Vulvovaginitis, inflammation of the vulva and vagina, most commonly occurs in reproductive-aged women secondary to infection. Candidal vulvovaginitis, or a vaginal yeast infection, is responsible for about one-third of cases of vulvovaginitis. Up to 75% of women will experience at least one vaginal yeast infection in their lifetime, and 8% suffer from recurrent infections. (15, 27)

Vaginal yeast infections can be physically uncomfortable and emotionally distressing to those they affect. Functional medicine offers a holistic approach to care that aims to restore balance to the vaginal environment to prevent infection, providing women with a comprehensive and personalized path to long-term relief.

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What is a Vaginal Yeast Infection?

Vulvovaginal candidiasis (VVC), commonly known as a vaginal yeast infection, is a prevalent condition caused by an overgrowth of fungus in the vaginal area, leading to inflammation. Yeast is a type of fungus. Along with bacterial infections, yeast infections are among the most common causes of vaginal inflammation. Candida, a variety of yeast, is a naturally occurring microorganism found in small amounts in the vagina. Various factors can disrupt the delicate balance of the vaginal microbiota, allowing Candida to overgrow and cause an infection. (9, 27) 

What Causes a Vaginal Yeast Infection?

The two most common strains of Candida responsible for causing VVC are Candida albicans (90% of infections) and Candida glabrata (15).   

Several factors contribute to the overgrowth of Candida. The most common cause is a disturbance in the vaginal microbiota, which can occur for various reasons. These include the use of broad-spectrum antibiotics that kill off beneficial bacteria, hormonal fluctuations during the menstrual cycle or pregnancy, uncontrolled diabetes, a weakened immune system, and high levels of stress. (9, 29)

Furthermore, certain lifestyle factors may increase the risk of developing yeast infections. These include a diet high in refined sugars and carbohydrates, which can promote yeast growth, as well as frequent or excessive use of feminine hygiene products; douching; wearing tight, non-breathable clothing; and prolonged use of oral contraceptives. (9, 31)

Symptoms of Vaginal Yeast Infections

The symptoms of yeast infections can range in severity from mild to severe. Yeast infections often cause thick, white, clumpy vaginal discharge (often described as having a cottage cheese-like appearance). Most yeast infections also cause itching, burning, and/or redness in or around the vagina. Vaginal irritation may cause pain during sex and burning with urination. Severe VVC is associated with extensive vulvar redness, swelling, excoriation, and fissure formation. (30) 

Functional Medicine Labs to Test for the Root Cause of Vaginal Yeast Infections

Self-diagnosis is inaccurate; research indicates that only about one-third of women are correct in self-diagnosing VVC. Therefore, it is essential that women see a doctor when experiencing vaginal symptoms for diagnostic testing to differentiate between VVC and other common causes of vaginal irritation. 

Vaginosis Panel

A vaginal yeast culture, which can identify a broad range of pathogenic yeasts, remains the diagnostic standard for diagnosing VVC. An advanced vaginosis panel is a helpful tool for differentiating between VVC and bacterial vaginosis, the most common type of vaginal infection diagnosed in women of reproductive age. This panel also includes antifungal susceptibility testing to prescriptive and natural agents for identified fungal species.

Microbiome Testing

The female gut and genital microbiotas have a complex and interconnected relationship that can influence each other's composition and overall health. Therefore, patients with recurrent yeast infections may benefit from a more comprehensive microbiome evaluation through vaginal and stool testing. These tests can identify chronic dysbiotic patterns predisposing a patient to infection recurrence.

Candida Antibodies

Frequent vaginal yeast infections can be a symptom of a more systemic overgrowth of Candida albicans throughout the body. While this test cannot pinpoint the specific sites of Candida albicans overgrowth, a serum antibody panel measures IgA, IgG, and IgM proteins produced by the immune system in response to C. albicans infection. The level of measurable antibodies can help quantify the severity and chronicity of overgrowth. 

Immune Function

Because a weakened immune response increases the risk of yeast infections, your doctor may recommend various tests to assess the integrity of the immune system in determining the underlying causes of recurrent VVC. 

A complete blood count (CBC) with differential is a standard screening panel that measures the various types of white blood cell counts in circulation. Changes in white blood cells' total number or distribution can indicate immune suppression.

The Lymphocyte MAP panel measures the integrity of the immune system at the cellular level by identifying key lymphocyte biomarkers, providing a picture of the underlying conditions triggering immune deficiency (12).  

Diabetes Panel

Diabetes is a risk factor for yeast infections because chronic elevations in blood sugar levels create an environment conducive to yeast overgrowth and compromise the immune system's ability to fight infections effectively (20). A diabetes panel measures several biomarkers, including blood glucose and hemoglobin A1c, associated with diagnosing and managing diabetes.

Comprehensive Hormone Panel

Estrogen dominance may cause recurrent VVC because of estrogen's control over glycogen (sugar) production in the vagina (7). Chronic stress suppresses the immune system, causes dysregulation of female sex hormones, and contributes to gut dysbiosis by altering intestinal motility. A higher incidence of VVC has been noted in women with a blunted cortisol awakening response (CAR), a sign of chronic stress. The DUTCH Plus extensively assesses female reproductive and adrenal (stress) hormones, including the CAR. 

