A vaginal yeast infection, known medically as vulvovaginal candidiasis, is an overgrowth of Candida, a fungus that normally lives in small numbers in the vagina. When the usual balance is disturbed, the yeast multiplies and inflames the vagina and vulva. It is one of the most common reasons women see a gynecologist, and in most cases it clears quickly with the right treatment.
The key phrase is "the right treatment." Several other infections cause itching, discharge and burning, and they need completely different medicines. Over-the-counter antifungals are easy to buy, but using them for an infection that is not yeast delays the correct treatment and can leave an infection such as trichomoniasis untreated. That is why we would rather confirm the diagnosis with a quick office test than have you guess.
Symptoms and who gets yeast infections
The typical symptoms are itching and irritation of the vagina and vulva, a thick white discharge that may look like cottage cheese, burning, especially when urine touches irritated skin, soreness, and pain during sex. The vulva may look red and swollen. The discharge usually has little odor, which is one clue that separates it from bacterial vaginosis.
Anything that upsets the normal vaginal environment can let yeast overgrow. MedlinePlus lists antibiotic use, pregnancy, obesity, diabetes and conditions that weaken the immune system. High estrogen levels, from pregnancy or estrogen-containing medications, favor yeast growth as well. Poorly controlled blood sugar is a particularly common driver of repeated infections, so women with frequent yeast infections should have their sugar checked, and those with known diabetes often improve as control improves. Still, many women who get a yeast infection have no identifiable trigger at all.
Why testing matters
Bacterial vaginosis, trichomoniasis and other sexually transmitted infections can all mimic a yeast infection, and skin conditions and irritation from soaps or products can too. Self-diagnosis is often wrong. The CDC notes that even women who have been diagnosed with a yeast infection before are not necessarily better at diagnosing themselves. If over-the-counter treatment has not worked, or your symptoms keep coming back, that is a strong signal that the diagnosis needs to be checked.
How we evaluate yeast infections at NYMD Center
The visit starts with a few questions about your symptoms, recent antibiotics, sexual history, contraception and any past infections. A gentle pelvic exam lets us see the vulva and vaginal walls and collect a small sample of discharge with a swab. The sample can be examined under the microscope and its pH checked, which often distinguishes yeast from bacterial vaginosis and trichomoniasis during the visit. When the picture is unclear or infections keep returning, we send the sample for culture or a laboratory test that identifies the specific Candida species, and we test for sexually transmitted infections when appropriate. For yeast infections elsewhere on the skin or nails, a small scraping can be taken for testing. None of these tests carry meaningful risk, and no special preparation is needed, although it helps to avoid douching, vaginal creams and intercourse for a day or two beforehand if you can.
Treatment options
Topical azole antifungals
Creams and vaginal suppositories such as clotrimazole and miconazole are effective for uncomplicated infections and come in one-day to seven-day courses. They work directly where the infection is and have few side effects beyond occasional local irritation. The trade-off is that they can be messy and some women find them less convenient than a pill.
Single-dose oral fluconazole
For uncomplicated infections in women who are not pregnant, a single 150 mg dose of oral fluconazole is a standard treatment recommended by the CDC. It is simple and clean. Symptoms may take a few days to settle fully, and it can interact with some other medications, so we check your medication list before prescribing it.
Recurrent yeast infections
The CDC defines recurrent vulvovaginal candidiasis as three or more symptomatic episodes in less than a year. Women with recurrent infections need a culture to confirm yeast and to identify less common species that may not respond to standard medicines. Treatment usually starts with a longer course to clear the infection, followed by maintenance therapy, commonly weekly oral fluconazole for six months, to keep it from returning. We also look for underlying drivers such as diabetes.
Yeast infections during pregnancy
Yeast infections are more common in pregnancy. Only topical azole treatments, used for seven days, are recommended; oral fluconazole is avoided during pregnancy. Please see us rather than self-treating if you are pregnant.
Yeast infections in men
Men can get yeast infections too, most often under the foreskin. Our urologists note that in uncircumcised men, redness and irritation under the foreskin is almost always fungal. The most important treatment is hygiene: gently retracting the foreskin, washing and, above all, drying the area thoroughly every day. Antifungal cream helps by stopping the yeast from growing, but it is the cleaning and drying that clears the infection. A partner can be affected as well, and the CDC notes that a minority of male partners develop this kind of inflammation and benefit from a topical antifungal.
What to expect at your visit
Most visits for suspected yeast infection are short. We talk through your symptoms, examine you, take a swab, and in many cases can explain the likely cause and start treatment the same day, with culture or STI results following. If infections keep coming back, we schedule a follow-up to plan longer-term care as part of our broader women's health services.
When to seek care promptly
See us promptly rather than self-treating if this is your first suspected yeast infection, if you are pregnant, if symptoms have not improved after a course of over-the-counter treatment, if you have three or more infections in a year, or if you have fever, pelvic or abdominal pain, foul-smelling discharge, sores or blisters, which point to something other than yeast.
Questions patients ask
Can I just use an over-the-counter yeast infection treatment?
If you have had a confirmed yeast infection before and the symptoms are exactly the same, an over-the-counter azole is reasonable. But self-diagnosis is often wrong, and bacterial vaginosis, trichomoniasis and other infections can feel very similar. See us if it is your first infection, if you are pregnant, if treatment does not work, or if infections keep coming back.
What counts as recurrent yeast infections?
The CDC defines recurrent vulvovaginal candidiasis as three or more symptomatic episodes in less than a year. Recurrent infections should be confirmed with a culture, which also identifies less common yeast species that may not respond to standard treatment. Treatment usually includes a longer initial course followed by maintenance therapy, often weekly oral fluconazole for six months.
Is a yeast infection a sexually transmitted infection?
No. Yeast infections are not considered sexually transmitted, because Candida normally lives in the body and overgrows for other reasons, such as antibiotics, diabetes or pregnancy. However, symptoms of sexually transmitted infections can look similar, and a partner can sometimes develop irritation, which is why testing is worthwhile when the diagnosis is uncertain.
How are yeast infections treated during pregnancy?
During pregnancy, only topical azole creams or suppositories, used for seven days, are recommended. Oral fluconazole is avoided because of concerns about effects on the pregnancy. Yeast infections are more common in pregnancy, but because other infections can look similar and some matter for the pregnancy, please see us for a diagnosis rather than treating yourself.
Why do I get yeast infections after antibiotics?
Antibiotics kill the protective bacteria that normally keep yeast in check in the vagina, which allows Candida to overgrow. If you reliably get a yeast infection after antibiotics, tell your physician when an antibiotic is prescribed. In some cases a preventive antifungal dose can be taken with or after the course.