigun says.

If your symptoms are mild—you get tiny, slightly itchy patches every few months or so—Dr. Kenkare says you can manage irritation with some gentle skin care. Her rec: Apply topical petroleum jelly wherever you're having issues. "People might not realize that an area in the body that can get to be humid and swampy would also require moisturization, but it really does," Dr. Kenkare says.

Look for products labeled as sensitive or fragrance-free and have the National Eczema Association seal on the bottle. Try not to pat on just any cream or lotion—some contain menthol, for example, which can exacerbate itchiness. The same goes for harsh, perfumy soaps. Also, steer clear of anything that claims to "freshen" things up, like sprays, douches, and powders. (Here are a few tips to safely clean your vagina in general.) Use a fragrance-free laundry detergent made for sensitive skin, Dr. Adigun says. It can also help to wear 100% cotton underwear, as synthetic fibers may make things worse.

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