Fungi are a normal and integral part of the vaginal flora. (The flora includes dozens of species of microbes and fungi in concentrations of hundreds of millions). Fungi are not microbes, which is why they are not treated with classic antibiotics, but with special antifungal drugs.
Fungi are also present in the oral cavity (children very often get fungal stomatitis) and in the intestine.
From time to time the fungi multiply excessively and then create an image of inflammation, commonly known as thrush. Thrush is usually caused by a yeast fungus called candida albicans and presents (not necessarily) with the corresponding symptoms:
- itching internally and externally on the skin of the vulva
- burning sensation and irritation
- whitish odorless secretions – like ‘cut’ milk.
- Externally, the skin may become red and there may be severe irritation during contact friction or during urination, as the urine wets the irritated area
Fungi can flare up because of:
- Sexually transmitted by the partner’s fungi – and men, because they have a drier anatomical area, have fewer symptoms. However, sexual transmission is not common and treatment of a partner is only required if he shows symptoms.
- Recent antibiotic intake by the woman: antibiotics kill the microbes of the flora, but not the fungi – so the fungi find an opportunity and occupy the ’empty space’ in the vagina. Probiotic formulations that favor the presence of lactobacilli (microbes that protect flora and limit fungi) may help prevent this imbalance of the flora.
- Stress and strain on the body, physical (disease) or psychological.
- High temperatures – tight underwear, synthetic clothes, the heat of the summer season – favor fungi.
- Glucose tolerance disorders – that is, a mild disorder in the regulation of blood sugar, which is also a predisposition to diabetes in the future. Fungi that often persist may help in the diagnosis of diabetes at a very early stage.
Diagnosis
The diagnosis is often easy when all the above are present – but more often the picture is vague with an undefined feeling of burning and irritation and minimal itching. The clinical examination, the measurement of the acidity of the vagina and finally the culture of the vaginal fluid confirm the diagnosis. Fungi often cause mixed vaginitis in collaboration with a microbe, and the administration of an antifungal alone will not solve the problem.
The treatment aims to reduce the fungi to the normal concentration to restore the balance of the flora – the fungi cannot and should not be completely eradicated.
Antifungal medications come in suppositories, vaginal ointments, and oral tablets. The treatment and the method of administration must always be individualized according to the intensity, localization, chronicity of the symptoms, partner’s symptoms, previous treatment, coexisting bacterial vaginosis, etc.
Forecast
Fungi are annoying, but they are completely benign – they don’t cause health or fertility problems.
Recurring fungal infections are unfortunately a frequent problem (1-2% of women) – from three or more episodes per year. The causes are many, imperfect treatments, infections from the partner, possible predisposition to diabetes, coexisting health problems or psychological disorders, which reduce natural defenses. In these cases, long-term and persistent treatment is needed.
