vaginal yeast infection (vaginal mycosis)

Vaginal mycoses are genital infections caused by fungi, which affect a great many women in the course of their lives. Even in a healthy state, the vagina is colonized by bacteria and certain fungi, but there is a balance between these germs. If there is a change in the vaginal environment and the balance between bacteria and fungi changes, a vaginal fungal infection can develop.

Female sex hormones have a great influence on the specific milieu in the vagina and their concentration can change during the monthly cycle and with age. This hormonal influence also explains the different vaginal milieu between girls before and after puberty, older women during menopause and after menopause.

In healthy women, the mucous membrane of the vagina is largely colonised by lactic acid bacteria (also known as lactobacilli). These bacteria are harmless to the woman and produce lactic acid from sugar, which they get from cells of the mucous membrane. This lactic acid creates an acidic vaginal environment in the vagina, which suppresses the multiplication of other bacteria or fungi and thus protects the woman from infections.

The pathogens

As the name suggests, a vaginal fungal infection is caused by fungi. Most often, the pathogen is a yeast fungus, namely Candida albicans. This fungus is a representative of the Candida group, which are recognizable under the microscope by their large, round, white cells. It is typical for yeast fungi that they can multiply very well at 37 degrees Celsius. Thus, the body temperature offers Candida albicans the best conditions to thrive in the mucous membrane of the vagina. If a smear is taken and examined under the microscope in the case of a Candida albicans infection, threads (hyphae) typical of yeast fungi can be seen. However, some women may also carry isolated Candida cells without developing symptoms.

Normally, the vagina is colonised with fungi a long time before infection, but the disease does not occur because the fungi are suppressed by the acidic environment in the vagina. The colonization of the vagina with the fungi can take place long before the first symptoms appear, for example, already at birth. However, the disease only breaks out when the relationship between bacteria and fungi becomes unbalanced and the fungus can spread easily.

Sexual intercourse can also be the trigger of vaginal mycosis; anal intercourse in particular can promote a vaginal fungal infection. This can be explained by the fact that the mucous membrane of the gastrointestinal tract, including the rectum, is colonized with Candida albicans, which can be transferred to the vagina during anal intercourse.

Sharing hygiene items, towels, and linens can also contribute to the occurrence of a vaginal fungal infection. Fungal infections can also be transmitted in public swimming pools. However, the fungus cannot survive in chlorinated water, so there is no risk of transmission in chlorinated pools.

Favouring factors

A disturbed vaginal environment can favour the development of a vaginal fungal infection. If, for example, the balance between bacteria and fungi is altered by antibacterial therapy in favour of the fungi, this can promote a fungal infection. In addition to the acidic vaginal environment, the immune system of course also plays a major role in protecting against vaginal mycosis. Thus, immunosuppressive drugs or drugs used in cancer therapy can also promote an infection. In addition, other existing diseases such as diabetes or changes in the hormonal balance can contribute to the spread of the fungus. Furthermore, the risk of contracting vaginal mycosis is also increased during pregnancy, which is explained by changes in sugar and hormone levels. Earlier generations of pill preparations can also be disturbing for the vaginal environment due to a higher sex hormone level. In these cases, it is recommended to switch to newer preparations with lower hormone levels.

Although a certain degree of hygiene is recommended to avoid a vaginal yeast infection, excessive washing of the genital area can promote the proliferation of fungi because it can disturb the vaginal environment. Therefore, the use of special washing gels and lotions is not recommended. Fungi need moisture and warmth to thrive. Therefore, one should refrain from wearing too tight and synthetic clothing. Often the outbreak of a vaginal fungal infection is also due to stress or stressful situations.

With a fungal infection of the vagina, the main signs of the disease are as follows:

- Severe itching

- Burning pain

- Reddening

- Edema (swelling)

- Pain during urination Some women also report pain of various degrees during sexual intercourse. Furthermore, a white, friable discharge is common with a vaginal yeast infection. On examination of the vaginal walls, a whitish coating may also be found. After this coating is removed, the now visible mucous membrane of the vagina usually appears swollen and reddened. Small bleedings after removal of the coating are also not uncommon.

