New York Health - Should I self-treat a vaginal yeast infection with a...

Introduction

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctors's recommendation.

Key points in making your decision

Consider the following when making your decision about self-diagnosing and self-treating an apparent vaginal yeast infection:

If you have mild symptoms, you may want to wait to see if they go away on their own. A mild vaginal yeast infection may correct itself without treatment.
Sometimes women think they have a vaginal yeast infection when symptoms are caused by another problem instead. One study found that about 2 out of 3 women who think they have a simple yeast infection don't.¹ This type of mistake could mean it takes longer to find out about and treat a different condition, such as bacterial vaginosis or a sexually transmitted disease (STD).
If you are not pregnant and you are certain that your symptoms are caused by a vaginal yeast infection, you can self-treat with a nonprescription antifungal vaginal medicine.
If you are pregnant, first see your doctor before treating vaginal symptoms. A vaginal yeast infection can be safely treated during pregnancy with vaginal (not oral) medicine.
When using an antifungal cream or suppository, you cannot trust a condom or diaphragm for birth control. Many of the vaginal creams and suppositories used to treat yeast infections are oil-based, which can weaken rubber (latex).

Medical Information

What is a vaginal yeast infection?

A vaginal yeast infection is an excess growth of yeast cells in the vagina. Although a vaginal yeast infection can cause severe vaginal and genital itching, pain, and irritation, it is very unlikely to lead to serious health problems. But a yeast infection that recurs frequently is considered a medical problem, because the symptoms can be so disruptive.

A healthy vagina normally contains many bacteria and small numbers of yeast cells (vaginal flora). The most common bacteria found in the vagina are Lactobacillus acidophilus. These bacteria help prevent other organisms, such as yeast, from growing in excess and causing vaginal symptoms. About 70% to 90% of yeast infections are caused by a strain of yeast called Candida albicans.^2,³ This type of yeast is targeted by azole antifungal medicines.

Overgrowth of vaginal yeast can be promoted by many factors, including broad-spectrum antibiotic medicines, high estrogen levels (as during pregnancy or hormone replacement therapy), or certain medical conditions, such as diabetes.

How is vaginal yeast infection treated?

A one-time vaginal yeast infection (acute infection) is usually treated with either:

An antifungal cream or suppository inserted into the vagina. You repeat this treatment over several days.
One antifungal pill you take by mouth.

An alternative treatment also recommended by experts is vaginal boric acid capsules, especially for yeast that has resisted antifungal treatment.^3,⁴

What are the risks of not treating or treating a vaginal yeast infection?

Not treating. A vaginal yeast infection does not lead to major health problems, and you may find that a mild infection corrects itself. But you are not likely to be able to go without treatment if you have severe symptoms.

Treating. Perhaps the greatest risks you face when treating a vaginal yeast infection are related to self-diagnosis and self-treatment. If you have had a diagnosed yeast infection before, if you correctly diagnose your condition based on past symptoms, and if you self-treat with a nonprescription treatment as directed, your risks are minimal. But if you misdiagnose your condition, you could be delaying diagnosis of a different problem, such as a bacterial vaginal infection or a sexually transmitted disease (STD). One study found that about 2 out of 3 women who think they have a simple yeast infection don't.¹

If you are pregnant and think you have a yeast infection, do not self-treat your symptoms. Only use treatment based on your doctor's diagnosis and treatment advice.

Treating a yeast infection vaginally poses no major risks. The cream or suppository medicine only affects the vaginal area and does not usually cause pain or tenderness. Some women get a headache, abdominal pain, or nausea after treatment with the oral medicine. But these side effects are not common after a single treatment dose. Side effects are more likely to occur after you have had more than one treatment (multi-dose treatment) of the oral medicine. You will most likely need multi-dose treatment only if your infection is severe or if it comes back after the first treatment.

If you need more information, see the topic Vaginal Yeast Infections.

Your Information

Your choices for treating apparent symptoms of a vaginal yeast infection are:

Self-diagnose your symptoms and use nonprescription vaginal medicine as directed on the package insert.
See your doctor for an examination. If you have a vaginal yeast infection, you can then proceed with treatment.

The decision about whether to self-diagnose and self-treat an apparent vaginal yeast infection takes into account your personal feelings and the medical facts.

**Deciding whether to self-treat a vaginal yeast infection**
Reasons to self-treat an apparent vaginal yeast infection without a doctor's medical advice	Reasons to consult your doctor before treating an apparent vaginal yeast infection
You are a good candidate for using a nonprescription yeast infection treatment if you are not pregnant, you are certain that you have not been exposed to a sexually transmitted disease (STD), and: You have had a diagnosed vaginal yeast infection in the past 2 months, and your symptoms are clearly a recurrence of the infection. You are certain of your diagnosis because your current symptoms are identical to yeast infection symptoms you have had some time in the past. Are there other reasons you might want to self-treat without a doctor's advice?	See your doctor for a diagnosis and treatment advice if you have vaginal symptoms and: You have not had a diagnosed vaginal yeast infection before. You are pregnant. There is any chance that you have been exposed to a sexually transmitted disease (STD). This appears to be your fourth yeast infection within a year, unrelated to antibiotic use (after four in a year, a medical examination is advised, to look for other causes). You would prefer to use an oral antifungal medicine to treat a yeast infection. Are there other reasons you might want to see your doctor?

These personal stories may help you make your decision.

Wise Health Decision

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about self-treating an apparent vaginal yeast infection with or without a medical diagnosis and treatment advice. If necessary, discuss the worksheet with your doctor.

Circle the answer that best applies to you.

I am pregnant.	Yes	No	Unsure
I have had a diagnosed vaginal yeast infection before.	Yes	No	Unsure
I have treated a diagnosed vaginal yeast infection within the last 2 months.	Yes	No	Unsure
This is the fourth time I've had symptoms of a vaginal yeast infection in the past year.	Yes	No	Unsure
It's possible that I have been exposed to a sexually transmitted disease.	Yes	No	Unsure
I have risk factors for diabetes.	Yes	No	Unsure
I have recently taken antibiotics.	Yes	No	Unsure
I have been taking estrogen, either as a birth control pill or as hormone replacement therapy.	Yes	No	Unsure
I am interested in trying vaginal boric acid capsules instead of a vaginal antifungal medicine.	Yes	No	Unsure

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to use or not use vaginal yeast infection treatment without a doctor's diagnosis and advice.

Check the box below that represents your overall impression about your decision.

Leaning toward self-diagnosis and self-treatment

Leaning toward consulting a doctor

Return to the topic:

References

Citations
Ferris DG, et al. (2002). Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis. Obstetrics and Gynecology, 99(3): 419-425.
Bauters TGM, et al. (2002). Prevalence of vulvovaginal candidiasis and susceptibility to fluconazole in women. American Journal of Obstetrics and Gynecology, 187(3): 569-574.
Eschenbach DA (2003). Vaginitis section of Pelvic infections and sexually transmitted diseases. In JR Scott et al., eds., Danforth's Obstetrics and Gynecology, 9th ed., pp. 585-589. Philadelphia: Lippincott Williams and Wilkins.
Kessel KV, et al. (2003). Common complementary and alternative therapies for yeast vaginitis and bacterial vaginosis: A systematic review. Obstetrical and Gynecological Survey, 58(5): 351-358.

Health Information

Should I self-treat a vaginal yeast infection with a nonprescription medication?