Do you know your personal risk factors for developing a yeast infection? And if you struggle with multiple yeast infections each year, did you know that your birth control might be the culprit?
According to the National Women’s Health Resource Center, almost 75% of women will develop at least one yeast infection during their lifetime. Small amounts of a specific type of yeast called candida naturally occur in the mouth, the GI tract, and the vagina. But overgrowth of this naturally occurring fungus can cause a vaginal yeast infection, also known as candidiasis. In this article, we’ll explore causes of yeast overgrowth, especially the connection between hormonal birth control use and yeast infections, plus treatment and prevention.
Symptoms of a yeast infection
While a naturally occurring bacteria called lactobacillus typically prevents yeast overgrowth in the vagina, sometimes that bacteria-to-yeast ratio is thrown off and infection results. Classic symptoms of a yeast infection include vaginal and vulvar (the tissue at the vaginal opening) itching and burning plus a thick white vaginal discharge with a “cottage cheese” appearance.
According to the Mayo Clinic, vaginal redness, swelling, pain, soreness, and rash are also possible manifestations, as well as watery vaginal discharge. Of note, vaginal discharge with a fishy odor is a symptom of bacterial vaginosis, not of a yeast infection. Read more info on distinguishing normal from abnormal vaginal discharge here and here.
Should you go to the doctor for a yeast infection?
If you’ve been diagnosed with a vaginal yeast infection before and are otherwise healthy, you can try an over-the-counter treatment for a presumed yeast infection for a few days to see if your symptoms resolve.
However, if you have symptoms of a yeast infection, but have never been diagnosed with one before, it’s a good idea to call your healthcare provider’s office to first get checked out. Bacterial vaginosis and trichomoniasis have symptoms that are similar to those of a yeast infection, but require different treatments; both can also have more serious health consequences than yeast infections.
If you go to a doctor’s office with yeast infection symptoms, your healthcare provider will visually assess the vagina and surrounding tissues, perform a pelvic exam, and possibly take a vaginal swab for culture.
If you’re in one of the higher risk categories listed below, always be sure to call your doctor’s office before taking any over-the-counter yeast infection medicines, as some may interact with medications you’re taking.
Who gets yeast infections?
The Mayo Clinic reports that women who start having sex for the first time, pregnant women, and women with poorly controlled diabetes or weakened immune systems (due to HIV or certain medications, for instance) are more likely to develop yeast infections.
Antibiotic use also predisposes women to yeast infections, which makes sense since antibiotics kill both good and bad “bugs” within the body. This is why many doctors recommend taking probiotics after or concurrent with antibiotics, to build back up the good bacteria that can keep yeast growth in check.
The connection between yeast infections and birth control use
Perhaps the most significant risk factor for yeast infections, since it affects the largest category of women at any given time, is birth control use.
Birth control, including condoms, spermicidal jellies and creams, intrauterine devices (IUDs), sponges and diaphragms, and oral contraceptives can increase vaginal yeast infection risk in several ways , .
Spermicides and spermicidal condoms
The chemicals in spermicidal jellies and creams disrupt the natural flora and fauna of the vagina by killing off lactobacilli, leading to yeast overgrowth. In particular, spermicidal condoms contain nonoxynol-9, which can irritate the vagina and kill off the good lactobacilli bacteria, paving the way for a yeast infection to develop. Additionally, the increased moisture caused by spermicides can feed yeast growth.
Birth control devices
Sponges, diaphragms, and IUDs are all foreign objects (read: potential irritants) continuously positioned in or close to the vagina; their use likewise correlates with higher likelihood of developing a yeast infection. However, the exact mechanism by whichthey increase yeast infection risk isn’t well understood.
Research suggests that elevated estrogen levels increase yeast infection risk, whether due to pregnancy or hormonal birth control use. One reason for this correlation is because yeast feeds on sugar, and estrogen can raise blood sugar levels and increase the body’s resistance to insulin. Elevated blood sugar levels appear to feed yeast, either locally or systemically.
