Ask Skepchick tackles Yeast Infections (and the sexism inherent in alt med philosophies)

Dear Skepchick,
Hi! Um…this is embarrassing, but I was wondering if you could do a post to enlighten…um…people with yeast infections. Because it would be wonderful if…people…could find cheap cures for yeast infections, but when I–I mean people–google “skeptic yeast infection treatment” I get nothing. If douching with yogurt or whatever actually worked that would be kind of fantastic, but I suspect that it doesn’t. (Which is maybe why the word “fantastic” is appropriate.) Do I just have to suck it up and shell out for the medicine? I hope it doesn’t cost too much…I’ve never had one before. Anyway, sorry for the awkward question–really hope you answer it!

It’s true. There is not much good help on the internet for women looking for information about the sometimes wonky things that can happen to our girl parts. Most of what turns up is at best rumor and misinformation, and at worst, quacks selling fake cures. I’ll get to answering the question shortly, but first, if you’ll indulge me, I’d like to dig into the politics of the matter. (Or, if you don’t care about the politics and would rather get straight to the answer, just skip the next 7 or so paragraphs; there’s a line of bold text to make it easier.)

Yeast infections remain a huge taboo in so-called polite society. If you have any doubt that this is true, just re-read the above question. Many women are afraid to talk about them. Why is this? Well, we are still fighting to get beyond a culture that tells us our vaginas in and of themselves are gross. So it’s understandable not to want to discuss something sort of gross that’s happening in a place we’ve been trying to convince ourselves (and the rest of society) is really not gross at all. I’m not suggesting that the state of your junk is necessarily suitable dinner table conversation, but we shouldn’t be afraid to talk about it, even in mixed company, much less with other women.

This taboo is not helpful. What happens is this: women who feel ashamed of their bodies or what’s happening to their bodies are afraid to seek treatment or ask questions and instead turn to home remedies or quack cures they find, privately, online. I really think that a big reason women might look like bigger believers in woo is a direct result of society making us feel like our bodies are dirty and inferior and that science can’t (or won’t) address our problems. Shame keeps women’s problems, and, by extension, their solutions, underground.

Looking back through Judeo-Christian cultural history, and how women were viewed through that lens, it is easy to understand why women would have developed socially transmitted, natural and intuitive systems for understanding and solving their problems. Because women were seen as inferior and their bodies as dirty wells of temptation, they had to come up with their own ways of figuring things out; ways that would necessarily be kept secret from men, and therefore kept out of mainstream culture.

This is the genesis of separate “ways of knowing” for men and women. It’s not that women are naturally more in touch with nature and intuition; just that we’ve had to be because the tools of science were not available to us until relatively recently. Much has changed, of course, but a lot of the social structure arising from these cultural dynamics still affects us today.

Which is why websites like this (and, really, the entire “natural medicine” cult) make me absolutely irate. These assholes make their living by reinforcing the idea that there are separate ways of knowing, which naturally will appeal to more women than men, because of how women are generally socialized in our culture. They display blatant misunderstandings of science, and of how the human body works, while claiming that established medicine is, at best, ineffective or, at worst, actively evil. In the case of the above website, they claim that “the medical establishment” doesn’t want you to know about their natural cure, because it’s cheap and effective, using common household ingredients, and that they know it works but that if you find out about it, you’ll stop buying drugs and lining their pockets. But then, as you scroll down the page, which oddly is an exact replica of a TV infomercial, but in text form, you come to this:

My e-book explains all the problems that cause yeast infections, the root causes and the SECRET ways to treat them. I reveal all the secrets, nothing is held back. Everything is explained in a simple, straight forward easy to understand fashion. I Sell no products …just my e-book.

Yup! There you have it. You don’t have to buy medicine (which you could get at the store for ten bucks), but, you have to buy a TOP SECRET ebook. For $39.97. No wait! If you act now, you can get it for $29.97. By now, they mean starting October 3, 2008 and ending after 100 copies are sold. And there’s a countdown, showing how many books are left. When I first visited, there were 7 copies left, and by the time I finished skimming, it was down to 3. Funnily enough, when I went back to double check something, the countdown had reset to 8. Hmmmm……

So. Bottom line. If you hadn’t already figured this out, pretty much the entire alt med machine depends on keeping us ignorant, ladies, whether the various perpetrators realize it or not. This is why I think skeptical activism in this area is so integral to feminism. Making women distrust science harms women and children, and continues to limit women to “natural” and “intuitive” ways of thinking. It’s an insidious form of sexism, almost always couched in pro-woman language. *SHE-HULK SMASH*

OK. Rant over. On to answering the nice reader’s question.

