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Candidiasis is caused by overgrowth of the fungus Candida albicans, which is almost always normally present in the vagina. Pregnancy, diabetes, impaired immune response and the use of antibiotics or contraceptive tablets, among other things, predispose to candidiasis. Tight clothes and non-breathable menstrual protection may also increase symptoms. However, the triggering factor for vaginal candidiasis cannot always be identified.

Candidiasis can be suspected based on symptoms, but it’s good to remember that in fewer than half of cases itching is not caused by candidiasis. You should be careful when using over-the-counter products, as gynaecological symptoms may also be due to other causes, which will require different treatment. 

Curd-like discharge with severe itching and in some cases with vulvar burning is usually a sign of candidiasis. There may be small ulcers and redness on the vulvar mucosa. Vaginal candidiasis does not usually involve other symptoms (such as fever, lower abdominal pain or difficulty urinating).

Self-care

To increase the chances of successful therapy and to prevent the symptoms from recurring, remember the following:

  • Be careful about personal hygiene. However, avoid too frequent washing, the use of soap and directing the shower into the vagina, because excessive hygiene may also cause symptoms. If you use cleansing products, their pH should be under 7.
  • Try a tampon or menstrual cup instead of sanitary pads.
  • Avoid strongly scented hygiene products.
  • Use loosely fitting underwear made of synthetic fabrics, mercerized cotton or silk.
  • Avoid eating lots of sugar. In contrast, you do not have to avoid pastry made with yeast. Eating lactobacilli-containing plain yoghurt daily may be useful for those with recurrent candidiasis.
  • Always wipe from front to back after using the toilet. The yeast infection may also spread from the colon to the vagina.
  • You may see recommendations about inserting yoghurt into the vagina or use of a mild vinegar solution to treat candidiasis. These kinds of methods have not been proved to be medically effective, and they may interfere with the efficacy of over-the-counter medicines.     

Over-the-counter products

If you’ve previously had vaginal candidiasis or you recognise the symptoms, you can treat it with over-the-counter products. Repeated symptoms of candidiasis require further examinations and assessment of potential causes of its recurrence.

  • The recommended over-the-counter medicines include pessaries containing imidazole derivatives, clotrimazole, miconazole or tioconazole. Recommended durations of the courses vary from one to six days depending on the product.
  • Pessaries should be used in the evenings, as instructed. You should continue the treatment during periods. Using tampons at the same time is not recommended. You can use sanitary pads or pantyliners. If the vulvar itching is severe, you can also use creams.
  • Allergic or irritation reactions are rare but possible. They manifest as irritation and burning during treatment. You may feel that the symptoms worsen despite treatment. In this case, you should stop the treatment and see a doctor.
  • Fluconazole-containing capsules taken by mouth are also available. The capsule should be swallowed whole with a meal or on an empty stomach. Fluconazole has interactions with some medicinal agents, the most important being warfarin (medicine to prevent blood coagulation) and some antidiabetics and antiasthmatics. You should talk to the pharmacy staff before using fluconazole capsules. 
  • During pregnancy, over-the-counter medicines are not recommended without first contacting a doctor or the maternity clinic.

When should you seek treatment?

Contact a healthcare professional if

  • you have symptoms for the first time,
  • you have frequent candidiasis episodes,
  • you are pregnant,
  • you have irregular bloody discharge or smelly discharge,
  • you have lower abdominal pain and/or fever,
  • you have blisters in your genitalia,
  • there is reason to believe that your symptoms are caused by an STD,
  • your partner also has symptoms,
  • you have difficulty urinating,
  • sensations of burning and irritation increase or the symptoms worsen during treatment,
  • self-care and over-the-counter treatment do not alleviate symptoms within 3 days or the symptoms do not disappear within a week.

Information sources: The Finnish Medical Society Duodecim: Terveysportti, Lääkärin tietokanta database

FSHS General Practitioner / 23/09/2019

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