Candida vaginitis, also called vulvovaginal candidiasis, is a fungal infection of the vagina and vulva caused by an overgrowth of Candida yeast. About 75% of women will experience at least one episode during their lifetime, making it one of the most common vaginal infections. Most cases are caused by a species called Candida albicans, which normally lives in small amounts in the vagina without causing problems. The infection develops when something disrupts the balance of microorganisms, allowing the yeast to multiply.
Why Candida Overgrows
Candida yeast is part of the normal vaginal environment. Healthy bacteria, particularly lactobacilli, keep yeast populations in check by maintaining an acidic environment. When that balance shifts, Candida can grow rapidly, change into a more invasive form, and trigger an inflammatory response in the vaginal lining.
Several well-established factors increase the risk of that imbalance occurring:
- Antibiotic use: Antibiotics kill off protective bacteria alongside the targeted infection, giving yeast room to expand. This is one of the most common triggers.
- Hormonal changes: Pregnancy and hormonal contraceptives (birth control pills) raise estrogen levels, which promotes yeast growth. Many women notice infections around their menstrual cycle for the same reason.
- Diabetes: Elevated blood sugar creates a favorable environment for yeast, particularly when glucose levels are poorly controlled.
- Weakened immune system: Conditions like HIV/AIDS, cancer treatment, or steroid use reduce the body’s ability to keep Candida in check.
What It Feels Like
The hallmark symptom is intense itching of the vagina and vulva. This can range from mildly annoying to severe enough to interfere with sleep and daily activities. Along with itching, most women experience burning, soreness, or irritation that may worsen during urination or sex.
Discharge is the other classic sign: thick, white, and often described as resembling cottage cheese. It typically doesn’t have a strong odor, which helps distinguish it from bacterial vaginosis (which produces a fishy smell). That said, some women have little to no noticeable discharge at all.
In severe cases, the vulva can become visibly red and swollen, with skin cracking or small fissures forming from irritation and scratching. The outer skin may look raw or excoriated. These complications are uncommon but tend to happen when treatment is delayed or the immune system is compromised.
How It’s Diagnosed
Many women recognize the symptoms from a previous episode, but self-diagnosis is unreliable. Studies consistently show that women who assume they have a yeast infection are wrong about half the time, often confusing it with bacterial vaginosis or other conditions.
A clinical diagnosis typically involves a pelvic exam and a sample of vaginal discharge. Under a microscope, the yeast appears as budding cells or branching thread-like structures called hyphae. Vaginal pH in a yeast infection usually stays in the normal range (below 4.5), which helps rule out bacterial vaginosis, where pH rises above that level. If infections keep coming back, a culture can identify the exact Candida species, which matters for choosing the right treatment.
Treatment for Uncomplicated Infections
A straightforward yeast infection, meaning mild to moderate symptoms in someone who gets them infrequently, clears up with short-course antifungal treatment. These regimens effectively cure up to 90% of uncomplicated cases. You have two main routes: topical creams or suppositories applied inside the vagina, or a single oral pill.
Over-the-counter options include antifungal creams and suppositories available at any pharmacy. These come in different lengths of treatment, from a single-day suppository to a 7-day cream. The one-day and three-day options are more convenient, while the 7-day versions may cause less local irritation. No single product has demonstrated superiority over another. All available options, whether over-the-counter or prescription, topical or oral, show equivalent cure rates in head-to-head comparisons.
The prescription oral option is a single-dose antifungal pill (fluconazole). Many women prefer this for convenience. Symptoms typically begin improving within a day or two of starting any treatment, though it can take up to a week for full resolution.
When the Usual Treatments Don’t Work
About 5 to 8% of women develop recurrent vulvovaginal candidiasis, defined as four or more confirmed episodes in a single year. Recurrent infections require a different approach: an initial treatment course followed by a longer maintenance regimen, often weekly antifungal use for six months.
Another reason treatment may fail involves the species of Candida causing the infection. While Candida albicans is responsible for 85 to 90% of cases, other species are increasingly recognized. Candida glabrata, in particular, is inherently resistant to fluconazole and standard antifungal creams. In one study, fluconazole cured only 33% of Candida glabrata infections, compared to 72% for boric acid vaginal capsules used over 14 to 21 days. This is why identifying the species through a culture becomes important when standard treatment fails.
The Role of Probiotics
Probiotics containing Lactobacillus strains have generated interest as both a complement to antifungal treatment and a prevention strategy. A large meta-analysis in the American Journal of Obstetrics and Gynecology found that combining probiotics with standard antifungal therapy improved short-term cure rates by about 19% and reduced the chance of recurrence at six months. For recurrent infections specifically, the combination improved three-month cure rates dramatically compared to antifungal treatment alone.
Probiotics used on their own, however, performed no better than antifungal drugs in the short term and worse over the long term. The bottom line: probiotics may offer a meaningful boost when added to conventional treatment, but they aren’t a replacement for it. The benefits also appear to fade over time, with no sustained advantage beyond six months in most studies.
Reducing Your Risk
You can’t eliminate the possibility of yeast infections entirely, but a few practical habits lower the odds. Avoid staying in wet clothing like swimsuits or sweaty workout gear, since warm moisture encourages yeast growth. Wear cotton underwear or underwear with a cotton crotch, and choose loose-fitting bottoms when possible. Skip douching and scented vaginal products, which disrupt the natural microbial balance.
If you notice a pattern of yeast infections following antibiotic courses, mention it to your prescriber. In some cases, a preventive dose of antifungal medication at the start of antibiotic therapy can head off the problem. For women with diabetes, keeping blood sugar well controlled is one of the most effective ways to prevent recurrent episodes.