Vaginal mycosis: symptoms, treatment, causes
Vaginal fungus (vaginal mycosis, soorkolpitis) is a common fungal infection in women. It is usually caused by yeast fungi. Typical symptoms are itching and burning of the vagina and a crumbly discharge. The vaginal fungal infection is treated with drugs that are specifically effective against fungi (antimycotics). Here you can read everything important about causes and symptoms of vaginal mycosis, diagnosis, treatment and prognosis!
- What is vaginal mycosis? Infection of the vagina with fungi, usually yeast fungi (especially Candida albicans). It is estimated that three out of four women will get a vaginal fungus at least once in their lives. The infection can occur at any age.
- Common symptoms: Itching and a burning sensation in the vagina and usually also in the pubic area, increased, whitish-crumbly discharge (reminiscent of coagulated milk), possibly pain during sexual intercourse; if the urethra is also affected, pain during urination.
- Treatment: Anti-fungal agent (antimycotics), usually applied externally (cream, vaginal suppositories etc.), only in severe cases also internally (tablets). Possibly antiseptics (generally effective against pathogens).
- Prognosis: Vaginal fungus is usually harmless, but very unpleasant and sometimes persistent. If the immune system is severely weakened, the fungus may spread in the body and attack internal organs.
Vaginal mycosis: Symptoms
The main symptoms of vaginal mycosis are severe itching and a burning sensation in the area of the vagina. In most cases, the symptoms also appear in the pubic area (vulva). They can increase before menstruation. By the way, itching is the first sign of vaginal fungus. It often occurs long before other symptoms appear.
A characteristically altered vaginal discharge is another sign of vaginal mycosis: women always have some discharge. This is often so small that it is hardly noticed. Its quantity changes during the menstrual cycle. Normally it is transparent to milky and odorless. In contrast, an increased, crumbly-white discharge is one of the characteristic symptoms of vaginal mycosis. It is – like the healthy discharge – odorless.
If the discharge from the vagina smells bad (fish smell), it is due to an infection with bacteria and not with fungi. Such a bacterial vaginosis must be treated medically!
Possible symptoms of vaginal mycosis are also pain during sexual intercourse (dyspareunia). If the vaginal mycosis has spread to the urethra, pain during urination (dysuria) is often added.
What does vaginal mycosis look like?
The vagina and pubic area can be swollen in vaginal mycosis. Often (but not always) there are also grey-white deposits on the mucosa at the entrance to the vagina and in the vagina. These coverings can be wiped off. Underneath it an inflammatory reddened mucous membrane is visible.
Female genital fungal infection can also cause small nodules to form on the surface of the skin in the genital area.
If the vaginal flora becomes unbalanced, fungi can spread in the vagina.
Vaginal mycosis: treatment
Fungal infections can be treated with drugs that are specifically effective against fungi – so-called antimycotics. For vaginal mycosis treatment, antimycotics are recommended, which are applied locally. They are available without prescription in pharmacies and usually contain active ingredients from the group of imidazoles (such as clotrimazole and miconazole) or nystatin. Combination packs are often offered, consisting of an anti-fungal Ceme for use in the external pubic area and vaginal suppositories or vaginal tablets that are inserted into the vagina. However, there are also products that only contain an antifungal cream as well as an applicator with the help of which the cream can be inserted deep into the vagina. Depending on the preparation, these local antimycotics are used only once or as a three- or six-day cure.
If this local vaginal mycosis treatment does not help or the infection recurs or flares up repeatedly, an internal (systemic) treatment with antimycotics (in tablet form) may be necessary. These drugs contain so-called triazoles (like fluconazole) and are prescribed by the doctor.
Vaginal mycosis treatment with antiseptics
Vaginal mycosis can also be treated with so-called antiseptics. These are agents that act non-specifically against many pathogens, but not specifically against fungi. They are therefore not as effective as antimycotics in the treatment of vaginal mycosis. For this reason, antiseptics are used especially for light vaginal mycosis or vaginal mycosis in the early stages. They can also be helpful in cases of mixed infections – i.e. infections with different pathogens.
