Although yeast infections are probably the most common type of vulvovaginitis, they rank second in office visits because many women never go to their doctor for this type of infection. Some recover spontaneously, others treat themselves with anti-fungal vaginal creams or suppositories available without prescription.

Classic symptoms of yeast infections include vulvar itching, redness, and irritation. If your urinary opening is inflamed, you may have to urinate somewhat more frequently than usual, and urination may be uncomfortable. If your infection is severe, your vulva may swell and fine breaks, called fissures, may appear. Your vaginal discharge will become thicker, whiter, and curd-like (similar to cottage cheese in texture and appearance). Inflammation of the vulva and vagina, combined with the dryness of your discharge, makes intercourse painful.

Yeast infections are the result of excessive growth of a family of fungi that normally live and thrive in the vagina. The most common of these is Candida albicans . Certain factors such as recent use of oral or vaginal antibiotics, clothing (such as nylon and lycra) that traps heat and moisture, obesity, pregnancy, and diabetes tend to disrupt the normal balance of vaginal organisms, causing the fungi to reproduce rapidly and leading to the uncomfortable symptoms we associate with yeast infections. Other possible causes of these infections include suppression of the immune system during such chronic illnesses as AIDS, the use of oral contraceptives, and eating large amounts of sugars, starch, and yeasts.

Because yeasts also normally inhabit the intestine, it's important always to wipe front to back (vaginal area first; rectal area second) after a bowel movement. During sex you must take care to prevent your vagina from becoming contaminated with organisms from your bowel and rectum.

Your chances of catching a yeast infection from a male sexual partner are quite low. The fungus does not fare well on a man's sexual organs, where exposure to the air can dry it out. However, men can develop the disease through frequent sexual contact with an infected female partner. In this case, tiny tender, itchy red bumps appear on the penis. Among lesbian couples, sexual transmission is more common. In all cases, treatment is the same.

To diagnose these infections, the doctor will take a case history, perform a pelvic examination, and examine a few drops of vaginal discharge under the microscope. When the diagnosis is unclear, a vaginal culture may be taken. A good response to an antifungal medication confirms the physician's diagnosis.

If you do have a yeast infection, your doctor will ordinarily treat you with either prescription or nonprescription antifungal vaginal creams and suppositories. These preparations usually provide substantial relief in a few days. You must finish all your medication even if you're feeling better. Otherwise, you run the risk of relapse. If you still have symptoms after you complete your medication, see your doctor. Several other skin conditions can mimic or coexist with yeast infections.

If you have frequent yeast infections (three or more per year), the first line of attack is elimination of any predisposing factors. If the problem persists, the doctor may prescribe preventive doses of antifungal creams or suppositories. For example, inserting a suppository one or more times per menstrual cycle has proven effective for some women.

Recently there has been substantial interest in the anti-yeast activity of boric acid. You can buy boric acid powder in most drugstores. Pack it loosely into size “ 0” capsules (available at some pharmacies and most health food stores). For a current yeast infection, insert 1 capsule as deeply into your vagina as possible in the morning and again at bedtime for five to seven days. To prevent recurrent infections, use 1 capsule vaginally at bedtime twice weekly beginning one week after menstruation and ending when the next period begins. The capsules cause a very slight watery discharge, but are far less messy than either creams or suppositories. They may also cause mild vaginal irritation. This can be eliminated by not using them for a day or two.