Vaginal care

Approximately 75% of women will experience a candida infection at some point in their lives. This is not a sexually transmitted disease and is not contagious, but rather a consequence of reduced immunity, giving the existing fungus a chance to develop. Other causes of vaginal issues can include bacterial vaginosis and vaginal dryness. There are also several sexually transmitted infections, such as trichomoniasis, chlamydia, and gonorrhea. 

This text focuses on candida and bacterial vaginosis. 

Candida, short for candidiasis, is caused by the yeast Candida albicans, which can turn into a mold form. This is why candida is also referred to as a yeast infection. Candida albicans is most common in the vagina and intestines, but can also be found in the mouth, throat, on the penis, and on the skin. If the body's natural balance is disrupted—due to factors like antibiotics, an unhealthy diet, stress, or a weakened immune system—the number of "good" bacteria may decrease significantly, allowing the yeast to grow into a full-blown fungal infection. 

Candida infections can cause additional health problems such as fatigue, insomnia, bloating, and weight gain. If infections occur more than three times a year, with at least one confirmed by a test, they are considered recurrent. 

Bacterial vaginosis, like candida, can arise when the vaginal flora is imbalanced, often due to an increase in pH levels. Unlike candida, the specific balance between different bacteria is more critical than which bacteria are present. This imbalance leads to discharge with a strong, unpleasant odor. 

Both candida and bacterial vaginosis can resolve on their own or may require treatment. Recurrence of symptoms over time is common. 

For both infections, a disturbance in vaginal acidity (pH levels) paves the way for infection. Below are some common causes: 

• A diet high in sugar and carbohydrates: Candida yeast needs sugar to reproduce. 
• Medication use: Antibiotics are a well-known cause of candida because they kill all bacteria, including beneficial ones, allowing the yeast to thrive. Birth control pills and corticosteroids are also known to promote fungal growth. 
• A weakened immune system: Illness, such as a cold or flu, can reduce the number of "good" bacteria, disrupting the balance and increasing the risk of fungal infections. 
• Environmental factors: Exposure to pollutants such as fine dust, pesticides, or emissions from intensive farming, or even heavy metals at work, can lead to an imbalance in the body's acidity (pH levels). The normal vaginal pH level ranges between 3.8 and 4.5 but can vary due to hormonal changes during menstruation or menopause. When this balance is disturbed, yeast and bacteria can grow unchecked, causing candida or bacterial vaginosis. 
• Use of scented or unscented soaps: This can disrupt the vaginal balance, making candida more likely. The vagina is self-cleaning, so washing the external genital area (e.g., the labia) with warm water is sufficient; soap is unnecessary and may harm the protective pH level. 
• Diabetes: Women with diabetes are more prone to vaginal yeast infections like candida. 

Often, these circumstances do not apply, and science is still not entirely clear on how vaginal yeast infections occur. However, there is no evidence that tight clothing, panty liners, or tampons increase the risk. 

Vaginal disorders can be divided into three categories: 

1. Naturally occurring yeasts and bacteria: These can grow into infections like candida and bacterial vaginosis if the balance is disrupted, for example, due to reduced immunity. 
2. Vaginal dryness. 
3. Sexually transmitted infections: These include conditions like trichomoniasis, chlamydia, and gonorrhea. 

Candida is typically recognized by the following symptoms: 

• Itching and burning sensations 
• Odorless, white, crumbly discharge resembling cottage cheese 
• Redness and irritation of the vaginal lining 
• No other symptoms, such as abdominal pain or bloody discharge 

Bacterial vaginosis presents similarly, but the discharge is grayish-white and has a strong, unpleasant odor. There is no pain or inflammation. 

You can reduce the risk of vaginal infections. With a healthy balance, good bacteria will keep yeasts and molds in check. Here are some tips: 

• Although synthetic fabrics, tight pants, and panty liners do not cause infections, they can create a warm, humid environment that encourages yeast growth. Washing with plain water is usually enough. 
• Always wipe from front to back after using the toilet to avoid introducing bacteria from the intestines to the vagina. 

For recurrent infections, three main treatments are recommended: 

1. On-demand treatment: Options include a single-dose miconazole vaginal capsule (preferred) or oral fluconazole. A supply of three treatments can be provided for future use. 
2. Preventive vaginal treatment: A single miconazole vaginal capsule can be used on day 5 of menstruation for 3-6 months. If this is not effective, it can be increased to once per week. 
3. Preventive oral treatment: Fluconazole (oral) is taken once on day 5 of menstruation for 3-6 months. If necessary, this can be increased to once per week. 

Medication

Candida can be treated locally or systemically, with local treatment preferred to minimize side effects. Vaginal treatments include inserting a capsule or tablet: 

• Miconazole (single dose) 
• Clotrimazole (one or three days) 
• Butoconazole (three days) 

Oral treatment usually involves fluconazole. If there is external itching, a cream containing miconazole or clotrimazole can also be used. 

Alternative treatments

Medications treat symptoms, but if the underlying cause is not addressed, recurrent infections may continue. Candida thrives on sugar, making dietary changes effective in eliminating yeast infections: 

1. Cut out sugars: Yeasts thrive on sugar, so removing it from your diet is a good starting point. Check product labels for hidden sugars. 
2. Avoid processed foods: Since many pre-packaged foods contain sugar and additives, cooking fresh meals provides more nutrients and energy. 
3. Avoid fungi and yeasts temporarily: This helps to rid your body of the infection, allowing you to reintroduce mushrooms to your diet later. 

Lifestyle changes

Apart from dietary adjustments, you can also target other causes like stress and a weakened immune system. For recurring infections, consider: 

• Yoga and meditation: These can help lower stress levels. 
• Daily exercise or long walks: These activities help clear your mind and improve overall health. 
• Get adequate sleep: A well-rested body and mind are better equipped to handle stress and maintain a strong immune system. 

Dutch Care Institute (z.j.) Vulvovaginale candidiasis, consulted on 4 May 2019, on https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/vulvovaginale_candidiasis 

Burg, Yvonne van de (z.j.), Candida; invisible source of physical complaints, consulted on 5 May 2019, at https://energiekevrouwenacademie.nl/candida-onzichtbare-bron-lichamelijk-klachten/?fbclid=IwAR1_mvgcG7LQst526JMr7S4QMSBkE7MLl99YCy9L4UceqZsBYo5p3juLe6s 

Velde, J. v.d. (2016), Candida test based on 56 symptoms, consulted on 4 May 2019, at https://jessevandervelde.com/candida-test-aan-de-hand-van-56-symptomen/?fbclid=IwAR3zui50B-IiXyOzd9lGg2MfPnrzxCwPVkYni2gQlL3JR6SjSc9j0ig7hA 

RIVM (2018), Candida, consulted on 4 May 2019, at https://www.rivm.nl/candida 

Nederlands Huisartsen Genootschap (2016), I have a vaginal yeast infection, consulted on 4 May 2019, at https://www.thuisarts.nl/vaginale-afscheiding/ik-heb-vaginale-schimmelinfectie 

Vrij-Mazee, Drs. H (2019), Candida, consulted on 4 May 2019, at https://www.gezondheidsplein.nl/aandoeningen/candida/item33189 

Nederlands Huisartsen Genootschap (z.j.), NHG-Standaard Fluor vaginalis, consulted on 5 May 2019, at https://www.nhg.org/standaarden/volledig/nhg-standaard-fluor-vaginalis