Natural Womanhood conducted a deep dive into the connection between the menstrual cycle and the immune system, and consequently the ways that hormonal birth control interferes with the body’s natural immune defenses. By accelerating the aging process of epithelial tissues in the cervix and altering immune cell function along both the female reproductive tract and in cervical mucus itself, hormonal birth control use appears to increase susceptibility to both bacterial and viral disease.
And remember how we said above that candida belongs in the mouth, the gut, and the vagina? Naturopathic doctor Jolene Brighten points out that oral contraceptives (i.e. the Pill) can increase yeast infections in any and all of these places. This makes sense given that the synthetic hormones in hormonal birth control impact both the immune system and the gastrointestinal system, as we explored here.
Yeast is a type of fungus, so typical treatment includes over-the-counter antifungal medications. Depending on the brand, the medication may be taken for one day, three days, or seven days. Over-the-counter treatments come in several forms, including 1) pills to be taken orally, 2) vaginal suppositories, or 3) creams or ointments applied topically to the vaginal area.
The active ingredients list will tell you what the medication you choose does. Products with an active ingredient name ending in -azole (such as Monistat, which has the active ingredient Miconazole) are antifungal and will actually fight the yeast infection. Products with an active ingredient of hydrocortisone, resorcinol, or benzocaine are for symptom relief (such as numbing the painful areas) but do not actually fight the yeast infection. Some over-the-counter options have multiple active ingredients to fight the yeast infection and provide quick symptom relief.
Taking the entire course of treatment, even if you are already feeling better after just one day, is important to prevent the yeast infection from coming back. While you are actively being treated, even if the symptoms have already gone away, avoid sexual intercourse and tampon use.
If you’re still having symptoms after completing a course of over-the-counter treatment, or if you have more than one yeast infection in a 12 month timespan, contact your doctor. At the doctor’s office, your healthcare provider will likely test a sample of vaginal fluid to check the type of yeast growing and to rule out bacterial vaginosis and trichomoniasis, which have some of the same symptoms as yeast infections but require different treatment. Your doctor may prescribe one-dose, oral Diflucan (fluconazole) to treat a yeast infection caused by candida, unless you are currently pregnant.
Approximately 5% of women experience recurrent yeast infections, defined as having four or more in a 12-month timespan, which will require more aggressive treatment, detailed here.
Generally, male sexual partners without symptoms do not require treatment.
Good hygiene for the prevention of yeast infections
- Take off wet swimsuits or sweaty workout gear right away.
- Wear underwear with a cotton crotch.
- Avoid tight-fitting panythose, leggings, pants, or other bottoms that can trap moisture.
- Avoid regular use of scented soaps or bubble baths.
- Avoid scented tampons, powders, and douching.
- Avoid regular use of hot tubs or hot baths.
- Take antibiotics only as directed by your healthcare provider.
- Use water-based rather than scented lubricants when needed.
Your best bet for preventing recurrent yeast infections is to eliminate as many of your personal risk factors as possible. While you may have one or more risk factors outside your control, take advantage of these hygienic best practices and consider switching from hormonal birth control or birth control devices, and utilizing a fertility awareness method (FAM) instead, to reduce your risk moving forward. If you were prescribed birth control for reproductive issues such as premenstrual syndrome (PMS) or abnormal bleeding, seek out care from a healthcare professional trained in restorative reproductive medicine (RRM) to address the root causes. If you are diabetic, work with your healthcare team to achieve adequate blood sugar control.
Yeast infections are no fun, but taking these common-sense steps today can help you reduce your risk for acquiring them.
 Gonçalves B, et al. “Vulvovaginal candidiasis: Epidemiology, microbiology and risk factors.” Crit Rev Microbiol. 2016 Nov;42(6):905-27. doi:10.3109/1040841X.2015
 Rezk M, Sayyed T, Masood A, Dawood R. Risk of bacterial vaginosis, Trichomonas vaginalis and Candida albicans infection among new users of combined hormonal contraception vs LNG-IUS. Eur J Contracept Reprod Health Care. 2017 Oct;22(5):344-348. doi:10.1080/13625187.2017.1365835