Any woman who has suffered the discomforts of vaginitis is aware of the myriad of products available, each proclaiming to be the best. However, before attempting self-treatment, it helps to familiarize oneself with both normal and abnormal vaginal physiology, safe and effective therapies, and the circumstances that necessitate a visit to a physician.

A healthy vagina produces a normal discharge, comprised of secretions from cervical glands, the uterus, fallopian tubes, and capillaries in the vaginal walls. This discharge acts as a natural cleanser, flushing out debris while maintaining the proper balance of micro-organisms, and an acidic pH level of 3.5 to 4.5. Discharge varies throughout the menstrual cycle in both consistency and quantity. All that is required for good hygiene is regular external washing with mild soap and water. Due to the possibility of irritation or masking of more serious symptoms, deodorant sprays, powders, creams and douches are unnecessary, and generally not recommended.

Vaginitis

Vaginitis, inflammation of the vagina, is a non-specific term describing a condition with many possible causes. The most common are:

• Yeast (Candida) - 25%
• Bacteria (eg. gonorrhea, chlamydia) - 25%
• Protozoa (Trichomonas) - 45%
• The remaining 5% of cases have varying origins including viruses (e.g., herpes), allergies (to soap, laundry additives, condoms), menopausal dryness/atrophy, and foreign bodies (e.g., a forgotten tampon).

While the symptoms in each circumstance tend to be different, they can still be misleading and first-time sufferers should see a physician for an accurate diagnosis.

The vagina normally acts as a host for a variety of micro-organisms, kept under control by a complicated system of checks and balances where bacteria and yeast compete for the same nutrients and living space, thereby limiting each other's overgrowth. The pH level also plays a role, as neither yeast nor bacteria like an acidic environment. Anything that disturbs the delicate vaginal equilibrium can potentially lead to a yeast infection. For instance, antibiotics can inadvertently wipeout important bacteria, surplus hormones (from pregnancy, oral contraceptives, or hormone replacement therapy), menstrual flow, systemic infections, and even semen, can increase the pH level. Diet seems to play a role in some individuals, and yeast infections tend to be most prevalent in women of childbearing age. Yeast, Candida, can also be present in the mouth (known as thrush), throughout the digestive tract, and on the skin.

Treatment

Once a diagnosis of vaginal yeast infection has been made, there are a number of over-the-counter treatments now available in pharmacies. The main active ingredients are clotrimazole, miconazole and tioconazole. All are available as creams, ointments or suppositories, and in therapy durations ranging from one to seven days.

The choice of product largely depends on:

• Sensitivity to product. Each product exhibits similar effectiveness, however some individuals may be more sensitive or allergic to one ingredient over another.
• Dosage form. Creams and ointments demonstrate superior effectiveness, but suppositories may be more convenient to use.
• Patient compliance. A shorter duration of therapy is easier to comply with, but longer therapy regimens are associated with better cure rates.

Regardless of the product you chose, it is important to follow the package directions carefully and finish the complete treatment, even if your symptoms disappear. If you're interested in alternative therapies, try the herbal product Australian Tea Tree Oil in a vaginal ointment, suppository or douche, or speak to your health practitioner about possible homeopathic remedies.

Consult your physician if the following applies to you:

• Abdominal pain, fever and/or odour (see doctor immediately)
• First diagnosis of yeast infection
• Patient under 12 years of age
• Pregnancy (especially first trimester)
• Recurrent (less than 2 months between infections) or infection not responding to treatments. This may mean the yeast infection is a symptom of a more serious condition, such as diabetes

It is important to discontinue any treatment and see your doctor if burning, blistering, rash or redness occurs.

General Measures for Treatment and Prevention

• Maintain good hygiene
• Keep the area as dry as possible
• Wear loose fitting, natural fibre clothing
• Eliminate or avoid predisposing factors (such as antibiotics)
• Avoid intercourse during an infection, or use a condom to help prevent re-infection (although yeast infections in males are uncommon)
• Occasionally use of vinegar douches (2-3 times per month) or boric acid capsules inserted vaginally can relieve symptoms and reduce pH level.
• Modify your diet. Increase your yogurt consumption (with live/active cultures, L. acidophilus) and decrease consumption of foods with yeasts and/or sugars.

Uncomplicated vaginal yeast infections can be safely and effectively cured using commercially available non-prescription products; however, what cures some people, may not work for others. If you have questions or concerns about vaginal yeast infections or the products available to treat them, speak to your doctor or pharmacist.

Compiled by Tracie & William Der
Island Apothecary, Gabriola Island, B.C.
Edited by Megan Stiles
Last Reviewed: September 2001