Forty percent of all types of vaginitis are caused by candida, a yeast-like fungus. When it multiplies in the vaginal tract, the disorder is called vulvovaginitis. Women often refer to it as a "yeast infection." About 75 percent of women get candida vaginitis at some time in their lives.

• Itching in the vagina and vulva
• Vaginal discharge (small amounts are normal, however)
• Red, swollen, painful vaginal mucous membranes and external genitalia
• Satellite lesions (tender, red, pus-filled bumps, which can spread to thighs and anus)

Candida is a yeast-like fungus that grows in the vagina. When there is too much, the fungus causes infection. The following increase your chance of getting a yeast infection:

• Antibiotics
• Pregnancy -- from increased heat and moisture and hormonal shifts
• Diabetes
• Corticosteroid use
• Human immunodeficiency virus (HIV) infection
• Taking birth control pills
• Being overweight
• High sugar intake
• Wearing panty hose, tight clothing, or noncotton underwear

Your health care provider will give you a pelvic examination and swab your vagina to check for candida. You probably will also have a Pap smear. Some women have chronic yeast infections. If this happens, your health care provider may want to do additional tests.

Treatment Plan

Usually topical treatments are started before oral medications. In the case of chronic infection, the dosage and length of treatment may be increased. If you have vaginitis, you should avoid excessive exertion and sweating, keep the vaginal area as dry as possible, and avoid sex until symptoms clear. Take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight-fitting pants can help prevent infection.

Drug Therapies

Topical and oral therapies are considered to be almost equally effective.

• Topical therapies: may initially cause burning from inflammation:
  • Polyenes (nystatin) -- one tablet twice a day for 2 weeks placed high in the vagina with applicator. This treatment is 70 - 80% effective and causes no side effects on other parts of the body.
  • Azole derivatives such as imidazole (such as miconazole, butoconazole) and triazole (such as fluconazole, terconazole) -- vaginal cream 1 -5 days, also may be used externally. This treatment is 85 - 90% effective and causes no side effects on other parts of the body.
• Oral therapies:
  • Fluconazole -- 75 - 92% effective. 150 mg once. This is often considered the treatment of choice. It should not be used during pregnancy. Appears to help HIV infected women.
  • Ketoconazole -- 83% effective. 400 mg/day for 5 days, or for 2 weeks with recurring infection. Oral nystatin helps reduce intestinal problems.

Complementary and Alternative Therapies

Alternative therapies may help to treat acute and chronic vaginitis. Always tell your health care provider about the herbs and supplements you are using.

Douches:

Use only one of the following douches at one time. Do not douche during menstrual periods. For first time or acute infection try the vinegar douche or boric acid capsules. For chronic vaginitis, use the herbal combination douche. For recurrent vaginitis, use the Betadine douche. Stop douching if you are in pain or your symptoms get worse.

• White vinegar: 1 - 2 tbs. to 1 pint of water. Douche daily for 10 - 14 days.
• Boric acid: One capsule (600 mg) inserted daily for 10 - 14 days. May cause irritation or problems from absorption into the bloodstream.
• Herbal combination: Mix equal parts of oregano leaf (Oreganum vulgare), goldenseal root (Hydrastis canadensis), and coneflower (Echinacea purpurea). Steep 1 heaping tbs. of herbal mixture in 1 pint of water. Cool and douche daily for 10 - 14 days.
• Povidone iodine (Betadine): Douche with one part iodine to 100 parts water twice daily for 10 - 14 days. Prolonged use can suppress thyroid function.

Suppositories:

• Tea tree oil (Melaleuca alternifolia ) vaginal suppository, insert one suppository vaginally daily, for symptoms of vaginitis. Ask your health care provider about the use of tea tree oil, as it can be irritating if not used properly.

Nutrition and Supplements

Following these nutritional tips may help reduce symptoms:

• Try to eliminate potential food allergens, including dairy, wheat (gluten), corn, preservatives, and food additives. Your health care provider may want to test for food sensitivities.
• Eat foods high in B-vitamins and calcium, such as almonds, beans, whole grains (if no allergy), dark leafy greens (such as spinach and kale), and sea vegetables.
• Eat antioxidant foods, including fruits (such as blueberries, cherries, and tomatoes), and vegetables (such as squash and bell peppers).
• Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes and yams), and psyllium seed.
• Avoid refined foods such as white breads, pastas, and sugar.
• Eat fewer red meats and more lean meats, cold-water fish, tofu (soy) or beans for protein.
• Use healthy cooking oils, such as olive oil or vegetable oil.
• Reduce or eliminate trans-fatty acids, found in such commercially baked goods as cookies, crackers, cakes, French fries, onion rings, donuts, processed foods, and margarine
• Avoid coffee and other stimulants, alcohol, and tobacco.
• Drink 6 - 8 glasses of filtered water daily.
• Exercise at least 30 minutes daily, 5 days a week.

