True or False: Everything You Thought You Knew About Yeast Infections

Welcome to Please, Health Me!? I'm Tristin, and each week I bring real health questions from around the internet to my mom, Rebecca, a board-certified family nurse practitioner with 45 years of experience. Together, we try to make healthcare a little easier to understand so you know more about what's happening, what questions to ask, and what options you might have.

We're here to educate, not diagnose or treat medical conditions. What we discuss should never replace advice from your own healthcare provider.

Okay, Mom, today I thought we could switch it up. I pulled some of our usual real health questions from online, and I'm going to ask them in a true-or-false format. So, first question: Yeast doesn't belong in your vagina. That's not true, right?

No, that's false. Yeast does belong in your vagina. We have our own vaginal microbiome. It has a lot of stuff in there. It has different species of yeast, and it has lots of bacteria. All of those belong there in a balance, and we have no problem when they're all in balance.

They all belong there. We can just forget about our vaginas because everything's good and we don't have any symptoms. But when you get an overgrowth of one or the other, then you do get symptoms and you're bothered. So, yes, it does belong there.

And there are different species of yeast. Candida is the most common one, and that's the most common one that, when it's overgrown, gives us what we call a yeast infection. But there are other types of yeast that belong there as well.

Okay, I'm going to deviate a little bit. I'm only bringing this up because I've read some things or seen things online about people's diets and Candida. Is it true when people say, "If you eat a lot of sugar, that inflames your Candida and creates a lot of overgrowth"?

Somewhat true, yeah. Yeast does like high blood glucose, and, of course, if we're eating a lot of sugar, our glucose will be up, just like we know is true in diabetes. Sometimes in the office, if I had a patient come in who might be in her 40s or 50s and was obese, and she said, "I just can't get rid of this yeast infection. I'm constantly having these yeast infections," I would sometimes see yeast on the skin in that area as well as in the vagina. That was because they were diabetic and did not know it. They were running a high glucose level in their blood at all times because they were diabetic, and sometimes these chronic yeast infections would be the first symptom or tip-off that they're diabetic.

Wow, that's interesting. Okay, another question: If you're itching down there, it's probably a yeast infection.

Not always, no. With typical yeast overgrowth, you'll get itching, burning, redness, sometimes even swelling, and possibly some burning when you urinate because it's touching irritated tissues. But itching down there can also be caused by other infections, including bacterial infections. That's why you need to be investigated if this is something new for you.

A lot of women have an occasional yeast infection. Most women occasionally will have one, and they know what it is and how to treat it. They can buy over-the-counter yeast medications. Or, if they have access to a provider, they'll get a medication called fluconazole, which is an oral medication. It's so simple. You can usually take it for one to three days, and you're done. That's the most common one people like to use if they can get ahold of it.

If you don't have a provider, sometimes you can find one online who will do that for you. Of course, there's no way they're going to determine whether you have a yeast infection; they're going to go by your symptoms and what you're saying. So that's possible, too. It's not a big deal for occasional yeast infections, but when it becomes more chronic, that's something different.

Okay, so that's a good question. True or false: If yeast infections keep coming back, it's probably because you're just not treating them correctly. Maybe I ask my provider, and it just keeps coming back because I'm not doing it right.

There are a lot of factors in that. Maybe you aren't doing it right. Maybe you have treatment failure. If you have fluconazole and it's not going away, that could be because it doesn't cover the kind of yeast you're having.

Chronic yeast infections are harder to diagnose and treat because there are a lot of possible reasons you have them. It could be your hormones, whether your own hormones or hormones disrupted due to age, surgery, pregnancy, or contraception. Those things can disrupt the vaginal biome, causing symptoms.

High-estrogen birth control pills, hormone replacement therapy, hormone-containing IUDs, and the intradermal contraceptive implant can all alter the environment down there. A recent study showed that 10.5% of Mirena users report vaginal irritation and increased yeast infections as a side effect.

The other part is that it may not start happening until after you've had your IUD for a year. After a year, you start having all these yeast infections and wonder why. It could be your IUD. That doesn't mean all these methods will give you yeast infections, but it's something to look at if you have chronic infections.

So I guess that's something to consider if it keeps coming back. It isn't always, "This treatment worked before, and now it doesn't." It could be a multitude of other factors. Especially a year later with an IUD, it seems like a long time. You wouldn't really think to correlate that.

