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Yeast infections: When to self-medicate (or not)

Many women use over-the-counter drugs to treat yeast infections. These work about half the time, says Dr. Judith Reichman.

Q: I tend to get yeast infections. What can I do to prevent them, and is it okay to use over-the-counter medication?

A: You’re in good company: 70 percent of all women will have at least one yeast infection in their lifetime, and 45 percent will have multiple infections. About five to eight percent of women will have what we call recurrent vulvovaginal candidiasis (RVVC), which simply means yeast, vaginal or vulva infections that crop up four or more times a year.

What are yeast infections?Let me start with a little Microbiology 101. Candida, the bacteria associated with yeast infections, is a fungus that 20 percent of women have as part of their regular vaginal flora. It only causes problems when it overcomes and overgrows the normal bacteria in the vagina, usually when the “local” environment has been disturbed. Such disturbances can occur if you take antibiotics, steroids or estrogen medications (such as birth-control and hormone-replacement therapy).

Likewise, certain medical conditions can also change things: pregnancy (with its huge outpouring of hormones), diabetes (which changes the glycogen and sugar content of the vaginal cells and their secretions) and HIV (which diminishes immunity and allows for the overgrowth of many things, including yeast).

In addition, antibiotics taken to kill “bad” bacteria in the body may also cause the demise of protective lactobacillus bacteria in the vagina, allowing yeast to multiply and become dominant. So, if you always seem to get a yeast infection after you take antibiotics you may want to take some anti-yeast medications towards the end of the antibiotic course.

Are they sexually transmitted?I’m often asked if yeast infections are sexually transmitted and if a patient’s partner needs to be treated; the answer is no. However, I have found that in very susceptible patients, the presence of semen and/or use of spermicides can upset the vaginal flora and change the pH levels, and in some cases instigate yeast infections.

What are the symptoms?A typical yeast infection is usually unpleasantly announced with a clumpy discharge or liquid, itching and swelling in the vaginal lips. In addition, because the area is so irritated, it may burn when you urinate and sex may smart.  You should see a doctor or nurse practitioner the first time you experience symptoms to confirm the diagnosis. She or he will swab the secretions and put a sample in special solutions, then look under the microscope to see if there are yeast (they look like short swollen pieces of string, or hyphae). The pH of your vaginal secretions can also be checked when making the diagnosis (it increases with yeast infections).

Over-the-counter treatmentsSince the advent of over-the-counter yeast medications, many women are self-diagnosing and self treating. Studies have shown that they are right about half the time — but therefore also wrong as often. In most cases, an over-the-counter medicine won’t hurt you, but if you don’t feel better within a few days, a doctor’s visit is mandated.

There are many over-the-counter creams, suppositories and vaginal tablets available, and they contain one of four active ingredients: butoconazole nitrate (Femstat ), clotrimazole (Gyne-Lotrimin and others), miconazole (Monistat  and others), and tioconazole (Vagistat). These drugs are in the same anti-fungal family and work in similar ways to break down the cell wall of the Candida organism until it dissolves. Depending on the product, they can be used for one, three or seven days, and should be applied at night before you go to sleep. If you have severe itching, cream options may deliver faster local relief to the labia. All of the products mentioned above are considered safe during pregnancy.

Prescription treatmentsI would urge all women who have made unsuccessful attempts to self-medicate to make sure they see a doctor, because often these symptoms aren’t from yeast; they can be caused by bacteria or dermatologic conditions requiring therapies ranging from antibiotics — both local and pill form — to steroid creams.

If your yeast infections are occurring more than four times a year, make sure your doctor performs tests to rule out pre-diabetes or HIV infections (although, in over half women who have recurrent infections, there is no obvious cause; there may just be a genetic tendency to these infections). There is help. Another option is fluconazole (sold as Diflucan), an oral tablet that must be prescribed. One dose is usually sufficient, though it takes a few days for symptoms to subside. Unlike the others, Diflucan should not be taken during pregnancy. Studies have shown that 150 milligrams of Diflucan given weekly for six months cause 90.8 percent of women to be free from RVVC.

Dr. Reichman’s Bottom Line: If you occasionally get symptoms of yeast infections and recognize them as such, it’s perfectly okay to use over-the-counter products. But if symptoms recur and/or don’t abate, see your healthcare provider.

Dr. Judith Reichman, the “Today” show's medical contributor on women's health, has practiced obstetrics and gynecology for more than 20 years. You will find many answers to your questions in her latest book, "Slow Your Clock Down: The Complete Guide to a Healthy, Younger You," which is now available in paperback. It is published by William Morrow, a division of .

PLEASE NOTE: The information in this column should not be construed as providing specific medical advice, but rather to offer readers information to better understand their lives and health. It is not intended to provide an alternative to professional treatment or to replace the services of a physician.