The antiseptic agents against vaginal mycosis are used locally, for example as ointment, solution or suppository. They contain the active ingredient povidone-iodine.
Povidone-iodine must not be used for thyroid diseases. In this case, the iodine contained can cause serious complications!
Pregnancy: What to do about vaginal mycosis?
Vaginal mycosis in pregnancy should be treated medically. It is recommended to use local antimycotics (such as antifungal cream) for seven days. Imidazoles such as clotrimazole, econazole or mitconazole are suitable as active ingredients. These antifungal agents are considered to be very effective, well tolerated and safe for the child throughout pregnancy. Oral antimycotics (tablets) must not be taken during pregnancy or only if the doctor considers it absolutely necessary.
In the last four to six weeks before the birth date, medicinal vaginal mycosis treatment is particularly important for pregnant women. It is important to clear the birth canal of all fungi in time. Otherwise there is a risk that the infection will be transmitted to the child at birth.
In addition to the local antifungal application, pregnant women with vaginal fungus Döderlein bacteria can be administered. These are lactic acid bacteria that belong to the normal vaginal flora. Their application can help to displace the disease-causing fungi in the genital area.
Co-treatment of the partner
Vaginal mycosis is contagious. It can be transmitted by direct physical contact between two people, but also via contaminated objects. So if you have a vaginal fungal infection, your partner can easily get infected and develop a penis fungus (see below).
Therefore, it makes sense if your partner can also be examined and treated if necessary. This is particularly important if you have a repeated case of vaginal mycosis. Co-treatment of your partner helps to reduce the risk of a new infection after successful vaginal mycosis treatment. Under the foreskin of the penis there are often some fungi, but they do not cause any discomfort. However, contact with them shortly after vaginal mycosis treatment may be sufficient to cause a new infection in the woman.
Home remedy against vaginal mycosis
In the media and among family and friends, various home remedies against vaginal mycosis are often advertised. Even though many women are convinced of its effectiveness: Many household remedies are more likely to harm the vaginal flora and do not help at all against vaginal mycosis.
Home remedies that are most often recommended for vaginal mycosis are for example yoghurt, vinegar and garlic. They should be applied to the outer pubic area or inserted into the vagina. This is supposed to kill the fungus. Instead, vinegar, garlic and other pungent substances disturb the vaginal environment and make it even easier for fungi and other pathogens to multiply.
Yoghurt is also not advisable for vaginal mycosis: yoghurt naturally contains various bacteria. These include lactic acid bacteria (lactobacilli), which are responsible for maintaining a healthy vaginal environment. For this reason yoghurt is considered an insider tip against all kinds of vaginal problems. However, yoghurt also contains bacteria that can damage the vaginal flora. Thus, in addition to the vaginal mycosis, a bacterial infection can also develop (bacterial vaginosis).
Basically, the following applies: Use the above described antimycotic vaginal mycosis medications from the pharmacy. They can eliminate the infection quite quickly, especially if used early. Home remedies for vaginal mycosis on the other hand usually only worsen the symptoms.
Other tips for vaginal mycosis
- Because vaginal mycosis is contagious, you should avoid sexual intercourse during the infection. After treatment, you and your partner should use condoms for the first time.
- To prevent the fungal infection from spreading, you should only use pH-neutral soaps (or even better: only lukewarm water) in the genital area and grease the skin regularly.
- Wear air-permeable underwear so that no warm and humid environment develops in the vaginal area – such conditions are ideal for fungal growth.
- Trim your pubes.
- Do not share your towel with others.
- Change your linen and towels every day and wash them at 60 degrees with a heavy-duty detergent.
A sugar-free diet is often recommended to “starve out” the vaginal fungus. So far, however, it has not been demonstrated that this actually works.
The counterpart to vaginal mycosis in women is the penis fungus in men. It is also usually triggered by yeast fungi of the type Candida albicans. The infection first becomes noticeable with a reddening of the foreskin and the glans. Within a few days the tissue swells. Itching, burning and even pain are added. In addition, small, liquid-filled blisters can form on the glans.