I know, and that's why people wouldn't even think about it, right? If you had just gotten your IUD and that happened, you'd go, "Oh my gosh, is this related to my IUD?" But, yeah, it can take a year for that to start happening. Chronic yeast infections need investigation because there are different directions you can go in looking for the cause.

What's considered chronic? Once every month? One that never goes away?

One that's hard to treat and keeps coming back right after treatment, or having one or two a month—that's way too many yeast infections. Something's going on there. An occasional yeast infection—a woman might have three in her lifetime or something—that's normal. But when you start having them regularly every month, there's something else going on.

Can clothing be a cause of that? Certain underwear?

Sure. You've always heard, "Have a cotton-crotch underwear if you have problems," and that's okay. I suppose that can help. Certainly, if you're a big workout person and you wear tight workout clothes that aren't breathable, get all sweaty, then run a dozen errands and never get that clothing off, that can cause problems. You're not getting enough airflow down there, and you're changing the whole system.

I don't think we think enough about our product usage. We've got all these influencers saying, "You need this for your vagina, and you need this cream or that oil." No, you don't.

I'm thinking of all those yoga-pants ladies who work out at the gym, then run around to Starbucks and the grocery store doing errands. So I'm looking at yoga pants.

Yeah, that's not a good thing to do. It doesn't mean you're going to get a yeast infection, but you're going to increase your chances. And you don't need vaginal products unless they're prescribed by a provider.

Here's the other one: The more products you use down there, the healthier your vagina.

No. That is false. Your vagina doesn't need anything. It has its own biome, like we talked about, and it likes to be natural on its own. We're allergic or sensitive to soaps and body washes, and even some scented toilet paper, laundry detergents, and fabric softeners. If we're sensitive to them, that can change your biome, too. And obviously, never douche. I don't think anybody does anymore, but that certainly would disrupt everything. Look at any new products or anything new you've used.

I had a girl come in with all kinds of problems. She had decided that, for lubrication during sex, they would use coconut oil. She was sensitive to coconut oil and was causing all kinds of problems down there. Coconut oil is pretty hefty, so don't do that. There are plenty of naturally sourced lubricants, like aloe lubricant, that you can buy. I wouldn't get creative with your lubricants.

I feel like I've seen coconut oil-based oil at one of the natural stores.

We go through these waves. Coconut oil was very, very popular for a while. Obviously, tea tree oil is popular all the time for all kinds of things. That's a big one in natural foods. All kinds of things come and go as the newest thing, but you don't want to put things like that in your vagina that don't belong there and that your vaginal microbiome isn't used to. It doesn't want it and doesn't need it.

I wouldn't apply the same regimen to my face.

As you do to your vagina? No. Your face is skin, and your vagina is not skin; it is mucous membrane. That's a different kind of tissue, and, of course, it has its microbiome. On our skin, we have staph and strep. They belong there on our skin, too, and at times they can flare up for whatever reason, such as if we get a cut and it gets infected. But it's different from normal skin. The closest thing on your face is your mouth, right? That's mucous membrane, and we have our own biome in our mouths for sure.

So we've talked about not treating your vajayjay like the rest of your body and overdoing it with products. What about your partner? Do they have anything to do with recurring yeast infections?

Most of the time, no. Sometimes the act of sex can interrupt or change the biome and maybe cause some disruption. But the biggest reason a partner might have something to do with a yeast infection is if your partner is not circumcised. An uncircumcised person can harbor that yeast underneath the foreskin and then pass it back to you during sex, maybe after your treatment.

That can happen. It definitely can harbor under the foreskin of the penis, and that could be a reason you get frequent yeast infections. Uncircumcised men can get yeast all on their own under the foreskin. It's not as common; sex is the biggest reason they would get it from a partner. An uncircumcised partner can pass yeast back and forth with you.

Can they get yeast infections, then?

Yes, they can get a yeast overgrowth. They might have redness, irritation, discomfort, and, if they have enough yeast under there, a little swelling. I've seen that before. Generally, they can just harbor it and give it back to you when you flare up, but they can also get irritated, red, and a little swollen.

