According to the Centers for Disease Control (CDC), three out of four women will get at least one vaginal yeast infection in their life, making yeast infections the second most common vaginal infection in the US (bacterial vaginosis is the most common). So chances are, you've most likely had one. But what makes a yeast infection chronic?
If you're experiencing "more than four infections in one year," explains Allison Hill, MD, "it is considered to be a chronic yeast infection." The culprit of chronic yeast infections lies in disruptions to the vaginal microbiome. "Our vagina is filled with billions of organisms, including bacteria and yeast known as the microbiome," explains Hill. "A healthy microbiome consists mostly of an organism called Lactobacillus. When the Lactobacillus levels are low, other bacteria and yeast can overgrow, leading to infections."
If you have never had a yeast infection before, Hill suggests "it is a diagnosis that a physician should make." She explains the typical symptoms of the infection are a thicker, white, or clumpy, odorless vaginal discharge, vaginal itching, vulvar itching, and swelling of the vagina and vulva. "This leads to burning and pain with sex," she says.
Hill goes on to say that "In some cases, a yeast infection can feel dry or cause some tears in the skin." It's important to consult with a physician because, she says, "typical symptoms of a yeast infection could be confused by other diseases such as a bacterial infection or herpes outbreak."
If you think you have a yeast infection, Hill suggests you try an over-the-counter anti-fungal. "Anti-fungal creams decrease the levels of yeast," she explains, "but it is also important to raise the Lactobacillus levels to restore a healthy microbiome." Another OBGYN-approved yeast infection treatment, according to Hill, is boric acid capsules made from a compounding pharmacy. If your symptoms do not improve within a week and, in fact, "seem to be getting worse instead of better, you should see your doctor." Hill also says if you have "bumps, lesions, or sores in the vagina, you should schedule an appointment with your gynecologist where you will have an exam and vaginal swab." Testing will confirm the diagnosis. Yeast infections can be treated with the oral anti-fungal Diflucan available with a prescription. They can also be treated with over-the-counter anti-fungal creams like Monistat.
If you're dealing with chronic yeast infections, our experts explain probable causes. The good news: there are lifestyle tweaks that can help you balance your vaginal microbiome.
Meet the Expert
- Yvonne Bohn, MD is a Los Angeles-based, board-certified OBGYN and the chief medical correspondent for Cystex.
- Allison Hill, MD is a Los Angeles-based, board-certified OBGYN. She is the chief medical correspondent for Florajen.
- Julia Rose, L.Ac, MSTOM is an herbalist, acupuncturist and co-founder, and formulator of Mayanaiya Botanicals.
Ahead, two OBGYNs and an herbalist trained in eastern medicine outline common causes of chronic yeast infections plus offer tips on how to address them.
According to Hill, "Having sex is the most common cause of yeast infections." She says the lubricants produced by the body or the use of lubricants you can buy over the counter alter the vaginal microbiome. "When the Lactobacillus levels are low, other bacteria and yeast can overgrow, leading to infections."
In addition to lubrication, Hill says, "condoms and semen can destroy the good bacteria of the vagina and allow for lower Lactobacillus levels and bad bacteria or yeast to overgrow. For women who are prone to yeast infections, using the withdrawal method can be helpful."
All our experts agree that candida overgrowth is a major culprit of yeast infections. "This happens when the balance of friendly bacteria and unfriendly bacteria in our bodies is tipped," explains Rose. "When we are imbalanced and compromised, the bad bacteria can easily take over."
Candida, according to Hill, flourishes when there's an imbalance in the vaginal microbiome. "I often recommend Florajen Women to my patients, a refrigerated probiotic that helps restore and maintain a healthy balance of vaginal flora and pH."
Like sex, menstruation can also disrupt the vaginal microbiome. "Our normal menstrual blood can alter the pH balance and affect Lactobacillus levels," explains Bohn. "Therefore, some women find that they have yeast infections more commonly in the time around their period." She adds that for those who use menstrual cups, as with anything foreign in the vagina, "a change in pH can occur which again disrupts the normal flora (also known as good bacteria) and can cause bad bacteria to overgrow, resulting in a possible yeast infection or bacterial infection."
Consider taking a tincture to help the body re-set and rebalance during menstruation if you're experiencing chronic yeast infections with your period, as this might work as a preventative measure.
Overcleaning the vagina is often a culprit of yeast infections. "Our vaginas are 'self-cleaning' and only need to be washed with warm water or a very mild soap," explains Hill. However, she adds that you should avoid "perfumed rinses or strong soaps because they decrease Lactobacillus levels."
To clean your vagina when you feel a yeast infection "brewing," Rose suggests a "baking soda sitz bath or wash." She also likes diluted apple cider vinegar washes and an "external application of neem oil" or a plain yogurt compress. "I'm not a fan of the garlic clove suppository or tea tree oil. Too caustic, in my opinion!"
She also advises you to change your underwear often.
Bohn says that antibiotics negatively alter the "microbiome in women’s vaginal and digestive tracts, which can contribute to the likelihood of a yeast infection."
She adds, "many women can be given oral antibiotics to treat a bladder infection or urinary tract infection (UTI). The antibiotics will destroy the bacteria responsible for the UTI. Still, they also destroy the good bacteria of the vagina, leading to a risk of yeast infection caused by the treatment for the UTI."
Oral Contraceptives and Spermicides
Contraception is another potential cause of yeast infections. Oral contraceptives, which affect hormone levels, can be disruptive to the microbiome, according to Hill. She also notes that spermicides can cause a disturbance in vaginal flora.
A healthy, balanced diet has a host of benefits for the body, including maintaining a balanced gut microbiome. Indeed, a healthier gut microbiome supports a healthier vaginal microbiome. Here's why. According to Bohn, when you eat sugary food, "blood sugar levels are consistently elevated. Sugar (glucose) is food for yeast."
This doesn't mean you have to abstain from sugar completely. "Most women are able to maintain normal glucose levels," she says, "but binge eating foods high in sugar may raise those levels and allow yeast to grow."
For those prone to yeast infections, Rose recommends an anti-candida diet, which she says is low in sugar or foods that turn to sugar in the body. "Candida feasts on sugar!"
Eastern medicine explains yeast overgrowth due to dampness, which manifests in the body as digestive issues. Rose explains. "Dampness, heat, and the combination of the two in the lower burner and liver channel are most commonly the culprits in yeast infections. Dampness is caused by poor transformation and transportation in the middle," which she says is digestion.
"I like to use the analogy of cooking a stew," says Rose. "If the temperature, balance of ingredients, and cooking method aren't right, you end up with stodgy goo instead of a nourishing stew." She adds that "excessive amounts of dairy, sugar, greasy foods, simple carbs, too many cold foods" as well as "habitually overwhelming the digestive system or eating irregularly are the main causes of damp in the middle."
Hill also says digestive issues are linked with an imbalance of the vaginal microbiome.
Lack of Rest
Stress can inhibit our bodily functions, as we're all painfully aware. According to Rose, "lack of rest and replenishment" leads to Qi deficiency. To function smoothly, the body relies on the proper flow of Qi, which Rose explains, is necessary to "properly process foods and liquids." This deficiency can also contribute to dampness.
Allowing the body to rest helps alleviate stress so that you can find your equilibrium.
Centers for Disease Control and Prevention. Vaginal Candidiasis. Updated October 12, 2021.
Rinninella E, Cintoni M, Raoul P, et al. Food Components and Dietary Habits: Keys for a Healthy Gut Microbiota Composition. Nutrients. 2019;11(10):2393. doi:10.3390/nu11102393