When pelvic floor dysfunction mimics yeast infections

Where’s the Yeast? When pelvic floor dysfunction mimics yeast infections

In Female Pelvic Pain by Stephanie Prendergast41 Comments

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Vaginal yeast infections aka candidiasis, are an uncomfortable and common issue that many women find themselves dealing with at some point. Three out of four women will experience at least one vaginal yeast infection in their lifetimes-many will experience two or more. If you’ve had one you know that the symptoms can be enough to drive you crazy:

-severe vaginal/labia itching
-burning during intercourse or urination
-genital redness/swelling
-sometimes (but not always) you will see a thick, white discharge *think cottage cheese*

If you are experiencing any of these symptoms and have not gotten checked out by your doctor-do it. A simple yeast infection can be easily treated by an over the counter or prescription antifungal. Here is what happens when we get a yeast infection:

Candida albicans-a fungus related to yeasts that are common in many of the bread products out there-is the most common type of yeast that we find in and on the human body. When balanced the candida albicans and other microbiota that reside in and around the vaginal canal work together to maintain a healthy environment. However, sometimes situations can go awry and the yeast is able to overproduce. This often leads to a full blown infection and an onset of the symptoms listed above.

The most common causes of a yeast infection are:
-Antibiotic use. Antibiotics not only kill the “bad” bacteria that is being targeted, but they virtually destroy all of the good bacteria that we have developed in our intestines and vagina. The good bacteria keep yeast from growing from their normals levels to infection status.
-Hormonal changes such as pregnancy, hormonal contraceptives, and right before menstruation will change the pH of the vagina, making it a more ‘hosptible’ enviornment for yeast to proliferate.
-Douching and/or inadequate lubrication with sexual activity
-Finally anything that compromises our immune system, such as diabetes, AIDS, cancer, stress, a poor diet, and lack of sleep

If you have any of these symptoms and are dealing with one or more of the above common causes of a yeast infection, I encourage you to get evaluated by a medical professional. Yeast infections are no picnic, but when diagnosed and treated properly they can resolve pretty quickly.

Now that we’ve covered the basics of a typical yeast infection, let’s talk about something that we deal with on a daily basis at PHRC: What happens when you have the symptoms, tested positive for yeast, treated it, but nothing changes? Or, what if you are feeling all of these symptoms, but you doctor was unable to find anything wrong?

Here is what could be going on:
It could be that you had a yeast infection and because a yeast infection is exactly what it sounds like-an INFECTION-your body is going to do whatever it can to protect you against this threat. Your pelvic floor muscles will, outside of your awareness and control, tighten up causing myofascial trigger points, pudendal nerve irritation, and connective tissue restriction. Even though you have taken the antifungal-your pelvic floor muscles may not have gotten the memo and are continuing, though ineffectively, to try to protect you against what it thinks is impending doom. So we have pain, itching,and redness caused by an initial yeast infection, followed by pain, itching, and redness due to our muscles being tight. This then reduces blood flow to the area, irritates the nerves and tissue, and thus becomes a safe harbor for inflammatory chemicals** to camp out. So begins the cycle of pelvic floor muscle dysfunction following a yeast infection.

In the other scenario-you are experiencing the completely maddening symptoms that are so famously associated with a yeast infection, but you go to the doctor and they find nothing. In this case, they will often write you a prescription for an antifungal anyway just in case it is a less common strain of yeast causing the infection (requires a wet mount of vaginal discharge to determine, so not always done initially). You take the antifungal, nothing happens, and you are about to check yourself into the nearest mental health facility because you are losing your mind over the vaginal/vulvar itching, pain, redness, and swelling. *Personal note: I have been this person and it was all I could do to make it into the office and keep my pants on.

What this might be is an onset of myofascial pelvic pain/dysfunction that is basically mimicking a yeast infection.  Because the muscles, nerves, and tissues in the pelvis are in charge of performing so many different functions, our proprioception (awareness of how our are body parts are positioned in space) in this area can easily be way off. So if you are the type of person that runs the risk of getting pelvic floor muscle pain/dysfunction, what feels like a yeast infection may in fact be nothing of the sort.

In the 2015 Guideline on Vaginal Candidosis, Mendel reports “Although itching and redness of the introitus and vagina are typical symptoms, only 35-40% of women reporting genital itching in fact suffer from vulvovaginal candidosis.”1 In other words about two thirds of women reporting vulvovaginal itching don’t actually have a yeast infection! By the time someone with this type of presentation makes it into our office they have likely been through quite a few pelvic exams, swabs, antifungals, or home remedies. Not only is the majority of the general public underinformed when it comes to this issue, but a lot of the medical community may not know much about this either.

