Forty percent of all types of vaginitis are caused by candida, a yeast-like fungus. When it multiplies in the vaginal tract, the disorder is called vulvovaginitis. Women often refer to it as a "yeast infection." About 75 percent of women get candida vaginitis at some time in their lives.

• Itching in the vagina and vulva
• Vaginal discharge (small amounts are normal, however)
• Red, swollen, painful vaginal mucous membranes and external genitalia
• Satellite lesions (tender, red, pus-filled bumps, which can spread to thighs and anus)

Candida is a yeast-like fungus that grows in the vagina. When there is too much of it, it causes infection. The following increase your chance of getting a yeast infection. 

• Antibiotics—especially broad-spectrum types
• Pregnancy—from increased heat and moisture and hormonal shifts
• Diabetes
• Corticosteroid use
• Human immunodeficiency virus (HIV) infection
• Taking birth control pills
• Being overweight
• High sugar intake
• Wearing panty hose, tight clothing, or noncotton underwear

Your health care provider will give you a pelvic examination and swab your vagina to check for candida. You probably will also have a Pap smear. Some women have chronic yeast infections. If this happens, your provider may want to do additional tests.

Usually topical treatments are started before oral medications. In the case of chronic infection, the actual dosage and length of treatment may be increased. If you have vaginitis, you should avoid excessive exertion and sweating, keep vaginal area as dry as possible, and avoid sexual relations until symptoms clear. Take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight-fitting pants can help prevent infection.

Topical and oral therapies are considered to be almost equally effective.

• Topical therapies—may initially cause burning from inflammation: polyenes (nystatin)—one tablet twice a day for two weeks placed high in the vagina with applicator; 70% to 80% effective; no side effects on other parts of the body. Azole derivatives such as imidazole (such as miconazole, butoconazole) and triazole (such as fluconazole, terconazole)—vaginal cream one to five days, also may be used externally; 85% to 90% effective; no side effects on other parts of the body.
• Oral therapies: fluconazole—75% to 92% effective; 150 mg once; often considered the treatment of choice; should not be used during pregnancy; appears to help HIV infected women. Ketoconazole—83% effective; 400 mg/day for five days, or for two weeks with recurring infection. Oral nystatin helps reduce intestinal problems.

Alternative therapies may help to treat acute and chronic vaginitis.

Use only one of the following douches at one time. Do not douche during menstrual periods. For first time or acute infection try the vinegar douche or boric acid capsules. For chronic vaginitis, use the herbal combination douche. For recurrent vaginitis, use the Betadine douche. Stop douching if you are in pain or your symptoms get worse. 

• White vinegar: 1 to 2 tbsp. to 1 pint of water. Douche daily for 10 to 14 days.
• Boric acid: One capsule (600 mg) inserted daily for 10 to 14 days. May cause irritation or problems from systemic absorption.
• Herbal combination: Mix equal parts of oregano leaf (Oreganum vulgare), goldenseal root (Hydrastis canadensis), and coneflower (Echinacea purpurea). Steep 1 heaping tbsp. of herbal mixture in 1 pint of water. Cool and douche daily for 10 to 14 days.
• Povidone iodine (Betadine): Douche with one part iodine to 100 parts water twice daily for 10 to 14 days. Prolonged use can suppress thyroid function.

• Avoid simple and refined sugars (breads, pasta, baked goods, sweets), dairy products, alcohol, peanuts, fresh or dried fruit, fruit juice, and food allergens. Eat plenty of protein, vegetables, and grains.
• Lactobacillus acidophilus reestablishes normal bacteria in the body and prevents the overgrowth of candida. Take one capsule orally two to three times per day. Insert one capsule into the vagina nightly during treatment (not to exceed 14 nights).
• Vitamin A (10,000 IU per day) or beta-carotene (50,000 IU per day) enhances the integrity of the vaginal lining. Remember to avoid high doses of vitamin A in pregnancy or if you may become pregnant within the next three months.
• Zinc (30 mg per day) and vitamin E (400 to 800 IU per day) are essential for immune function.
• Vitamin C (250 to 500 mg two times per day) enhances immunity and helps restore the integrity of vaginal lining.

Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Unless otherwise indicated, teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers, and 10 to 20 minutes for roots. Drink 2 to 4 cups per day. 

• Pau d'arco tea has antifungal effects.
• Garlic (Allium sativum) has antimicrobial, antifungal, and immune-stimulating properties. Prepare a tea with two cloves of garlic. May add fresh lemon and honey for flavor.

Some of the most common remedies for vaginitis are listed below. Usually, the dose is 3 to 5 pellets of a 12X to 30C remedy every one to four hours until your symptoms get better. 

• Calcarea carbonica for intense itching with thick white or yellowish discharge that is worse before you start your period
• Borax for burning pains with egg-white colored discharge
• Sepia for burning pains with milky white discharge and pressure in vaginal area, especially if you feel depressed and irritable
• Graphites for backache with thin white discharge that is worse in the morning and when walking
• Arsenicum album for when you have burning, discharge
• Homeopathic combinations are available as creams to apply vaginally.

Acupuncture may be helpful in improving immune function.

To prevent recurrence of infection, take showers instead of baths, use unscented soap, and always wipe from front to back after bowel movements. Wearing cotton underwear and avoiding pantyhose and tight-fitting pants can help prevent infection.

Yeast infections occur twice as often during pregnancy. 

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