We also talked about shaving. Our hair is a type of barrier down there. It's there to protect us. I've seen so many women in the clinic who are completely bare. They've shaved themselves or had laser removal. Besides irritation and ingrown hair follicles, that can alter the biome, too. You don't have that extra little barrier there, and it doesn't keep your clothing and underwear away from the area. Tight pants and no hair can cause some problems. I would always want to ask my patients, "Who are you shaving for?" I think you need to answer that question. Is it for you?

Also, a side note about tampons: I know they're expensive, and that's not fair, but we have to change them in a timely fashion and not forget that last end-of-the-period tampon up there, because a retained tampon can certainly disrupt the biome.

It can cause an increase in bacteria. It can cause a staph infection, which can be dangerous, called toxic shock syndrome. That's not common, thank goodness, but it can happen. I have taken out many retained tampons. A person comes in complaining about a bad smell down there, so we think infection. I put in a speculum, and here's this crumpled-up old tampon pushed way up high that's been there a while.

When you pull that out, I don't know that there's a smell worse than that. I'm not trying to be gross, but it is so bad that we double-bag it and take it right out to the toxic waste. I've taken them out and seen almost a little sore spot where the thing was. That could be the start of a bad infection like toxic shock, because it wears down that wall of the vagina and then the staph starts gearing up.

Remember, put your fingers up there and check if you're not sure. A retained tampon will certainly disrupt the biome.

How long would it take for someone to notice that? Months?

Most of the time, it's noticed by a partner. A partner says, "Whoa, there's a really bad odor down here." That's what sends people in. They think they have an infection, and they say, "My partner says it smells." Most of the time, a partner discovers it more than you do yourself.

Going back to shaving, when you asked people what they were shaving for, did you actually ask that question, or did you just think it?

I didn't ask that question all the time because it's not really my business. I just wanted them to know that, if it was related to their visit or could be related in some way, I would talk about it. I wouldn't say it that way, but I would discuss that it might have an impact on what was going on when they came in. But I would think it for sure: Who are you shaving for? Do things for yourself, not for other people.

I was going to allude to that. I don't know if this is a social-media thing or if the person they're with wants that, because I think there's a lot of pressure in that aspect. People end up doing that because they think the person they're with prefers it.

It's true. And I can say that I've seen many a male shave, too, so it's not just women. It's just something to think about.

Going back to a partner saying, "Hey, it really smells down there," here's another question: If it looks like a yeast infection, is it always a yeast infection, or could it be something else besides, obviously, a tampon that we forgot?

Many women would make an appointment for a yeast infection. In my mind, I'd think, "Why are you making an appointment for a yeast infection? If you have one, you know you can try home treatment." Many times, "yeast infection" was just a catch-all: There's something wrong down there, so it must be a yeast infection.

Many times, it turned out to be something entirely different—a whole range of things from bacterial infections to herpes to UTIs. But it gets lumped in as, "I must have a yeast infection." Be honest about your symptoms and the possibility of an STD. Don't just say that's what you have. I would always ask the patient, "Are you worried about an STD?" Very rarely did they say, "Absolutely not." They might say, "I don't think so," or, "It could be."

Provide as much information as you can so the provider has a clear picture of your problem. I know there's a tendency to be squeaky clean when you come in for an exam, and I appreciate that. But if you clean really well, douche, or treat yourself—especially with an over-the-counter vaginal medication—it makes diagnosing really hard.

We need a good sample of what's going on in there to either look at under the microscope or culture. I don't think many providers these days ever look under the microscope and do what we call a wet prep. A wet prep is when I take a sample out of the vagina, mix it in a little bit of saline, and look at it under the microscope.

I trained that way. I've always done it because you can find yeast, overgrowth of bacteria, trichomonas, and things that you could never really test for. There is a yeast culture, and if there have been multiple attempts at treating a yeast infection, then a yeast culture should be done. That will tell you what kind of yeast it is, and maybe it isn't a typical yeast that's easy to treat with the medication we usually use.

There's nothing wrong with it. It takes two seconds to look at a sample under a microscope. It just isn't done that often anymore.

Can someone ask for that to be done if they know it wasn't?

Probably not. I've hired NPs in my clinic who had no clue how to do that. That's kind of old-school, but it's really helpful, I think. A gynecologist could certainly do it if they have some reason to think it's needed. They're trained to do that, though not all do it routinely.

Time is a factor for everybody, and it's harder when people see different providers. You're always seeing somebody different, it seems, especially if you go to clinics. Providers move around and change jobs much more than they did before.

