Women spent over half a billion dollars on medications to treat vulvovaginal candidiasis in 2002. Half of this amount was spent on over-the-counter preparations. However, many women wrongly diagnose the condition and may actually suffer from bacterial vaginosis.
It is hard to find data on the epidemiology of vulvovaginal candidiasis, likely because vaginal colonization with Candida, which is a prerequisite for the condition, occurs in at least 40 percent of adult women.
According to experts, at least half of women will experience vulvovaginal candidiasis by their mid-20s, and up to 25 percent of these women will suffer from four or more episodes a year.
Women with poorly controlled diabetes, systemic immunosuppression or immunodeficiency, and who use antibiotics may be predisposed to vulvovaginal candidiasis, however the pathogenesis of recurring vulvovaginal candidiasis among women with no known risk factors is under investigation.
Recurrent disease likely involves some breakdown of the normal mucosal immune processes that allow for mucosal "tolerance" to the organism. Behavioral risk factors for recurrent vulvovaginal candidiasis are unclear, however investigators have suggested that receptive oral sex and increasing frequency of intercourse may play a role.
The effectiveness of suppressive treatment for women with recurrent infections has recently been validated. Taking weekly medication after an initial regimen of topical imidazole or oral fluconazole works well. However, it can be difficult to determine when to stop such a regimen, as once the medication is stopped the episodes may start up again.
Investigators note that many symptoms attributed to vulvovaginal candidiasis are actually caused by bacterial vaginosis, the most common cause of vaginitis among women. Bacterial vaginosis is often diagnosed with vulvovaginal candidiasis. Genital herpes and genital dermatitis, such as lichen planus, may also be misdiagnosed as recurrent vulvovaginal candidiasis.
There is debate over the effectiveness of vaginal fungal cultures, however most experts agree that they can enhance the sensitivity of diagnosis of vulvovaginal candidiasis in women.
BMJ May 10, 2003;326:993-994 (Full Text Article)
Using drugs alone to treat this problem is rarely effective.The drugs for yeast in no way, shape or form treat the causeof the infection. This topic is close to my heart as it isthe path that started me into high-level natural medicine.
When I first finished my residency in 1985, I tried Dr.Crook’s approach to treating yeast. However, I wasso brainwashed with drug medicine that all I used to treatit were antifungal drugs. After a large number of failureswith exclusive drug therapy I concluded that Dr. Crook wasnot operating in reality.
However, what I had failed to appreciate was Dr. Crook’sstrong recommendation to avoid all sugars and grains. I dismissedthat advice because I thought I understood nutrition, andin fact in medical school I even had the nickname Dr. Fiber.I just couldn’t imagine that whole grains could possiblybe bad for anyone.
This misperception excluded me from effective therapiesfor nearly five years when I tried it again. However the nexttime I recommended excluding grains and sugars when I usedthe drugs, and I noticed amazing results.
Now I have come full circle and use diet nearly exclusivelywith no drugs to treat this pesky problem. These yeast infections are a common annoyance for many women. Most doctors however,don’t realize that the infection is a result of imbalancesthat result from the intestine.
There are 10 times as many bacteria (about 60 trillion)in our intestines as cells in our entire body. When you eatsugars and grains, which break down to sugar, the sugar servesas fuel for bad bacteria and yeast to thrive on. Eventually,the infection in the intestine can extend into the vaginalarea.
So simply treating the vaginal area may not be an effectivetherapy.
Excluding all grains, sugars, fruits and nuts are typicallynecessary to successfully treat the yeast infection. Fruitscan be added in if the infection resolves and there is noother evidence of elevated insulinlevels.
I go into far more specific details on the importanceof grain restriction and give practical steps on how to dothis in my new book The No-Grain Diet.
If the vaginal yeast infection does not resolve, you canuse local topical therapy. Typically, I recommend adding probioticslike acidophilus directly into the vagina in addition to takingit orally. The acidophilus works by making a mild acid andchanging the pH of the vagina, making it less inviting foryeast to hang around. Additionally, a mild acid like boricacid can be put into capsules and inserted vaginally for thesame effect.
The boric acid is very inexpensive, effective and non-toxicwhen combined with a rigid restriction of grains, sugar andfruit.