Vaginal Candidiasis: Causes, Symptoms, Diagnosis, and Treatment

Vaginal candidiasis is one of the most frequent intimate infections in women. Around three out of four women will experience at least one episode during their lifetime. Although common and usually easy to treat, this condition can cause significant discomfort and, when recurrent or untreated, may interfere with sexual wellbeing, emotional balance, and reproductive health.

Understanding why vaginal candidiasis occurs, how it manifests, and when medical evaluation is needed helps reduce unnecessary suffering and lowers the risk of chronic or recurrent infections.

What Is Vaginal Candidiasis?

Vaginal candidiasis is a fungal infection of the vaginal mucosa, most commonly caused by Candida albicans. Candida species are part of the normal vaginal flora and usually coexist harmlessly with other microorganisms.

Under certain conditions, this balance is disrupted. Candida multiplies excessively, outcompeting protective bacteria and irritating the vaginal lining. The result is inflammation, itching, abnormal discharge, and local discomfort.

Candida behaves as an opportunistic organism. It becomes pathogenic not because it is acquired from the outside in most cases, but because local or systemic conditions allow it to overgrow.

Several Candida species may be involved, including C. albicans, C. glabrata, C. tropicalis, C. parapsilosis, and C. kefyr. Some non-albicans species are associated with recurrent or treatment-resistant forms.

Factors That Promote Vaginal Candidiasis

Multiple biological and lifestyle factors can favor fungal overgrowth:

Elevated blood glucose levels, particularly in diabetes
Hormonal fluctuations related to the menstrual cycle, pregnancy, or hormonal therapies
Antibiotic use that disrupts protective vaginal bacteria
Impaired immune function due to illness, stress, or immunosuppressive treatments
Frequent vaginal douching
Use of scented intimate hygiene products
Synthetic or tight underwear that retains moisture
Prolonged use of internal menstrual products
Nutritional deficiencies affecting immune defense

Although candidiasis is not classified as a sexually transmitted infection, Candida can be transferred during unprotected sexual contact, especially when one partner has active symptoms.

Symptoms of Vaginal Candidiasis

Symptoms vary in intensity depending on the severity and duration of the infection. Typical manifestations include:

Intense vulvar and vaginal itching
Redness and swelling of the vulva
Burning sensation during urination
Pain or discomfort during sexual intercourse
Vaginal soreness or pressure
White, thick, clumpy discharge, often described as curd-like

Some women experience mild symptoms, while others report significant discomfort that interferes with daily activities. In chronic or recurrent cases, inflammation may extend beyond the vagina, contributing to pelvic pain or dyspareunia.

It is also possible for vaginal candidiasis to be asymptomatic and discovered incidentally during routine gynecological examination.

Diagnosis of Vaginal Candidiasis

Diagnosis is established by a gynecologist through clinical evaluation and laboratory testing.

Microscopic examination of vaginal secretions can identify yeast cells and pseudohyphae. Vaginal culture is used to confirm the species and is particularly important in recurrent or treatment-resistant infections.

Culture results may be accompanied by antifungal susceptibility testing, which guides targeted therapy and reduces the risk of recurrence.

Treatment of Vaginal Candidiasis

Treatment is effective in most cases when tailored to the identified Candida species and clinical context.

Therapy may involve local or systemic antifungal agents. The route of administration depends on symptom severity, infection extent, pregnancy status, and patient tolerance.

Local treatments are often preferred during pregnancy. Oral therapy may be used in non-pregnant patients but can occasionally cause gastrointestinal side effects.

Strict adherence to the prescribed dosage and treatment duration is essential. Incomplete treatment increases the risk of relapse.

After treatment, follow-up testing may be recommended to confirm eradication and support restoration of healthy vaginal flora.

In recurrent or resistant cases, alternative regimens may be considered, including treatments designed to disrupt fungal biofilms. In some situations, partner treatment and temporary sexual protection are advised.

How Common Is Vaginal Candidiasis?

More than 75% of women experience at least one episode during their lifetime. Between 5% and 8% develop recurrent candidiasis, defined as four or more episodes per year.

The condition is most frequent in women of reproductive age, reflecting hormonal influences and sexual activity. After bacterial vaginosis, vaginal candidiasis is the second most common vaginal infection.

When to Seek Specialist Evaluation

Medical consultation is recommended when:

Symptoms appear for the first time
Symptoms are severe or persistent
Infections recur frequently
Pain during intercourse or chronic pelvic pain is present
Fertility problems occur
Symptoms do not improve after treatment

Prompt evaluation ensures correct diagnosis and prevents complications.

Prevention of Vaginal Candidiasis

Preventive strategies focus on maintaining vaginal microbial balance and supporting immune health:

Wearing breathable cotton underwear
Avoiding unnecessary vaginal douching
Using unscented intimate hygiene products
Changing wet clothing promptly
Managing blood glucose levels
Using antibiotics only when necessary
Maintaining balanced nutrition

Preventive measures significantly reduce recurrence risk, especially in women with previous episodes.

References:

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