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Conventional Treatment for Vaginal Yeast Infections

Conventional options for treating vaginal yeast infections typically involve antifungal medications available in various forms. Over-the-counter antifungal creams, ointments, or suppositories containing active ingredients like clotrimazole, miconazole, or tioconazole are widely used. These topical treatments are applied directly to the vagina to relieve symptoms and combat yeast overgrowth. Prescription-strength antifungal medications like fluconazole may be recommended for more severe or recurrent infections. Fluconazole is an oral medication taken as a single dose, and it works systemically to treat the infection throughout the body. (19) 

Functional Medicine Treatment Protocol for Vaginal Yeast Infections

By addressing the underlying causes, restoring balance to the body, and enhancing its innate healing abilities, functional medicine offers a personalized and holistic approach to tackle the root of the problem and provide long-term relief for women experiencing recurrent or chronic vaginal yeast infections.

Therapeutic Diet and Nutrition Considerations for Prevention of Vaginal Yeast Infections

Many doctors recommend following a Candida diet to reverse and prevent yeast overgrowth. This diet eliminates certain foods that contribute to increased inflammation and yeast growth. Proponents of the diet suggest that eliminating certain foods can restore balance to the human microbiome and reduce systemic inflammation. Research studying the effects of dietary modifications on treating candidiasis is limited, but preliminary research suggests that making Candida diet-like dietary modifications during and after treatment with antifungals results in better clinical outcomes.

Foods to Eat

• Non-starchy vegetables: artichokes, broccoli, cabbage, cucumber, spinach, zucchini
• Low-glycemic fruits: avocado, berries, lemon, lime
• Non-glutenous whole grains: buckwheat, brown rice, millet, oats, quinoa
• Lean proteins: chicken, eggs, fish, legumes
• Some dairy products: butter, ghee, kefir, probiotic yogurt 
• Low-mold nuts and seeds: flaxseed, hazelnuts, sunflower seeds
• Herbs and spices
• Healthy fats and oils: avocado, coconut, olive
• Sugar-free sweeteners:  erythritol, stevia, xylitol
• Fermented foods: kimchi, pickled vegetables, sauerkraut 
• Herbal teas (23) 

Foods to Avoid

• Sugars: agave, aspartame, cane sugar, corn syrup, honey, maple syrup
• Gluten-containing grains: barley, rye, spelt, wheat
• High-glycemic fruits: bananas, dates, fruit juices, mango
• Processed meats
• Some dairy products: cheese, milk, cream
• Condiments: barbeque sauce, horseradish, ketchup, soy sauce, white vinegar
• Refined fats and oils: canola, margarine, soybean, sunflower
• Alcohol, soda, and energy drinks (22) 

Supplements Protocol for Vaginal Yeast Infections

The protocol presented below focuses on using vaginal and oral supplements to treat both vaginal and intestinal dysbiosis, aiming to restore a healthy microbiome necessary to treat and prevent VVC. 

It's important to note that this protocol does not include additional supplemental support for chronic stress, hormonal imbalances, chronic immune dysfunction, and hyperglycemia. While not all patients may require assistance in addressing these factors, if laboratory findings suggest any of them as a contributing cause to recurrent yeast infections, the treatment protocol should be tailored accordingly to address these specific factors.

​Yeast Arrest® Suppositories

These homeopathic and botanical vaginal suppositories offer a natural option for treating yeast infections. They utilize ingredients that include boric acid, berberine, neem, and tea tree, which are supported by evidence to be safe and effective in treating fungal infections. 

Dose (Acute Infection): insert one suppository vaginally in the morning and one in the evening for one week

Dose (Chronic Infection): insert one suppository vaginally twice daily for 2-4 weeks

Dose (Maintenance): insert one suppository at bedtime, during menses, for 4-6 consecutive months

CandidaStat®

CandidaStat® combines botanical herbs and vitamins to create a comprehensive antifungal and immune-supportive formula. Taken orally, the combination of caprylic acid, garlic, and berberine offers a systemic antifungal and antibacterial solution, combating dysbiosis and maintaining healthy flora within the gut and vagina.

Dose: 2 capsules three times daily

Duration: 6 weeks

FemEcology™

Probiotics, taken orally and inserted vaginally, can help restore the healthy balance of the gut and vaginal microbiomes and suppress Candida growth. Lactobacillus spp. are of particular importance for vaginal health and function. Lactobacilli create an acidic vaginal environment inhospitable to yeast and adhere to the vaginal epithelium, out crowding opportunistic yeast and bacteria. FemEcology™ contains a combination of Lactobacillus probiotics specific to vaginal health to maintain a healthy vaginal microflora and pH.

Oral Dose: take one capsule by mouth daily for at least 1-3 months 

Vaginal Dose (Active Infection): insert one capsule vaginally daily for two weeks

Vaginal Dose (Maintenance): insert one capsule vaginally 2-3 times weekly for 4-6 months

When to Retest Labs

A vaginosis panel can be repeated after finishing a course of treatment for acute infection to confirm fungal eradication. Protocols that address the underlying factors contributing to recurrent VVC often take at least 1-3 months, if not longer, to have full effect. The frequency at which labs are repeated will depend on provider preference, chronicity of symptoms, and baseline lab findings. Functional medicine providers often reorder specialty diagnostic labs 3-6 months after baseline to monitor patient progress.

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Summary

While yeast is a commensal microbe naturally found in the human microbiome in small amounts, overgrowth can cause infection and uncomfortable symptoms. Vulvovaginal candidiasis, or vaginal yeast infections, commonly cause vaginal inflammation in women of reproductive age. A functional medicine approach to treating VVC aims to treat infection, reduce vaginal symptoms, and address underlying factors predisposing an individual to infection. This root-cause treatment approach reduces the infection recurrence rate and promotes long-term vaginal health and overall well-being.