When you are evaluated by one of the PHRC therapists for this issue we will want to know the background. The who, what, when, where, and why, as it were. Then we will want to look at you objectively. The main areas of concern for us will likely be the adductors, the vulvar and perianal connective tissue, the pudendal nerve, and the deep and superficial pelvic floor muscles. If you are still also experiencing infections we will also work with your medical team or help you find a team that will help get the infections under control once and for all while we treat the musculoskeletal consequences in physical therapy. (Check out this blog post for a better idea of what a typical first appointment for pelvic floor physical therapy will look like.)

The bottom line is that if you are experiencing some or all of the symptoms that I have listed in this blog post (vaginal/vulvar pain, itching, redness, and swelling) and you have been through all of the first line steps but are STILL having issues, get evaluated by a physical therapist that specializes in pelvic floor dysfunction. Your symptoms may not actually be a yeast infection, but may be the pelvic floor muscles masquerading as such. Here is a link with some tips to find a pelvic floor physical therapist in your area.

Readers we want to hear from you! What are some of your experiences with yeast infections? Please share in the comments section below!

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** One of the main inflammatory chemicals hanging around in this situation are histamines. Sound familiar? As in anti-histamine…as in benadryl? Histamines are famous for causing redness and itching.

  1. Mendling W1. Guideline: Vulvovaginal Candidosis (AWMF 015/072), S2k (excluding chronic mucocutaneous candidosis). Mycoses. 2015 Mar;58 Suppl 1:1-15. doi: 10.1111/myc.12292.

 

 

Comments

  1. Good advice but I want to add a couple of details.

    Non albicans strains have become more prevalent and that may be due to the ease woman can self treat with drugstore yeast medication when they think they have a yeast infection. They essentially are knocking out all the albicans leaving the non albicans to flourish. And worse, they may not even have a yeast infection so they are just setting themselves up for resistance to the drugs.

    The most common non albicans strain is Candida Glabrata. So if a woman has had numerous occurrences of un resolving yeast infections despite many treatments it is possible she really has a non-albicans strain. Diflucan does not treat non-albicans. Treatment for non-albicans is longer length of treatment days/weeks with Terazol intravaginally, Nystatin and other more involved fungal medications.

    Make sure you do not self treat until your doctor has sent off a culture to test for both Albicans and non-albicans. Yeast infections may not have any discharge, just redness and irritation which can be very difficult to tell from a bacterial infection.

  2. I live in outside of Phila. And have been to see Dr. Nyirgesy at the Drexel Vaginitis Center–I’ve been tested for all the infections: yeast, bacterial etc. Long story short, I have generalized Vulvodynia–been havin symptoms for 8 months–presently seeing Pelvic Floor PT and taking gabapentin for pain. We have just begun doing internal work–too much flaring before and hopefully with a couple months or less I will see some change. The gabapentin has muted the symptoms some, but they are still very annoying, to say the least! You mentioned Histamines In your article above. I’ve read something about this. Are you suggestin to try anti histamines to maybe quell the symptoms. Please tell me more.
    I eat very healthy and meditate twice a day trying to train my brain to heal itself. This has been the most awful thing to deal with by far. I Will get better. I will. Please let me know I there is Anything you can suggest.

    1. Author

      Hello Jan,

      I would encourage you to discuss the mind body connection with your therapist. There are many studies that indicate an individuals perception of pain can determine the level of pain he or she experiences. Your therapist may be able to suggest additional methods that can compliment your daily meditation, and help you decrease your symptoms. I recommend that you read Dr. Lorimer’s Explain Pain book for more insight. You will find it in this blog, under the ‘Writings and DVD’ section:

      https://pelvicpainrehab.com/pelvic-pain/2564/fave-pelvic-health-resources-products/

      Best,

      Allison

  3. After a colonoscopy, I had a fissure (rectal tear), which turned intone tolerable rectal pain. Have you ever heard of something like this? I think (guessing) that I have a chronic fissure, which heals slightly (then feel better) and then it gets re-torn. Do you know a rectally surgeon in Los Angeles, or San Fernando Valley area who you recommend? Can you recommend a OT close to Cslabasas, who would do physical therapy ( I have Medicare & Blue Anthem), but I’m willing to be a cash only patient?
    Have you decided to accept cash patients? Medicare says they font care.

