Is It Really A Yeast Infection?

A lot of nasty vaginal concerns can masquerade as a yeast infection. Here’s what it could really be.

Cottage cheese representing discharge from a vaginal yeast infection

For around two years, I had recurrent vaginal yeast infections - or so I thought. Every few months, like clockwork, I would start to sense that slight itch that indicated that it had happened again. I would head straight to the pharmacy for some anti-fungal medication, and then spend the remaining two to three days driven to distraction by the itching and cottage-cheesy discharge. 

Like many other women and people with vaginas, I brushed this off and never did get to the bottom of the cause.

Yet, yeast infections can be a serious problem for many people with vaginas, causing discomfort and disruption to their daily lives and affecting their self esteem and relationships. Yeast infections are usually easy to treat, but if you’re suffering from recurrent yeast infections, it may not be what you think it is. 

Since most women have had a yeast infection at some point, many assume all similar symptoms that arise in the future are also yeast infections. However, yeast infection symptoms can be very easily confused with other, lesser known infections.


What is a Yeast Infection?

A vaginal yeast infection is a fungal infection that causes irritation, discomfort, unusual or copious discharge and intense itchiness of the vagina and the vulva (the tissues at the vaginal opening) and may involve the following symptoms:  

  • white vaginal discharge (often like cottage cheese), which does not usually smell
  • itching and irritation around the vagina
  • soreness and stinging during sex or when you pee

70% of people with vaginas will experience a yeast infection in their lifetime. Most will experience a single yeast infection which will clear up with treatment. However, many people experience recurrent yeast infections with symptoms returning at least three times a year, and some people even suffer from chronic yeast infections, in which the symptoms return immediately after treatment. 

Woman itching her underwear caused by vaginal yeast infection


While a single yeast infection is easily treated by over-the-counter medicine, recurrent and chronic yeast infections can have a huge impact on your quality of life. Many people report that chronic yeast infections affect their self-esteem, relationships and everyday activities.

In some more extreme cases, recurrent yeast infections are linked with chronic pain in the vulva, also called vulvodynia.

What Causes Yeast Infections?

Acute yeast infections are fairly straightforward, and are usually caused by an overgrowth of a fungus called Candida albicans. Other times, however, it can be caused by a related member (a non-albicans Candida) such as Candida glabrata. It’s important to test to find out which species is causing a yeast infection because this affects treatment approaches. For instance, whereas the commonly used antifungal called fluconazole has been shown to work against C. albican infections, C. glabrata infections are often resistant and require other prescription antifungals.

Your yeast infection symptoms may be the result of a non-albicans Candida infection.

It’s important to note that Candida species exist in two forms and that the first form exists naturally in healthy vaginas at low levels but the second form is at high levels when a yeast infection is present. Although scientists are unsure about the mechanism by which healthy levels of Candida change and become a yeast infection, research is clear that a yeast infection is the result of a disrupted vaginal microbiome.

This disruption can be triggered by antibiotics, diabetes, immunosuppressant medicine or changes in hormones. Hormonal changes in turn commonly occur from menopause, pregnancy, contraception use, and sexual activity. In a disrupted vaginal microbiome, protective vaginal bacteria known as Lactobacilli are depleted in number. Lactobacilli work to protect you from Candida growing out of control by producing lactic acid which creates an unfavourable environment for this fungus. So when this protective lactobacillus microbe population is disrupted, all hell can break loose.

How to Treat a Yeast Infection

Most acute yeast infections can be treated with over-the-counter medicines available from a drug store without a prescription. They are usually an antifungal cream, ointment or suppository, and some types combine a pill with a cream. Depending on the treatment, it can take one to seven days to be effective.

If you have recurrent or chronic yeast infections you should speak to a doctor for alternative treatments.

While the exact causes of yeast infections remains unknown, there are a few things you can do to help prevent them. Wearing breathable underwear, such as from a fabric like cotton as opposed to polyester, can help your vagina to remain healthy. Many synthetic fabrics like polyester and nylon trap heat and moisture which can be a breeding ground for bacteria and fungi.

