Most women are familiar with the dreaded yeast infection. In fact, it is estimated that 50% of college women in the United States have been diagnosed with at least one yeast infection by the age of 25. Luckily, yeast infections are fairly easy to treat. But it's important to remember that there are a number of vaginal infections whose symptoms mimic those of a yeast infection, and should be ruled out before treatment begins. Below, gynecologists Dr. Gloria Bachmann and Dr. Joseph Apuzzio talk about the symptoms of a yeast infection, and when you should consider a visit to your doctor.
What exactly is a yeast infection?
JOSEPH APUZZIO, MD: A yeast infection is an overgrowth of a naturally occurring yeast in the vagina, which is severe enough to cause the patient to have symptoms.
Which women are more prone to yeast infections?
JOSEPH APUZZIO, MD: If a woman has diabetes, she is more prone to have yeast infections of the vagina. Also, if a woman is taking steroids for some medical illness, that also puts her at high risk. Women who are taking antibiotics for a long period of time are also at high risk, because the antibiotic suppresses the other flora in the vagina and allows the yeast to overgrow. Birth control pills may actually be a cause in some women as well.
What are some of the environmental causes or lifestyle habits that may precipitate a yeast infection?
GLORIA BACHMANN, MD: Tight-fitting jeans can trigger a yeast infection. Wiping from back to front can also cause an infection. Wet bathing suits can trigger an infection too.
Douching can also result in a yeast infection, because it may actually kill off organisms in the vagina that suppress the growth of the yeast, so in essence, one should not douche unless they consult their doctor.
Are women who are HIV-positive also more at risk?
JOSEPH APUZZIO, MD: Yes. Any time a woman's immune system, or natural way of fighting off infections is suppressed, she is at greater risk of infection, including yeast infections.
What are some of the symptoms, for those women who have not experienced a yeast infection?
GLORIA BACHMANN, MD: Probably the most important symptom that a woman notices at the time that she's in the throes of it is severe itching. She almost feels that she wants to scratch the skin away because it's so intense. Another is redness of the external area of the vagina. Cheesy discharge is another common complaint that women have. Burning, irritation, even intercourse pain are symptoms that women will report.
Are these symptoms the same for every woman that you have seen in your practice?
JOSEPH APUZZIO, MD: Yes, but there's variation. Some patients have more discharge. Other patients may have more itchiness of the vaginal area. But pretty much, the symptoms are alike.
If a woman has these symptoms that you've mentioned, does she definitely have a yeast infection, or could it be something else?
GLORIA BACHMANN, MD: Many times, women know that they have a vaginal yeast infection if they've been to their physician and know exactly what symptoms to expect. But women who are having symptoms for the first time should go to their physician, because these symptoms can mean any type of vaginal infection or vaginal inflammation -- for instance, trichomonas, or bacterial vaginosis. These are all mimickers of yeast vaginitis.
So getting an accurate diagnosis is the first step?
JOSEPH APUZZIO, MD: Absolutely. It's really crucial. The doctor can do certain tests to see if the patient has yeasts that are causing the symptoms. One of the tests is a slide test where the doctor will take some secretions from the vaginal area, look at it under a microscope. A doctor can see the yeast under the microscope and make a specific diagnosis, and determine an accurate treatment.
We can also culture the yeast, but we usually don't need to do that for patients who are having their first infection. The microscopic examination in the doctor's office is really sufficient. Only in the more recurrent or resistant cases should one have a vaginal culture for yeast.
If someone comes in with these complaints, do doctors perform these cultures or examine these slides as a matter of course?
GLORIA BACHMANN, MD: Many times physicians will diagnose because of the symptoms that the patient comes in with, and I think it's really important for women to say, "Doctor, have you looked at the secretions to verify that I have a yeast infection?" I think it's a good dialogue on the part of the woman to ask the physician that indeed she or he has looked at the secretion and made a definitive diagnosis of yeast.
So let's say you get the right test and the results come back positive. You have a yeast infection. What sorts of treatments might be undertaken at this point?
JOSEPH APUZZIO, MD: I think it depends on the patient's preference. One can give oral therapy or a vaginal cream or suppository to treat the yeast. They all have about the same success rate.
Why do some women choose the pill over the cream or vice versa?
GLORIA BACHMANN, MD: I find that there are actually two types of women. One chooses the pill and will use nothing in the vaginal area. She feels it's an untouchable area. Other women say, "I only want to treat the area that is infected and I don't want something systemic."
When should a woman consider treating herself? It's certainly easy to do. Any drugstore carries a number of these products.
JOSEPH APUZZIO, MD: Patients who have recurrent infections, and have visited the doctor and made accurate diagnoses may treat themselves because they know what they're dealing with. However, a patient should not treat herself if she hasn't had that kind of evaluation at least on one or two occasions by the doctor.
And if a woman has any doubts or concerns about what her symptoms may really be, even if she thinks this might be a yeast infection, she's had one before, what do you recommend?
GLORIA BACHMANN, MD: She should see her doctor. Absolutely, bottom line.