How best to deal with a yeast infection? Well, first, let’s talk science. Specifically, vaginal flora (sounds a little bit like a Georgia O’Keefe painting, doesn’t it?). All of us are basically walking microbe farms. Our bodies are covered with billions of bacteria and other microorganisms, inside and out, that have evolved with us over millions of years to perform various functions for us in exchange for a place to stay. Vaginas are no exception. In fact, vaginal bacteria and yeasts, in proper balance, help keep things normal and healthy for us.

A yeast infection occurs when the balance between bacteria and yeasts is disrupted (by antibiotics, hormonal changes, stress, etc) and yeast overgrows, irritating the skin and making your vagina and labia (and sometimes even your clitoris, hood, urethra, and/or anus) unhappy. Nothing at all to be ashamed of, just some unruly little microbial critters that need to be told what’s what.

Critical, responsible advice: If you’ve never had a yeast infection before, and think you may have one, you should definitely see a doctor to make sure it isn’t a more severe type of bacterial infection that can cause you damage. Once you’ve had one, and know what they look/feel like, it’s usually okay to self diagnose and treat future infections, if you feel comfortable doing so, with the obvious caveat that any prolonged or medicinally unresponsive infection should send you to the doc ASAP.

Over the counter yeast infection treatments work by killing off a sufficient amount of yeast to restore your vaginal flora to its normal, balanced state. That’s about as far as my knowledge on the matter goes, so I talked to Dr Amy Tuteur of The Skeptical OB and Science Based Medicine for some further information on the topic and some advice on navigating the often overwhelming range of treatment options.

Is candida necessarily a pathogen? Does it have any beneficial purpose in normal amounts? I’ve come across some obvious quackery online claiming that the only way to truly cure yeast infections is to eradicate all yeast from the body (using a top secret recipe you have to pay to get). This doesn’t sound right to me.

Candida is a yeast. It is normally present in many places in and on the body, including the vagina. Under most conditions, it is not a pathogen, but alteration in the normal bacteria or alternation in immune function may lead to candida infections such as vaginitis or thrush (mouth infection). In cases of severe immuno-compromise, candida can spread through the body and invade the blood stream.

Although women can develop yeast vaginitis at any time, it is more common after taking antibiotics. That’s because antibiotics interfere with the normal balance of organisms in the vagina, killing some organisms, and allowing yeast to over grow. Treatment of yeast vaginitis has the goal of restoring candida to its normal role in the vagina, not erradicating it. Indeed, eradicating it permanently is virtually impossible.

Recurrent yeast infections may be a sign of an underlying medical problem. For example, women with diabetes are especially prone to yeast infections.

A google search for info on yeast infections turns up many “natural” cures, some of which seem plausible (eating yogurt), and some that just sound stupid and dangerous (douching with boric acid). Is there any science to back any of these claims?

Yogurt will not treat yeast infections, but some claim that it will prevent yeast infections. That’s because yogurt contains lactobacillus acidophilus, which supposedly helps repopulate the normal vaginal mix of bacteria. However, clinical trials have been very disappointing. To my knowledge, there are really no effective “natural” cures.

How often will a yeast infection cure itself? I’ve heard that menstruation will often clear things up, but I suspect this may be a matter of correlation/causation confusion.

It’s certainly possible for a yeast infection to go away, since it is possible for the mix of bacteria in the vagina to go back to normal, but it doesn’t happen that often. By the time a woman has symptoms, the infection is unlikely to go away on its own.

The range of treatments at the pharmacy can be rather overwhelming; everything from creams to suppositories to supplements, one day to seven day treatments, name brand vs store brand, all at prices ranging from $5 to $30 and up. What should a girl spend her money on to get the best fix at the best price?

The active ingredient of the treatment should be miconazole, clotrimazole, tioconazole, and butoconazole. Miconazole and clotrimazole are the treatments most commonly recommented. There’s no need to buy brand name if the store brand contains the same active ingredient in the same amount. Some women can be successfully treated with a short course (1 day), but many women find the 3 (or even the 7) day treatment more effective.

Thank you, Dr Amy, for helping us out with this one, and for fighting the good fight against quackery. You rock.