The vagina’s pH balance is delicate (it’s one of the first things Juno Bio looks at in our at-home test kits!). A disrupted vaginal pH can contribute to several vaginal problems, including yeast infections. One of the easiest ways you can accidentally affect your pH is with scented products, such as period products or detergents, so these should be avoided.

Douching is also not recommended for vaginal health (though occasionally, doctors might recommend a specific bicarbonate douche for Cytolytic Vaginosis - do your research and make your own call!). Although it might seem like you’re cleaning your vagina, you’re actually killing the good bacteria inside your vagina that help fight off infections. You should clean the vulva with water and maybe some gentle soap, but the vagina should be left alone, unless told otherwise by a medical professional.

What Else Could the Symptoms Be? 

Woman thinking about symptoms of a vaginal yeast infection

Many conditions are often misdiagnosed as a yeast infection. In fact, one study found that two-thirds of non-prescription drugs used to treat yeast infections were used in error. Antifungal drugs are typically extremely effective at killing the Candida causing a yeast infection, although resistance to antifungal medication is becoming more common, likely in part due to overuse of these medicines.

If antifungal treatment from your drug store hasn’t helped your symptoms, you might not have a yeast infection. Yeast infections are often confused for other vaginal conditions, such as cytolytic vaginosis.

Cytolytic vaginosis has many of the same symptoms as a yeast infection, and is caused by overgrowth of Lactobacilli in the vaginal microbiome. Though this bacteria is usually protective, high numbers can cause a breakdown of vaginal epithelial cells, which are the top layer of the vagina.

This breakdown then leads to high amounts of discharge which is easily confused with a yeast infection. However, unlike yeast infections, cytolytic vaginosis will not respond to antifungal treatments.

Changes in hormones can also lead to symptoms that are similar to a yeast infection. In particular, oestrogen levels decrease during menopause leading to vaginal itching which is often misdiagnosed as a yeast infection. This symptom can be cleared in menopausal individuals by increasing oestrogen levels via oestrogen patches, pills or hormone replacement therapy.

Cytolytic vaginosis has many of the same symptoms as a yeast infection, and is caused by overgrowth of Lactobacilli in the vaginal microbiome.

What Can I Do Next? 

Whether you’re suffering from what you think are recurrent yeast infections, or simply want more information about what’s going on inside your vagina, you should speak to a medical professional. When doing so, it’s important to be your own advocate. No matter if it’s your first appointment or fourteenth, you are not powerless. 

Do your own research beforehand, speak with friends and family about the outcomes you’re hoping for to help you approach your discussion with a doctor, and don’t be afraid to request a second option. 

You could need specific medical interventions, or it may not be a yeast infection at all. A comprehensive microbiome test can give you the answers you need to get you started. The first step is knowing exactly what you’re working with. 

When your vaginal microbiome is not in it’s optimal state, the microbes in your vaginal microbiome can lead to both vaginal infections and increased susceptibility to UTIs

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References

1. Blaganje M, Barbič M. Vaginal Yeast Infection. Current Bladder Dysfunction Reports. 2020;15(4):325-331.

2. Jeanmonod R, Jeanmonod D. Vaginal Candidiasis [Internet]. Ncbi.nlm.nih.gov. 2021 [cited 9 August 2021]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459317/

3. Ardizzoni A, Wheeler R, Pericolini E. It Takes Two to Tango: How a Dysregulation of the Innate Immunity, Coupled With Candida Virulence, Triggers VVC Onset. Frontiers in Microbiology. 2021;12.

4. Drake S, Evans B, Gerken A. Vaginal pH and microflora related to yeast infections and treatment. Sexually Transmitted Infections. 1980;56(2):107-110.

5. Xie H, Feng D, Wei D, Mei L, Chen H, Wang X et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database of Systematic Reviews. 2017.

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