    1. Author

      Hello Adele,

      Julie Guthrie and Laura Horn are located in Los Angeles. They will be able to assist you. Unfortunately we cannot legally treat Medicare patients, even if they wish to pay out of pocket. Please read our blog for more information.

      https://pelvicpainrehab.com/patient-questions/2179/cant-phrc-treat-medicare-patients/

      Julie Guthrie,PT
      Synergie Physical Therapy
      Los Angeles CA
      (310) 686-3926

      Laura Horn, PT
      Laura Horn Physical Therapy
      Los Angeles CA
      (323) 314-3415

      All my best,

      Allison

  4. This sounds exactly like what has happened to me. I have had itching for 4 years and am at a terrible emotional place. The docs I have been to have never heard of the itching after the yeast infection has gone. I was given 3 rounds of cipro for a bladder infection, got a terrible yeast infection and the itching has never gone away. Some days are better than others but it has destroyed my life. It sounds like I need to find a good pelvic floor therapist in northern Co or even Denver which is an hour away.

    1. Author

      Hello Kathy,

      Here are the therapists we recommend in Colorado:

      Hollie Neujahr, PT
      Denver, CO
      (303) 260-5092
      Nishimoto & Neujahr Physical Therapy

      Laurie Byrne, PT
      Ft. Collins, CO
      (970)221-1201
      Colorado Physical Therapy

      Margaret Woodward, PT
      Littleton, CO
      (303)797-0988
      Motion On Main Street

      Terri Nishimoto, PT
      DenveR, CO
      (720) 402-3801
      N2 Physical Therapy

      Amy Fife, PT
      Grand Junction,CO
      (970) 243-3061
      Western Colorado Rehab

      Laura Krum, PT
      LittletoN, CO
      Providence Physical Therapy

      Mollie Ressler, PT
      Fort Collins, CO
      (970) 377-1422
      Momentum Physical Therapy

      Regards,

      Allison

  5. I have been dealing with what my urologist describes as a yeast infection for three years. Itching, redness, some blistering but no apparent discharge. I am on difulcan and nystatin. The doctor says that chronic yeast infections are associated with interstitial cystitis(my primary diagnosis) and that there’s nothing more to do than the medications that she’s already prescribed. This yeast infection has never been cultured, by the way. Can you recommend a PT in New Orleans area? Thanks so much!

    1. Author

      Hello Shara,

      Actually, pelvic floor physical therapy is a valuable option for your situation. Below are PF a few therapists located in Louisiana that have taken our course:

      Jacqueline Bravo, PT
      Bravo Therapy Services
      Lafayette LA
      3374060712

      Emily Mike, PT
      Melanie Massey Physical Therapy
      West Monroe LA
      3183961969

      Erin Thibodeaux, DPT
      The Wellness PT’s
      Baton Rouge LA
      2253025067

      Regards,

      Allison

      1. Shara i live in New Orleans and see an excellent pelvic floor doctor (dr knoppe) at Ochsner babtist who then referred me to a pelvic floor physical therapist at ochsner. They are both great. I have chronic symptoms of yeast, vulvadynia and pudendal nerve pain. For the pudendal nerve pain I received 3 nerve blocks which toned down the pain for a few weeks. 4 months ago with the consent of my doctors I started acupuncture which has given the greatest relief out of all the treatments.

  6. Thank you for a very helpful article, it described me very well ! I also have IC and food allergies.
    I was interested in your last comment re histamines, do you think OTC antihistamines like Benadryl can help ?
    Thanks again

    1. Author

      Hello Karen,

      Yes over the counter antihistamines can help relieve some symptoms, but treatment is still recommended.

      All my best,

      Allison

  7. Last year I was diagnosed (tested) with a yeast infection (Albicans and parapsilosis) and put on fluconazole for only two days, the yeast kept coming back, after three rounds, then they put me on metradinazole, which only made things worse. Here I am a full year, 14 drs later, diagnosed with pudendal nerve inflammation with rectal and vaginal pain. I seem to get a yeast flare up during ovulation and then it goes away. I take the fluconazole for two days but the whole thing comes back the next month. Am seeing a wonderful dr. in NYC for yeast- Dr. Morton Teich if anyone needs him. Unfortunately, though, I sit all day at work and am in unbearable pain- even w/ Pelvic Floor PT. Has anyone out there seen real improvement with PT? all the books say yes, but I don’t know if that is all real.
    This has been awful.

