Candida vaginitis, also called vulvovaginal candidiasis, is a fungal infection of the vagina and vulva caused by an overgrowth of Candida yeast. It affects roughly one in three women globally at any given time, with a pooled prevalence estimated at about 33%. Most people know it simply as a vaginal yeast infection, and it’s one of the most common reasons women seek gynecological care.
What Causes the Infection
Candida yeast naturally lives in the gastrointestinal and genitourinary tracts without causing problems. In about 85 to 90% of vaginal yeast infections, the species responsible is Candida albicans. The remaining 10 to 45% of cases involve other species, most commonly Candida glabrata, which accounts for roughly half to two-thirds of those non-albicans infections. Less frequently, species like C. tropicalis, C. krusei, and C. parapsilosis are involved.
The shift from harmless to harmful happens when Candida changes form. In its normal yeast state, the vaginal lining tolerates it without mounting a significant immune response. But when conditions allow it to switch into a more invasive, thread-like form, the fungus begins producing enzymes and toxins that damage tissue. As the fungal population grows beyond a certain threshold, the body’s immune system kicks into overdrive, triggering the intense inflammation and irritation you experience as symptoms.
Common Risk Factors
Several things can tip the balance in Candida’s favor:
- Antibiotic use: Antibiotics kill off the protective bacteria (especially lactobacilli) that keep Candida in check in the vagina. This is one of the most common triggers.
- Poorly controlled diabetes: High blood sugar impairs the white blood cells that normally clear Candida. Excess glucose also feeds the yeast directly, and sugar excreted in urine provides additional nutrients for colonization. Higher A1C levels are associated with increased risk.
- Hormonal changes: Pregnancy, oral contraceptives, and hormone therapy can alter the vaginal environment in ways that promote yeast growth.
- Immunosuppression: Steroids, chemotherapy, and conditions that weaken the immune system reduce the body’s ability to keep Candida populations small.
What It Feels Like
The hallmark symptom is intense itching of the vulva and vaginal area. Beyond that, you may notice vaginal soreness, burning during urination (typically felt on the outside skin rather than internally), and pain during intercourse. Vaginal discharge is often thick, white, and clumpy, sometimes described as cottage cheese-like. Unlike bacterial vaginosis or trichomoniasis, yeast infections typically produce no strong or foul odor.
In more severe cases, the vulva can become noticeably red and swollen, with small cracks or fissures in the skin and areas of raw, irritated tissue from scratching. Severe infections tend to respond more slowly to short courses of treatment.
How It’s Diagnosed
Symptoms alone aren’t enough for a reliable diagnosis because other vaginal infections can look similar. One distinguishing feature is vaginal pH: yeast infections typically keep the vaginal pH at a normal level around 4.0, while bacterial vaginosis pushes it above 4.5 and trichomoniasis raises it further to 5.0 or higher. A normal pH in the presence of itching and thick discharge points strongly toward Candida.
To confirm, a clinician usually examines a sample of vaginal discharge under a microscope, looking for the characteristic branching threads and budding yeast cells. In some cases, a culture may be sent to a lab, which is especially useful for identifying non-albicans species that may not respond to standard treatment.
Treatment Options
Most uncomplicated yeast infections are treated with antifungal creams applied inside the vagina or a single oral antifungal pill. Over-the-counter vaginal creams are widely available in 1-day, 3-day, and 7-day formulations. The CDC recommends getting tested before starting treatment, even with OTC products, because many women who self-diagnose a yeast infection actually have a different condition.
If your infection is caused by a non-albicans species like C. glabrata, standard treatments may not work as well. These cases often require longer courses or different antifungal agents, which is one reason lab testing matters when infections keep coming back or don’t respond to initial treatment.
Recurrent Infections
Recurrent vulvovaginal candidiasis is defined as four or more episodes within a 12-month period. It’s a distinct clinical problem that affects a significant number of women and requires a different management approach than a one-time infection, typically involving an extended course of antifungal treatment to suppress the yeast over several months.
For women with diabetes who experience recurrent infections, better blood sugar control is an important part of breaking the cycle. Certain diabetes medications that increase glucose excretion through urine can also contribute to recurrence. If you’re taking one of these and dealing with frequent yeast infections, your provider may consider switching to an alternative.
Can Probiotics Help Prevent It?
The evidence on probiotics is mixed but leaning cautiously positive for preventing recurrence, not for treating active infections. In one study, women who took a lactobacillus probiotic after completing antifungal treatment had a recurrence rate of just 7% over six months, compared to 36% in those who took a placebo. Another study found that women using probiotics had fewer and less frequent recurrences over 90 days.
However, probiotics taken during or after antibiotic courses to prevent yeast infections from developing in the first place have not shown a clear benefit. A study of nearly 500 women using oral or vaginal probiotics for four days during antibiotic treatment found no reduction in subsequent Candida infections. The current picture suggests probiotics may help reduce recurrence after treatment but aren’t reliably useful as a preventive measure during antibiotics.