Some patients “get” the fungal infection through sexual intercourse with a woman with vaginal mycosis. However, yeast fungi – in small numbers – are also part of a man’s healthy skin flora. Under certain conditions they can multiply strongly and cause complaints. This can happen, for example, if the man has a weakened immune system, for example as a result of diabetes. A lack of hygiene in the genital area can also promote a fungal infection of the penis.
You can read more about symptoms, causes and treatment of a fungal infection in the male genital area in the article Penis fungus.
Vaginal mycosis: causes and risk factors
A healthy vagina is never germ-free, but is home to a natural vaginal flora: this consists mainly of lactic acid bacteria (lactobacilli). Some other bacteria and, in very small numbers, fungi can also (temporarily) be part of the natural vaginal flora. The lactic acid bacteria convert the sugar originating from the vaginal cells into lactic acid. This creates an acidic environment in the vagina in which pathogenic germs can hardly multiply.
However, if the balance of the healthy vaginal flora is disturbed, yeast fungi, for example, have the chance to spread – vaginal fungus develops. About 80 percent of all cases of vaginal mycosis are caused by the yeast Candida albicans. Candida glabrata or Candida tropicalis, for example, are responsible for the remaining 20 percent of diseases.
Can the underwear influence the appearance of vaginal mycosis? Yes, especially if it is made of synthetic fibres and is therefore not breathable. If it is still tight, wear tight trousers over it, maybe a panty liner with a plastic layer and I will have a warm and humid breeding climate in the genital area. That’s where the vaginal fungi thrive!
In men, the fungi usually do not adhere well to the genitals. Infections have to do with a disturbed local defence. Normally, a fit immune system throws out fungi again. And: Fungi can be present in the vaginal flora in a completely normal way. The infection only develops if you multiply massively. Help your bacterial flora by washing only with water and regular fat care.
Risk factor: sexual intercourse
Sexual intercourse is a common transmission route for a genital fungal infection: Women and men can infect each other with fungi; in women this can lead to vaginal fungus, in men to penis fungus.
Risk factor: Weak immune system
A disturbance of the vaginal environment can have various causes. Usually a weakened immune system is behind this. This can, for example, be the result of treatment with drugs that suppress the immune system. These so-called immunosuppressive drugs include, for example, cortisone and cancer drugs from the group of cytostatic drugs (chemotherapeutic drugs).
Some diseases can also weaken the body’s defences and thus promote vaginal mycosis. This applies, for example, to HIV or AIDS and diabetes mellitus.
Risk factor: antibiotics
Some women get a vaginal mycosis by taking antibiotics: antibiotics work against bacteria by inhibiting their reproduction or killing the germs. They make no distinction between useful and harmful bacteria. Antibiotic therapy can therefore also eliminate the lactic acid bacteria in the vagina and thus trigger a vaginal mycosis. The longer the antibiotics are taken, the higher the risk of a fungal infection.
Risk factor: Hormonal changes
Hormonal changes also lead to a change in the vaginal environment. They occur naturally in women during the menstrual cycle and throughout life. For example, women after menopause are more susceptible to vaginal mycosis.
The frequent occurrence of vaginal mycosis during pregnancy can also be attributed to hormonal changes: In pregnant women, for example, these cause an increased sugar content and reduced acidity in the vagina – ideal growth conditions for fungi. The danger here is that the fungi can be transmitted to the child during normal (vaginal) birth. The possible consequences are, for example, a fungal infection in the mouth area (oral thrush) or in the diaper region (diaper dermatitis).
Hormone treatment also promotes the development of vaginal mycosis. For example, some women who use progestin-based hormonal contraceptives are prone to fungal infections in the genital area. Treatment with antiandrogens (for example in severe acne) is also considered a risk factor.
There are also some diseases that cause hormonal imbalances and make her more susceptible to vaginal mycosis. These include overactive and underactive thyroid glands and Cushing’s disease.
