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Do your vaginal yeast infections keep coming back? Conventional azole antifungals may not work for you, so how do you get rid of vaginal candidiasis and keep it that way?

Three in four women will experience a vaginal yeast infection at least once in their lives [1]. Experiencing the vaginal itching, burning, redness, soreness, altered, cottage cheese-like vaginal discharge, and possible pain during intercourse associated with vulvovaginal candidiasis [2] once in a blue moon is bad enough, but a select few women — about five percent of those who have had a vaginal yeast infection — will go on to develop recurring yeast infections or chronic yeast infections. [3]

If that's you, you'll be "itching" to get rid of your chronic yeast infection, and you'll have lots of questions:

  • Why me??? Why do my yeast infections keep coming back?
  • Why aren't antifungal yeast infection creams helping the vulvovaginal candidiasis stay away?
  • What on Earth can I do to make sure those nasty recurrent yeast infections go away and stay away, whether it's by means of conventional medicine or natural yeast infection treatment at home?

What Causes Recurrent Vaginal Candidiasis?

Recurrent vulvovaginal candidiasis (RVCC) can be defined as four or more vaginal yeast infections over the course of one year [3], while some women also develop a chronic yeast infection, in which some of the symptoms of vulvovaginal candidiasis persist for at least six months [4]. 

Candida albicans is the most likely yeast species to be responsible for your recurrent vaginal yeast infections, just like it is with isolated, one-off, vaginal candidiasis episodes. A third of all recurrent yeast infections are due to non-albicans species like Candida glabrata, Candida parapsilosis and Saccharomyces cerevisiae, however. [5

This matters because non-albicans species are more likely to be resistant to the azole antifungals that are usually used to treat vaginal yeast infections. Women who self-diagnose a vaginal yeast infection, and those whose doctors diagnose a vaginal yeast infection based only on physical presentation, could be using the wrong type of yeast infection treatment — rendering it completely ineffective. [6, 7] This is why it's so important to get a positive fungal culture, studied in a lab, if you have recurrent yeast infections.

Other risk factors for recurrent vulvovaginal candidiasis include:

  • The repeated use of antibiotics. If you have been prescribed several courses of antibiotics recently, or are on a long course of antibiotics, your natural vaginal microbiome may be disrupted to the point where you end up with yeast infections that keep coming back, or a chronic yeast infection. [8]
  • Diabetes is another proven risk factor for repeated yeast infections, because high blood glucose levels give yeast the chance to proliferate. [8]
  • Women who use hormonal contraceptives are more prone to yeast infections as well [9]. It is even possible that Candida species have estrogen and progesterone receptors that cause these fungal infections to run wild when stimulated by these female hormones. [10]
  • Immunocompromised women, including those who are HIV-positive, have a higher risk of developing repeated vaginal yeast infections. [10]
  • It is also possible that wearing tight or synthetic clothes gives Candida species an environment in which yeast infections are more likely to recur. [10]

Meanwhile, though frequent sexual intercourse does increase your risk of developing a vaginal yeast infection, and men can get yeast infections, too, research indicates that treating your partner with antifungal medications while you are being treated does not decrease your risk of having yet another yeast infection. Diet and Candida hiding out in the intestinal tract and then coming back to haunt you have been investigated as possible causes of repeated yeast infections, very much with inconclusive results. [10, 4]

How Are Recurrent Vaginal Yeast Infections Treated?

The treatment of repeated episodes of vaginal yeast infections begins with proper diagnosis.

Women who keep being plagued by what they suspect are vaginal yeast infections should not self-diagnose their yeast infection and treat themselves with over-the-counter azole antifungal agents. They should see their doctor and insist on swabs being taken and examined. This ensures that patients and their healthcare providers know exactly what they're dealing with — whether it's a yeast infection caused by Candida albicans, a yeast infection caused by another species, or even something completely different, such as bacterial vaginosis. 

Should you be diagnosed with recurrent vulvovaginal candidiasis, your doctor may recommend vaginal terconazole (Terazol) has been shown to be particularly effective for a vaginal yeast infection caused by a species other than Candida albicans. [10]

Prophylaxis, treatment to maintain the disease-free state or prevent disease, is another key part of the treatment of recurrent vaginal yeast infections. 

Your doctor may recommend 400 mg of ketoconazole, taken orally for two weeks, or 100 mg daily of clotrimazole vaginal suppositories for a week after your initial antifungal treatment is complete. This "maintenance regime" was found to significantly improve a woman's chances of being free from yeast infections in the long-term — one study revealed that around 80 percent of women in the prophylaxis group remained free of vaginal candidiasis, compared to just over half in the control group. [11]

You may also be advised to take 150 mg of fluconazole monthly [12], or either 200 mg or 400 mg of itraconazole, also on a monthly basis [13]. Both have been shown to cut your risk of developing yet another yeast infection in half.

Another option is boric acid administered in the form of vaginal suppositories. You'd normally be advised to use 600 mg twice daily for a fortnight, followed by a period of using boric acid every day during your menstrual period. [13] Some women use boric acid for natural yeast infection treatment at home, as well. 

Finally, you may wish to try probiotics supplements with Lactobacillus species. While probiotics haven't conclusively been proven to prevent the recurrence of vaginal yeast infections, their use is also highly unlikely to cause you any side effects. As such, probiotics are a matter of "if it doesn't help, it won't do ant harm, either". [14]