    1. Author

      Hello Sue,

      Patients in a similar situation do see improvement, and a significant reduction/eliminiation in their pain. However receiving a second opinion from a different therapist is an option if you do not see improvement after consistent treatment.

      Regards,

      Allison

    2. Don’t know if it will help you but there is a homeopathic brand called Azo that some people says have helped them with yeast even when prescriptions haven’t. Good luct to you.

    3. Sue I have the same situation. I see an excellent pelvic floor doctor who then referred me to a pelvic floor physical therapist. They are both great. I have chronic symptoms of yeast, vulvadynia and pudendal nerve pain. For the pudendal nerve pain I received 3 nerve blocks which toned down the pain for a few weeks. 4 months ago with the consent of my doctors I started acupuncture which has given the greatest relief out of all the treatments.

  8. I have the burning all the time and have been diagnosed with pfd. I don’t have itching right now but have noticed a little bit of thick discharge and I’m burning more than usual. Is it possible that I may actually have a yeast infection this time and not just pfd

    1. Hello Nicole,

      Without an evaluation it is difficult to know what may be causing your symptoms. I encourage you to consult with a local pelvic floor therapist who can conduct an assessment.

      Best,

      Allison

  9. I have been having the same problem, only with random itching and tingling of the groin as well and my butt burns sometimes! I am on paxil 20mg, Trieptal 300mg 2x day, and remeron to sleep! I can’t wear underwear, and certain chairs make my symptoms worse. This happened after a yeast infection and months of tingling in the urethra, although now i rather that! I feel anxious because of this and it isn’t fun, i am missing a lot of school, and was wondering what steps to take next. I am trying to be hopeful, but i am so close to giving up yet again. 🙁 I live in the Putnam County, New York area and would even travel to Mt. Kisco for medical help.

  10. Thanks for this informative post. Throughout this past summer, I had a recurring yeast infection that was associated every time with pelvic floor pain. Three doctors here in NYC all denied that these two things were occurring together. This week I’m experiencing the same situation and would be so grateful to find a pelvic floor specialist in NYC who accepts insurance. Could you make some recommendations?

    Thanks very much!

    1. Hello AnnHi,

      Below are our recommendations for New York:

      Futterman Stacey PT New York NY (212) 226-2066 Five Points Physical Therapy
      Kafka Diana DPT New York NY (212)3542622 Beyond Basics Physical Therapy

      Best,

      Allison

  11. Hi Allison,

    Thanks for your post. I have suffered from yeast infections for over 20 years and know that my trigger is stress. I recently went through a stressful period of time which came along with a lovely spate of recurring yeast infections. I took fluconozole for 2 months which cured the primary infection and kept it away for the rest of the time but then soon after the itchiness and redness returned. When my doctor couldn’t find any sign of candida or any other issues I stopped thinking about it and it seemed to go away on it’s own. This was when I first started to realise my issue could be related to muscle tension.
    I recently had another yeast infection which I treated with fluconozole but I noticed that afterwards I was left with itchiness in the anterior wall of my vagina. While having sex with my partner he noticed that my vagina was super tight and tense in the beginning and then afterwards, when I was less tense, I actually had a reduction of symptoms. This has confirmed my thoughts that my issue is related to muscle tension and not an actual infection. Consequently, I have become more and more aware of the fact that I seem to tense my pelvis while I am working or rushing around without even knowing it. Relaxing this muscle has helped a lot and I have to say that having more frequent sex is doing the trick as well. I want to suggest to all the women to try this out because although it may hurt a little at first, it should loosen things up and help give some relief.

  12. I am very grateful that I ran across this blog today. I have been dealing with what I believed were recurrent yeast infections for 20 years. My most recent flare came in September 2012 and since then, I have not been able to get any relief. I have been through it all, it’s yeast, it’s BV, wait, it’s yeast, no, it’s not, let’s see if it is diabetes, an STD, maybe, it’s eczema ( seeing a dermatologist that I don’t think had seen a vagina since medical school was a horrific experience!) Fast forward 20 years, I just met a doctor in 2015 and a PT that know what I am going through and are helping me through this. My diagnosis is vestibulodynia. (as well as other things) The emotional ups and downs are really getting to me at this point. I could talk for days about my journey. Not better yet and I have a long way to go as this did not happen over night. I really thought I was the only one.