Particularly if women have already experienced vaginal mycosis, they can usually recognise the appearance of the typical symptoms fairly quickly as an indication of a new fungal infection. Especially the cardinal symptoms of itching and burning in combination with the typical discharge cause many women to self-diagnose vaginal mycosis.

However, a similar clinical picture can also be caused by other pathogens, which is why a therapy on one's own is not advisable and it is better to have a check-up by a gynaecologist. In any case, you should see a gynecologist if the symptoms persist, recur at short intervals, but also in case of vaginal fungal infection during pregnancy. Fever and pain in the abdomen can be an indication of severe infections of the lower abdomen and should also be clarified.

A vaginal fungal infection can be diagnosed by the medical history, by a gynaecological examination and by a vaginal smear.

Sometimes it is not possible to detect a fungal infection under the microscope or to distinguish it from bacterial infections. In this case, the preparation of a fungal culture is often very helpful. Especially in the case of repeated vaginal mycoses, it is very important to identify certain risk factors such as medication, other diseases or hygiene habits that can promote the development of a fungal infection.

Antifungals

Antifungals in various dosage forms, such as vaginal tablets, ointments or suppositories, are used to treat vaginal mycosis. Typical antifungals include clotrimazole, ketoconazole, or fenticonazole. Most antifungals are used for topical therapy of vaginal fungus, but in some cases systemic treatment using tablets is also useful. However, this type of therapy, in which the tablets are taken orally, should not be used during pregnancy. There are no objections to topical treatment with ointments or suppositories, but the therapy should still be monitored by a doctor. Sexual intercourse should be refrained from during therapy, and after completion of treatment at least temporary use of condoms is recommended.

Self-measures

Among the measures that one can take oneself if a vaginal fungal infection is suspected is the local administration of yoghurts enriched with lactic acid bacteria. This can restore or support the acidic vaginal environment, which inhibits the spread of fungi. However, the success of this measure is variable from woman to woman.

Another method of counteracting the progression of an incipient vaginal yeast infection is to let the vagina dry out for a few hours. For example, you can use a tampon to remove moisture from the fungi, which the pathogens need to multiply. However, drying out the vagina for too long can lead to further damage.

Vaginal mycoses usually have a good prognosis. 90 percent of vaginal mycoses respond well to therapy and heal. However, a new vaginal mycosis infection (recurrence) can occur after a short time, which in most cases is due to an imbalance between bacteria and fungi. Blaming the therapy for the only short-lasting healing success is therefore not justified in most cases. Rather, the recurrence of vaginal mycosis should also be treated with antifungals.

In contrast to earlier assumptions that the risk of recurrence of fungal infections could be reduced by treating the partner at the same time, many studies have unfortunately shown little success in this regard. In some cases, however, it still makes sense to examine the partner and include him or her in the therapy.

If the affected person suffers from vaginal mycosis more than four times a year, a precise survey of factors that can promote a fungal infection should be carried out. In many cases, prescribing a preparation with a lower estrogen content has been found to be effective in women taking the pill. It may also be necessary to treat with oral antifungals over a period of several months to six months. Unfortunately, however, the permanent treatment is only really successful in the long term for about fifty percent.

The affected person can take various measures to counteract the occurrence of an infection:

- For example, one should not wear skin-tight, synthetic underwear.

- For some women, wearing tampons can also lead to vaginal mycosis. Above all, however, panty liners with a plastic coating are not advisable because they can generate moisture and heat, which in turn promote the growth of fungi.

- Damp swimwear should also be changed as soon as possible.

- One should not wash the genital area excessively with soap and in the best case use soap with an acidic pH value.

- Fungi need sugar to thrive. Thus, one can somewhat prevent fungal infections by eating a diet as low in carbohydrates as possible.

- If vaginal mycosis has already occurred, it is important to change all towels, bed linen and clothing and to wash them with special detergents available in pharmacies.

- To prevent the spread of germs from the anal area, the intimate area should always be cleaned from front to back after a visit to the toilet.

- The use of preparations to build up the acidic vaginal environment, such as lactic acid bacteria cultures, is also recommended.

- Sometimes the use of condoms can protect against new infections. This is because fungi can multiply under the foreskin of the male member and be transmitted during sexual intercourse. This is much less common in circumcised men.