If you have a question for “Ask Skepchick”, please submit it via the comment form, under the subject heading “question”.

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  1. Yall are doing a great job lately with the new posts. For a while, the discussions have been pretty general skeptical issues. But I enjoy the fact that the last month or so has had plenty of female-centric topics.

    Great point, of course, about how women are taught that they’re dirty, Carrie. I’m sure you could talk a lot about that, from a skeptical perspective.

  2. If you think yeast infections are difficult and embarrassing for women to talk about, imagine how much more difficult for a guy to talk about his yeast infections.

  3. I’ve been hearing for years that eating yogurt will help prevent yeast infections. But honestly, how do you think that microbes in your food, which are mostly killed off in your stomach, going to migrate to your vagina? Unless you’re doing some improper wiping after #2 (which can actually lead to yeast infections or bacterial vaginosis), there’s no way that eating yogurt can help.

    As for douching with yogurt, that seems even worse. Yogurt is full of sugar, which a majority of microbes (yeast and bacteria) totally love. It kind of reminds me of that post of vaginal mints.

  4. @jabfish: yeah, that and the fact that the species of lactobacillus in yogurt is different from the species that are generally found in the vagina.

    basically what i learned in my research is that there are a few studies that have found yogurt to have preventative or curative properties, but they have been too small to be considered conclusive.

  5. The alt-med fruffy love earth mother bullshit which is nearly always deeply misogynistic was one of the main things that drove me to skepticism. But so many women (and men) don’t see that misogyny and only see the other which they take to mean that science doesn’t love them but alt-med does. Only fake-med will tell them their bodies are lovely places of life and goodness. Only fake-med will soothe and lie and make you feel better. Real Med will just give you boring facts and shoo you out the door without really listening to your issues (which can be the case with some doctors, many doctors). It is a big frustration. Posts like this and the others (preg etc) are great because hopefully when a woman does a search and comes up with this she see that there are women who really do care and listen and want to help and want it to be BETTER. And that is the key part here. Real med actually wants to fix the issue, not slather your vag with something and tell you to have more sex.

    Well maybe that too. But knowing that it won’t cure everything. At least not this.

  6. It seems to me to be somewhat ironic that a post lamenting our historical and present marginalization of women and concomitant inability to discuss female genitals and the problems one might encounter, said genitals are referred to as “your junk.” Sure, it’s a colloquialism, but is it not one that perpetuates the inability to talk about these things in an unashamed manner?

    Anyway, I thought the term referred specifically to male genitalia.

  7. @cornwalker: yes, a colloquialism, intended to strike a casual and slightly humorous note.

    it is no longer only for dudes, and i guess i’ve always thought of it as more akin to “stuff” than to “garbage”. but i suppose any word usage is open to the interpretation of the reader.

  8. Back when I was young and stupid I tried the yogurt thing, except at least I was smart enough to get unsweetened plain yogurt.

    It didn’t help, although the cooling-down sensation was at least temporary relief. But it was messy and gross and wholly unpleasant.

    I learned shortly thereafter that menstruation cleared them up for me, or at least they cleared up in about that amount of time.

    I haven’t had once since I got married and stopped using condoms. In fact, I had noticed that I tended to get them whenever I used condoms. Not that I am advocating unsafe sex in any way…just that I was probably sensitive to the lubricant or something.

  9. Suppositories are one of the real treatments for yeast infections, but I think they’re really unpleasant. It’s more unpleasant to go to the doctor and get the pill that clears it up (tried it once and it is awesome!), so I usually wind up just getting those. I imagine a lot of people try the yogurt and other myths because they don’t want to deal with these things. It also just doesn’t occur to me to buy this stuff.

    So imagine my surprise when I saw the suppositories near the checkout at my university bookstore! Hooray for actually being somewhere you might notice it and… wait… are those HOMEOPATHIC!?

    Now I know that yeast infections can be a bit deceptive and can (appear to?) go away after a while, but using Homeopathy? Not to mention the thing looks totally legit. It’s no wonder people buy it. Heck, I almost did and I actually know what Homeopathy is! So many people don’t and probably wouldn’t think twice, especially since the school doesn’t carry any other treatments for yeast infection at the school store. In fact, other than a Homeopathy and skin care section, I don’t remember seeing any remedies at all! I mean, what’s more nonthreatening than putting woo next to the lip balm?

