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
-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.
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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.
- 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.