You may address nutritional deficiencies with the following supplements:

• A multivitamin daily, containing the antioxidant vitamins A, C, E, the B-complex vitamins and trace minerals such as magnesium, calcium, zinc, and selenium.
• Omega-3 fatty acids, such as fish oil, 1 - 2 capsules or 1 tbs. of oil one to two times daily, to help decrease inflammation and help with immunity. Cold-water fish, such as salmon or halibut, are good sources.
• Vitamin C, 500 - 1,000 mg one to two times daily, as an antioxidant, immune support and to protect the vaginal lining.
• Zinc lozenge, 1 lozenge one to two times daily, when needed for immune support during vaginitis outbreak.
• L-glutamine, 500 - 1,000 mg three times daily, for support of gastrointestinal health and immunity.
• N-acetyl cysteine, 200 mg daily, for antioxidant effects.
• Probiotic supplement (containing Lactobacillus acidophilus), 5 - 10 billion CFUs (colony forming units) a day, for maintenance of gastrointestinal and immune health. You should refrigerate your probiotic supplements for best results.
• Grapefruit seed extract (Citrus paradisi), 100 mg capsule or 5 - 10 drops (in favorite beverage) three times daily, for antibacterial, antifungal, and antiviral activity, and for immunity.

Herbs

Herbs are generally a safe way to strengthen and tone the body's systems. As with any therapy, you should work with your health care provider to get your problem diagnosed before starting any treatment. You may use herbs as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, you should make teas with 1 tsp. herb per cup of hot water. Steep covered 5 - 10 minutes for leaf or flowers, and 10 - 20 minutes for roots. Drink 2 - 4 cups per day. You may use tinctures alone or in combination as noted.

• Green tea (Camellia sinensis) standardized extract, 250 - 500 mg daily, for antioxidant, anticancer and immune effects. You can use caffeine free products. You may also prepare teas from the leaf of this herb.
• Cat's claw (Uncaria tomentosa) standardized extract, 20 mg three times a day, for anticancer, immune and antibacterial or antifungal activity.
• Milk thistle (Silybum marianum) seed standardized extract, 80 - 160 mg two to three times daily, for detoxification support.
• Relora, 250 mg 1 - 3 times a day, for stress and related adrenal insufficiency.
• Garlic (Allium sativum), standardized extract, 400 mg two to three times daily, for antifungal and immune activity.

Homeopathy

Some of the most common remedies for vaginitis are listed below. Usually, the dose is three to five pellets of a 12X to 30C remedy every 1 - 4 hours until your symptoms get better.

• Calcarea carbonica for intense itching with thick white or yellowish discharge that is worse before you start your period
• Borax for burning pains with egg-white colored discharge
• Sepia for burning pains with milky white discharge and pressure in vaginal area, especially if you feel depressed and irritable
• Graphites for backache with thin white discharge that is worse in the morning and when walking
• Arsenicum album for when you have burning, discharge
• Homeopathic combinations are available as creams to apply vaginally.

Acupuncture

Acupuncture may be helpful in improving immune function.

To prevent recurrence of infection, take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight-fitting pants can help prevent infection.

Yeast infections occur twice as often during pregnancy. 

Cabrera C, Artacho R, Gimenez R. Beneficial effects of green tea -- a review. J Am Coll Nutr. 2006;25(2):79-99.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3^rd ed. New York, NY: Penguin Putnam; 1997: 268.

Cvetnic Z, Vladimir-Knezevic S. Antimicrobial activity of grapefruit seed and pulp ethanolic extract. Acta Pharm. 2004;54(3):243-50.

Crook WG. Diet changes may aid vaginitis prophylaxis. Nurse Pract. 1993;18(2):13.

Dambro MR, ed. Griffith's 5 Minute Clinical Consult. Baltimore, Md: Lippincott Williams & Wilkins; 1999:358-361.

Edman J, Sobel JD, Taylor ML. Zinc status in women with recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 1986;155(5):1082-5.

Fauci AS, Braunwald E, Isselbacher KJ, et al., eds. Harrison's Principles of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998.

Friedrich EG Jr. Vaginitis. Am J Obstet Gynecol. 1985;152(3):247-51.

Habif TP. Clinical Dermatology. 3rd ed. St. Louis, Mo: Mosby-Year Book; 1996.

Heggers JP, Cottingham J, Gussman J, et al. The effectiveness of processed grapefruit-seed extract as an antibacterial agent: II. Mechanism of action and in vitro toxicity. J Altern Complement Med. 2002;8(3):333-40.

Heitzman ME, Neto CC, Winiarz E, Vaisberg AJ, Hammond GB. Ethnobotany, phytochemistry and pharmacology of Uncaria (Rubiaceae). Phytochemistry. 2005;66(1):5-29.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

LaValle JB, Krinsky DL, Hawkins EB, et al. Natural Therapeutics Pocket Guide. Hudson, OH:LexiComp; 2000: 452-454.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Morrison R. Desktop Guide to Keynotes and Confirmatory Symptoms. Albany, Calif: Hahnemann Clinic Publishing; 1993:43, 69, 85, 171, 346.

Reid G, Burton J, Hammond JA, Bruce AW. Nucleic acid-based diagnosis of bacterial vaginosis and improved management using probiotic lactobacilli. J Med Food. 2004;7(2):223-8.

Scnitzler P, Schon K, Reichling J. Antiviral activity of Australian tea tree oil and eucalyptus oil against herpes simplex virus in cell culture. Pharmazie.2001;56(4):343-7.

Simopoulos AP. Omega-3 fatty acids in inflammation and autoimmune diseases. J Am Coll Nutr. 2002;21(6):495-505.

Sufka KJ, Roach JT, Chambliss WG Jr, et al. Anxiolytic properties of botanical extracts in the chick social separation-stress procedure. Psychopharmacology (Berl). 2001;153(2):219-24.

Yoon JH, Baek SJ. Molecular targets of dietary polyphenols with anti-inflammatory properties. Yonsei Med J. 2005;46(5):585-96.