    So be sure to check you’re not getting the wrong treatment when you shop for treatments for yeast infection.

  10. Back when I was in grad school, the student health centre had what-is-a-yeast-infection posters on the wall in the “girl” room [the one with the stirrup table]. I asked the doctor if these were necessary/helpful. She responded that every year, around exam time, she got a couple dozen freshman girls coming in sure that they had contracted an STD from a toilet. What they had done was live on Coke and candy bars whilst studying, thereby over-sugaring their systems.

    When I was a lass, there were no over-the-counter treatments. If you were an impoverished student, you douched with vinegar & water. [Yet another use for vinegar!] It worked moderately well.

  11. “insidious form of sexism” Bravo. So tired of women accepting the message that their bodies are dirty and shameful. Burns me up that a deragotory term for a useless man is a “douche bag”. Yes, because nothing is lower on earth than what women use to clease the vagina. Grrrr!

  12. Ugh, have you heard of women sticking whole cloves of garlic up their junk as a treatment for yeast infections?

    For when smelling like bread isn’t enough, try new garlic bread cooch!

  13. Best advice is to see a doctor. I did have recurring yeast infections during my late 20’s. It was mostly caused by my love of beer and nuts. I did try the garlic clove cure once when there was nothing else readily available, and it did work. I wouldn’t recommend it as you smell like garlic for a couple of days.

  14. Anecdotes are not evidence but . . . I was a hippie for a long time, and some habits have died hard.

    I’ve gotten relief from yeast infections by taking a small amount of yogurt — unsweetened, organic, full-fat yogurt with live acidophilous cultures — and inserting it overnight with a medicine syringe, the type you use to dose a baby with liquid medicines. Yes, it’s messy even though it’s only a couple of milliliters, so I use a (reusable cloth) pad to protect my jammies and sheets.

    Another thing that’s helped me is to use that medicine syringe again in the morning and douching with a 50/50 solution of vinegar and water. Yes, it stings for a moment. Yes, it makes the itch go away. Candida likes a higher pH; vinegar lowers the pH and makes candida unhappy. Add some acidophilous with a yogurt treatment, and you’re good to go. In my anecdotal hippie experience.

    More scientifically and less hippie-ly, when you get your period, the pH in your vagina lowers, making it harder for the candida yeast to survive. However, the pH goes back to its pre-menstrual level when you’re done bleeding, so any candida that survived the onslaught during “shark week” will repopulate as soon as possible.

    Clothing: Every winter, once I start wearing tights and longjohns again, I seem to get a constant yeast infection. Tossing some vinegar into the laundry rinsewater helps, because it kills the candida that survive washing.

    Last point: it can be a very good idea to check with your doctor to make sure that what you’re certain is a yeast infection isn’t actually trichomoniasis. Now, where a yeast infection will give you that weird white or yellowish discharge, trich will give you something more green, so usually it doesn’t take a doctor to tell you that you’ve got more than candida going on. But it can still be a very good idea to check in anyway.

  15. Let’s face it, there’s a lot of crappy advice out there no matter if you’re shopping over the counter or rummaging through your refrigerator.

    Even the mainstream pharma people market to us as though we are all afraid of normal body functions. Are we?

  16. @Akiko:

    Yes, because nothing is lower on earth than what women use to clease the vagina. Grrrr!

    Douchebag is a great insult. Why? Because douches are HARMFUL and SEXIST. Douching is not healthy. Douches were created because vaginas are thought of as icky and gross. Women shouldn’t CLEANSE their vagina, especially not by douching. Doing so will actually cause yeast infections.

    Telling women they must CLEANSE their vagina is sexist. Douches are sexist.

    That’s why douchebag is used as an insult.

  17. I hate taboos like these and have long participated in my own personal effort to stamp them out by talking about things like this whenever remotely appropriate. Like now. I work with a bunch of health psychologists and quality of life researchers – in addition to being a barrier to appropriate treatment, stigma can have some serious implications for your mental and social well-being.

    I never internalized this particular taboo myself. Might have something to do with the fact that I had recurrent, alternating UTIs and yeast infxs as a kid. I apparently come from a family with vaginal flora problems because it was a common conversation topic between mom, aunts, cousins, etc. Husbands and fathers were quite accustomed to having to stop by the store to pick up prescriptions and other items for the female fam.

