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 cause of the infection. This topic is close to my heart as it is the 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 was so brainwashed with drug medicine that all I used to treat it were antifungal drugs. After a large number of failures with exclusive drug therapy I concluded that Dr. Crook was not operating in reality.
However, what I had failed to appreciate was Dr. Crook’s strong recommendation to avoid all sugars and grains. I dismissed that advice because I thought I understood nutrition, and in fact in medical school I even had the nickname Dr. Fiber. I just couldn’t imagine that whole grains could possibly be bad for anyone.
This misperception excluded me from effective therapies for nearly five years when I tried it again. However the next time I recommended excluding grains and sugars when I used the drugs, and I noticed amazing results.
Now I have come full circle and use diet nearly exclusively with 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 imbalances that 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 eat sugars and grains, which break down to sugar, the sugar serves as fuel for bad bacteria and yeast to thrive on. Eventually, the infection in the intestine can extend into the vaginal area.
So simply treating the vaginal area may not be an effective therapy.
Excluding all grains, sugars, fruits and nuts are typically necessary to successfully treat the yeast infection. Fruits can be added in if the infection resolves and there is no other evidence of elevated insulin levels.
I go into far more specific details on the importance of grain restriction and give practical steps on how to do this in my new book The No-Grain Diet.
If the vaginal yeast infection does not resolve, you can use local topical therapy. Typically, I recommend adding probiotics like acidophilus directly into the vagina in addition to taking it orally. The acidophilus works by making a mild acid and changing the pH of the vagina, making it less inviting for yeast to hang around. Additionally, a mild acid like boric acid can be put into capsules and inserted vaginally for the same effect.
The boric acid is very inexpensive, effective and non-toxic when combined with a rigid restriction of grains, sugar and fruit.