To take care of yourself, record your symptoms, their frequency, what you've been tested for in the past, the treatments you've had, and the results from those treatments. Somebody will take you more seriously if you have a whole record of what's been going on, and it prevents wasting time.

It helps the provider know, "This person has had six yeast infections in the past two months. They've been treated with this and with that, and it's not working." They'll take you more seriously when you have a chronic yeast infection and give them that information.

Also record the timing of the infections in relation to periods, intercourse, medication use, or any lifestyle changes. You're doing your own little history so you can give the person a history, which they should have been taking, but sometimes don't have time for. You can cut into that and say, "This is my history."

So some big takeaways would be: If the vajayjay is not okay-kay, there are three things you should be aware of. Number one, maybe it's not always a yeast infection. Maybe it's something else. Number two, do not go and super-hygienically clean your vajayjay before you see your provider, because you might be doing yourself a disservice.

Yes. I guess I'm speaking for myself as a provider, but it's true that if you clean—

From a patient perspective, I don't want to go in saying, "Here's my stinky, nasty..." It's like the dentist. Before I go, I always make sure I brush my teeth and floss, even that morning beyond my normal routine. Even though I know they're going to clean my teeth—which, again, you're not cleaning people's vajayjays—I just want to put my best foot forward.

I want to clarify that. Certainly take a shower and wash yourself, but don't try to get a washcloth, your fingers, or anything else up there and clean everything out as much as possible. I need to take that sample from inside the vagina. Yes, I can put my swab way back there.

It's fine to wash the outside of your genitals. Just don't use anything else. Don't put on powder or personal spray. Just wash yourself and come that way. Hopefully that clarifies what I mean.

And when you come in, if you have something recurring that you've been trying to solve yourself and it doesn't seem to be working, at least keep a symptom diary. Track the timing, the things you tried, what worked, and what didn't work.

Record everything your vajayjay has been up to—periods, intercourse, going for walks, doing your yoga-pants thing—so you can provide as much information as possible. Speak on behalf of your vajayjay.

Yes. Give a history. It's really helpful nowadays when appointments are so short and people have no time. Start talking and give your history. That can help you be taken seriously.

I don't want to harp on it, but gaslighting for women is out there. When providers hit the door and pick up the chart, they may already have in mind what they're going to treat. Make sure you tell them what's going on, and don't be afraid to speak up and say, "This is what's going on. This is how long it's been going on," so you're taken seriously and these symptoms aren't brushed aside because they're women's symptoms. Don't get me started.

I think we've all felt that at some point. I've been lucky. My first experience was really good, but it's also because I knew someone who told me who to go to. They had such a great experience with their provider, who really sat, took the time, listened to me and my history, and made me feel heard. This person has already moved practices, and I'm going to follow them.

That's great. It's great to have a referral from someone you know and trust, because you don't know who to go to. Sometimes it's constrained by a lack of funds. If you don't have insurance, you don't have a lot of choices. For gynecology-type things, a health department is another place to look. Planned Parenthood is another clinic to try, though I don't know what their prices are anymore. A lot of that funding has been cut, so it's harder and harder. The health department would be the first place to try if you're really low on funds and have no insurance.

That's good to know, too. Even if you're having a hard time getting in, I think it took nine months for me to get in with this provider.

Yes, that's another problem.

I should probably call the new practice she moved to and book my yearly appointment now because it'll probably take that long to get in. She's an NP. I didn't even see the gynecologist. I saw the NP, who was highly recommended, and my experience was fantastic.

I know I'm an NP, but I truly believe NPs take better histories and have a little more time to spend. That's why they're popular: They listen to people. Way back when I was in training, they used to say 90% of the visit is history.

Ninety percent of the diagnosis comes from the history, from listening to the patient tell you what's going on. It's true. That's why NPs can do a good job: They listen.

Was there anything else you wanted to talk about around yeast? The biggest myth today wasn't really about yeast; it was that not everything is always a yeast infection.

Yeah, certainly true. And there's a big difference between the occasional yeast infection, which is no big deal, and a chronic infection, which has many more things you need to investigate.

The treatments are changing. Fluconazole is the normal medication they use for a chronic infection, but it will be for much longer. It'll be once a day for two or three days and then once a week for up to six months. It's a long-term treatment for a chronic infection. If they've gotten a fungal culture and decided that, yes, it is yeast, and they don't see any other reason, they would treat for up to that amount of time to try to eradicate it. There are new treatments coming out besides fluconazole if that should fail.