    Another big taboo is anything poop-related. Girls aren’t even supposed to poop to begin with so we definitely don’t want to hear anything about what might be going wrong in that arena. It’s totally cool to complain to your coworkers about a migraine or your asthma but not that you’ve had diarrhea 12 times today because of your irritable bowel, were crying in the bathroom doubled over in pain after lunch, and discovered that you can dry-heave out of more than one end of your digestive system.

    Oh, and STI’s, especially HIV/AIDS. General stigma across the board there but some extra-special gender-specific stigma as well.

  18. I have to say, as a woman who suffered from recurring yeast infections for about a year, I never found either OTC or prescription medication helpful. The OTC creams seemed to make the problem worse, in fact. A tampon dipped in plain yogurt DID seem to provide the most relief for me…however, I should note that I was always told by my OBGYN that if you have a yeast infection, it generally clears up on its own by your next menstrual cycle. Something about the vagina restoring its own pH balance. Several others have noted this in the comments.

    That being said, douches are horrible, and any woman who suspects she has a yeast infection should see a doctor.

  19. Thanks for such an interesting and informative post, Carrie! (And Dr Amy – what a cool blog!)

    Warning: slightly graphic references to follow…

    I suffer from recurrent yeast infections and there’s nothing more miserable than feeling that persistent itch and burn yet thrusting a stiff plastic applicator up your %&$# and having that gooey crap trickle out of you for hours.

    I saw my gynecologist a few weeks ago for my annual check-up and this happened to coincide with a case of this very problem (n.b. in the States, Australians shouldn’t use our usual term “thrush” else the doctor will think you’re talking about oral yeast infections!).

    He did a swab and confirmed what I had, then prescribed Diflucan (Fluconazole), an oral tablet that usually works within 1-3 days, and worked within 2 for me. I asked him if any of the home remedies worked, and he replied that not only does yogurt, et al. not work, but that most over-the-counter creams are pretty fucking useless too. He always recommends the Diflucan (but if you don’t have health insurance then that can be expensive and difficult to acquire).

    I asked if there’s anything that can help prevent yeast infections and he replied, “If only I had the answer to that, I could help a lot of women.”

    While this isn’t of much use when we’re suffering, at least it should help us to steer clear of dodgy books and dangerous advice…

  20. @blaisepascal:

    I’m with ya’ on that one buddy. The first time I got one (from a girlfriend *cough cough*) I had no idea what it was. I knew it couldn’t be an STD (they don’t itch like that as far as I know) but I was panicked. It took a calm nurse and a lot of antifungal cream (athlete’s foot stuff works well) to calm me down. I’ve still never talked to any other male about it.

  21. @Karen Stollznow: Want to point out that oral fluconazole can have side effects (liver toxicity is the big one) which is why lots of docs insist on starting with topicals (no side effects). Having said that, you’re right. Anectdotally at least it seems to be more effective.

  22. @marilove: I do understand that douching is unhealthy. But I doubt the jocks at the local sports bar are thinking in feminist terms when they call another guy a douchebag. So we can use it with a feminist mindset but we may be in fact perpetuating a sexist notion when we do.

  23. @davew: I’ve only had one, due to antibiotics, and it was pretty mild and went away on its own. So I’d imagine it would depend on the severity. As others have mentioned, starting your period will usually also help it clear, unless it’s particularly bad, in which case it might come back.

  24. @DominEditrix: “sure that they had contracted an STD from a toilet”

    I worked at a posh summer camp where many of the pre-teen girls believed, because THEIR MOTHERS had told them, that they had to wrap toilet seats in paper several layers thick because, as one of them explained to me, “Sometimes boys go into girls’ bathrooms and do naughty things and then if you sit on that toilet, you could get pregnant or AIDS.” This was the early 90s when lots of people worried about AIDS constantly, but still.

    The wads of TP were a huge problem because they clogged the narrow pipes in the camp washrooms. Plus the wastefulness, and the overall sadness that these poor girls really believed this.

    @Michele: “a medicine syringe, the type you use to dose a baby with liquid medicines.”

    I’m so glad I’m not the only one who did that. :D But the yogurt didn’t actually work for me beyond a pleasant but messy cooling sensation.

  25. A nurse did recommend plain, sugar-free yogurt as a way to handle symptoms while waiting for treatment. And, she also said that if you and your partner are trading yeast infections back and forth (especially since men don’t suffer symptoms as often with yeast) the yogurt can squelch things on his end.

    But, yeah, still not a replacement for seeing a doctor.

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