  13. This is all very interesting and yet I don’t see any recmet replies so maybe no ones reading these !??! But I’d like to ask what could cause different smells / how they may occur (ie triggers?) *without* discharge/itching …. And no,. As per other info on douching etc,. I don’t do that….and not a fishy smell but definitely more akin to yeasty…

    – triggers / things to avoid / things I can change in my diet? / I’m very particular about my diet .. (closer to vegan…still with some process junk, but mostly super healthy foods…)

    1. Author Allison Romero says:

      Thanks for this question. There are various reasons why you may be experiencing vaginal odors. There are certainly dietary links to yeast, a primary one being sugar. Here is a recent blog posted that one of the PHRC therapists wrote on vaginal odor https://pelvicpainrehab.com/female-pelvic-pain/2478/vagina-supposed-smell/ . It may also be a good idea to consult with your primary care physician or gynecologist to further evaluate if needed.

  14. I’ve been doing PT for pelvic floor hypertension since January, and despite her skilled assessment and treatments I saw little improvement. The problem started a year ago, when a severe UTI-turned-chronic yeast infection-turned bacterial vaginosis-turned constant, unbearable pain/itching/burning without any kind of pathology.

    With treatment for pelvic floor dysfunction, my ability consciously relax my pelvic floor muscles improved, and some of my pain improved. But the itching and burning sensations? The feeling like my skin was on fire? Didn’t go away. Actually, it got worse.

    Until one day my PT suggested, “Well, maybe you’re having an allergic reaction, try some benadryl.” And I was extremely skeptical, because I hadn’t changed any household/personal detergents, or bought any new clothes, or used a different lotion/lubricant/ANYthing. But I broke down one night and picked up a pack of Benadryl, and ‘lo and behold a few hours later I didn’t, for once in the past few months, feel like I was going out of my mind. I’ve taken it a total of 4 times since that first day, all with the same effect. I take it at night, and wake up the next morning with an almost entirely normal feeling crotch.

    I was having a really hard time comprehending why Benadryl would have helped, because I thought histamines were exclusively a response to allergens. But I understand now that my body has been trying to put out a fire, and feeding it instead. Kind of a revelation!

    1. Hello,

      I’ve been experiencing these same symptoms (among others) for about 3 months now likely triggered by muscle tension anc years of anxiety. I am also seeing a PT who has taught me techniques to relax my pelvic floor, ABC for a while my pain anccoverall symptoms improved, until recently when they all came flooding back. It’s very frustrating to say the least, as I’ve been trying to refrain from pain meds and go the more natural route. Please do let me know if the Benedryl is still working for you, I’d definetly try it out if it has. Good luck and Blessings to you and your family.

      Jan

  15. Hi, can you recommend a good Pelvic floor doctor and a good pelvic floor PT in the Washington metro area, particularly Northern Virginia? Thank you! And thanks for this forum. It has been very enlightening.

  16. Hi. My story is very similar. It’s kind of nice to know I’m not alone. Can you recommend a good doctor and/or pelvic floor PT in IL and Kansas City? I’ve just finished grad school and not sure where I’ll end up.

  17. Could you suggest Pelvic Floor therapy in Tucson AZ area ? Thank you

  18. Hi,

    Is it possible for this type of pelvic floor dysfunction to occur as a response from reccurent BV as well? Wondering because my symptoms of urinary frequency, painful sex, pelvic pain, and itchiness, vaginal cuts started after a hard to treat BV and yeast infection (which I had at the same time). Which came back 3 times. Prior to that I had always had yeast infections since I was like 15 and a few UTIs. Since then the symptoms seem to persist after a new infection.

    I am seeking a pelvic floor PT soon, but wonder about this because my doctors have done many tests, ultrasounds, etc and can’t explain the issue. And none of them mentioned muscle issues as the potential culprit

    1. It sounds like you may have a pelvic floor disorder. Unfortunately we cannot make specific recommendations without evaluating you. We would be happy to evaluate you in one of our locations or you can use our website to find a pelvic floor physical therapist in your area that can help.

  19. Hi! Could you recommend a good pelvic floor specialist in the sacramento area please?

  20. Do any of the symptoms you ladies have come and go? Or are they constant? My symptoms seems to get better (not gone, just better) for a few weeks then come back with a vengeance for several weeks. Been going on nearly a year now.

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