So they're making progress on the treatment of chronic yeast infections?

Yes. The common yeast infection is usually treated well with fluconazole, but there are others that aren't treated well by this medication. They're developing other medications because those other types can sometimes be the source of a chronic yeast infection that just won't respond to fluconazole.

Your body might not react to it?

The yeast could be different, and it just won't respond. That's why they're developing other medications for the other types of yeast.

Did we cover everything?

I think so. There's more to talk about with yeast than you'd think. Everyone just sort of says, "Ah, it's a yeast infection." But not always. Especially when it's chronic, it can be something else that needs to be dealt with and is causing you to get a yeast infection.

There are so many factors that can play a role in getting a yeast infection or a recurring one that maybe you don't think of. It goes back to some of the questions you can ask: What has changed? What's different? What products are you using? Who are you sleeping with?

These are all best answered by you, right? You're the person who can answer all those questions, but you need to know what the questions are. If your provider isn't asking them, these are the questions you need to answer.

Exactly. This goes back to providing resources for people. I think we should take what you're saying and create a nice cheat sheet that people can download and take with them, with the answers ready to go.

Sure. Talk about saving time: Just hand your sheet over. Hopefully it would be taken seriously and read, but I would think, "This is great. I don't even have to ask them." If nothing else, you have that list of questions to look at and say, "I can answer all these." Then you know what you need to tell them.

I think it would be nice to have something so people know what to expect to answer. They can start thinking about these things when they're not in a high-stress situation, sitting in a room waiting and agonizing: "What are they going to ask me? What should I remember?"

There was a cute little New Yorker cartoon recently. It must have been a woman sitting or lying on the exam table. She's obviously nervous, and she's saying to herself, "I hope they like me," meaning the provider. What? Who cares? You're here with a problem. But it's kind of true. People are nervous about being there. They want to be liked, and they want to be taken seriously—and they should be.

I think a lot of it is, "They're more willing to hear me if they like me."

Yeah. It was sad in a way, but it's true. They're not thinking about all the things they should be thinking about—what they're going to say, answer, or tell. They're thinking, "I hope this goes well. I hope they're a good person. I hope I like them. I hope they like me." If you have some questions you know you can answer and have the answers right off the top of your head, that would be a good thing.

You don't want to miss anything. It's nice to sit on your own in a relaxed environment and write all the answers to these questions. Then you won't forget anything when you go in.

It happens to everybody. As soon as that person walks in the door to see you, all that drains out of your brain. For many visits, not necessarily this, having another person with you helps because they remember things you don't. You're nervous, and you forget things.

The other thing is, if you pull out a big sheet of paper and the provider sees that, they're going, "Oh, crap. We have to go through all of this?" So I don't know about that.

You could preface it: "I wrote some notes because I don't want to forget." Then they'll know it's not like you're going to give them a lecture. You took the time to write your history down so they can help you in the best way possible.

Yeah, it's taking charge of your healthcare a little bit. We're in a bad situation with healthcare. The more you can get educated and try to keep up with this stuff, the better, because time is a factor. You know it when you go. No one's happy when they see someone for five minutes. This way, I think you can go to your appointment with more confidence.

I think that's where we'll leave this one. If something feels off, don't assume it's automatically a yeast infection, and don't wait until you're sitting half-dressed on an exam table to try to remember every product you've used, every treatment you've tried, and when all of this started. We're putting together a Please, Health Me!? appointment cheat sheet for this episode, which you can fill out before you see your provider.

It'll help you track your symptoms, timing, treatments, products, medications, and anything else that may have changed, so you can walk in feeling more prepared and have a better conversation. Because when your vajayjay is not okay-kay, the most helpful thing you can bring to an appointment is a really good history.

Thanks for listening to Please, Health Me!? You can find the cheat sheet, this episode, and our other conversations at pleasehealthme.com. If this episode helped you, follow Please, Health Me!? on Instagram, Apple Podcasts, or Spotify, and consider sharing it with someone who might need to hear it. Please remember, we're here to help you better understand your health, not diagnose or treat medical conditions.

Everything we discuss is for educational purposes only and should never replace advice from your own healthcare provider. Until next time, take care of yourself, and thanks for listening.