Risk factor: Excessive or inadequate hygiene
Both too much and a lack of personal hygiene can promote vaginal mycosis. Excessive personal hygiene can disturb the sensitive balance of the natural vaginal flora and thus pave the way for a vaginal mycosis. A lack of personal hygiene can also promote the development of the fungal infection.
Risk factor: Wrong clothing
Fungi grow particularly well in a warm and humid environment. Therefore, skin-tight clothing and underwear made of synthetic fabrics can promote vaginal fungus: they promote sweating and can cause heat build-up.
Risk factor: stress and psychological strain
According to recent research, stress and psychological strain also have a negative effect on the vaginal environment. They can therefore also promote vaginal mycosis.
Vaginal mycosis: examinations and diagnosis
If vaginal mycosis is suspected, a gynaecologist is the right contact person. This person will first talk to you in detail to take your medical history (anamnesis). Possible questions from the doctor are:
- What exactly are your complaints?
- How long have the symptoms been present?
- Have you had such complaints before?
- Have you already made any attempts at therapy (for example with over-the-counter antifungal agents from the pharmacy)?
- Do you have any underlying diseases (like diabetes, HIV)?
- Do you use any medication (antibiotics, cortisone etc.)?
- Does your partner suffer from a venereal disease?
After the anamnesis a physical examination takes place. The doctor proceeds in the same way as with the regular gynaecological examination. A vaginal fungal infection can often be recognized by a whitish to grayish coating on the mucosa. If it is carefully wiped off, an inflammatory reddened vaginal mucosa is revealed.
To determine which pathogens are responsible for the infection, the doctor takes a smear of the vaginal mucosa. This can be examined under the microscope. Thread-like structures in the microscopic image (so-called hyphae) indicate a fungal infection.
Rarely does this microscopic examination not yield clear results. The germs are then cultivated in the smear (pathogen culture): in the laboratory, the smear is placed on a suitable culture medium and optimal growth conditions are created for the germs to multiply. This makes them easier to identify.
Vaginal mycosis: course and prognosis
With timely and consistent therapy, the prognosis for vaginal mycosis is favourable. Usually a fungal infection does not last longer than a few weeks and heals without consequences. Rarely does the infection prove to be very protracted, for example in the case of a weakened immune system. Under certain circumstances, the vaginal mycosis can even spread in the body with very severe immune deficiency and attack internal organs.
After a vaginal mycosis has healed, a relapse can occur (repeatedly) if there are still favourable factors such as incorrect genital hygiene, continued antibiotic therapy or a weakened immune system. Where possible, such risk factors should therefore be eliminated or reduced.
Vaginal mycosis: Prevention
If you want to prevent vaginal mycosis, you should avoid or reduce known risk factors as far as possible. That is:
- Avoid synthetic clothing and clothing that is very tight in the genital area and may even chafe.
- Only wear underwear made of breathable materials such as cotton. This prevents heat and moisture accumulation in the genital area.
- Do not use plastic-coated panty liners and bandages. They can also cause moisture and heat to build up in the vaginal area. Perfumed bandages are also unfavourable: The fragrances can irritate the sensitive mucous membrane, making it more susceptible to infection.
- Tampons dry out the vaginal mucosa and can thus promote vaginal mycosis in sensitive women. Then it can be helpful to change the tampons often or to switch to breathable bandages (bio-bandages).
- Make sure that intimate hygiene is careful, but not excessive. Only use lukewarm water or at most pH-neutral or slightly acidic products (syndets) to clean the genital region, so as not to disturb the vaginal environment. Avoid intimate sprays and vaginal rinses.
- When going to the toilet you should always wipe from the front (vaginal entrance) to the back (anus). If you do it the other way round, fungi from the intestines could get into the vagina. According to some experts, this can lead to a vaginal mycosis infection.
In certain cases, a medicinal prevention of vaginal mycosis can be useful. For example, a doctor may recommend preventive use of antifungal drugs at intervals (from twice a week to monthly) for women who have diabetes or are receiving antibiotic therapy.