20 Comments

damn I wish I had all of this information 30 years ago :( This is brilliant, thank you.

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Ponied up for a year just to get access to the AMA! This is all super helpful - I have a family member dealing with yeast in the bladder and chronic UTIs.

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Hi Dr. Jen! New to your substack. I have RA, take immunosuppressants, have a skin condition (either lichen simplex chronicus or lichen schlerosus, I've gotten different diagnoses), and seem prone to yeast infections. My doctor has me on the #3 protocol you suggested, along with nystatin-triamcinolone ointment 1-2x/day until symptoms subside, then 1-2x/week indefinitely. In your work, have you seen anything work long-term that helps people on immunosuppressants? I don't think taking fluconazole and the topical ointment for the rest of my life is ideal! Thank you so much, really thankful to have found you.

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is it possible for IUDs to be colonised with yeast? I know this is anecdote rather than data but I had recurrent yeast infections which started shortly after having a Kyleena inserted, which only went away when I removed it after about a year from frustration (I am hypermobile - and a Dr so removal wasn't a big deal).

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So useful, thank you. Is it a good idea to take fluconazole to PREVENT a possible yeast overgrowth while taking several antibiotics (plus probiotics) to treat chronic endometritis? Or should one take fluconazole only if a yeast infection appears?

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Love your insights and remarkable writing! I would love to do a podcast with you to talk about my patented invention that treats yeast infections faster and more effectively without the need for drugs and stops the symptoms immediately. The disposable device is tampon-like and after two 30-minute uses, the infection is gone! Let's get the message out! This should have been on the market 50 years ago. Thanks. Kim Langdon OB/GYN kim@coologics.com or kimlangdon.md@gmail.com

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Your knowledge, writing skills and insights are remarkable. I would love the opportunity to do a podcast with you about Vulvovaginal candidiasis (VVC). I'm a retired OB/GYN who invented a drug-free cure for VVC that is faster and more effective than drugs, stops symptoms immediately, and only requires two 30 minutes uses--it's a tampon-like device. Please see my 60 second video. https://youtu.be/CqubE_om5-cp Kim Langdon M.D.

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Hi Dr Jen, thank you for your article. I have had thrush for the last two months now and it’s been quite debilitating. I have taken fluconazole (1 x 150mg every 72 hours for one week) and am starting the regimen of 1 x 150mg a week for 6 months. I still haven’t noticed an improvement in symptoms and am wondering whether it’s normal for this to take time? Would you recommend cutting yeast and sugar from diet? Many thanks

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I never hear this mentioned as something that helps w/yeast infections, so just in case it helps anyone: I used to get yeast infections ALL the time with the bad burning/itching (and diagnosed with a microscope). Then I started wearing a pantyliner every day, the kind with the "dry weave" type material on top (I use a generic drug store brand). The natural moisture from daily discharge was my problem, and the liner wicks that moisture away just enough to stop the problem. (Plus I can always just change the liner as needed if there's even more moisture than usual). It has been a total life changer for me, and now I don't get yeast infections EVER unless I'm on an antibiotic, or I forget to wear a liner for a day or two.

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There is no association with pantyliners and yeast infection. I am glad they have helped you but they can't prevent yeast infections and so I do need to to correct this in case others read it. Moisture can irritate the skin and cause irritation that is misdiagnosed as yeast, but it doesn't cause yeast in the vagina or on the vulva.

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Thanks for you comment, and I certainly value you opinion highly (just finished reading your Menopause Manifesto book and it was very helpful). So I guess I'm very surprised to hear you say this. Most any medical site I go to talks about how yeast tends to thrive in wet, humid conditions. Like this info I found linked from the NIH site that says "sweating and using “non-breathable” panty liners or sanitary pads [can cause them] ... "These things allow the yeast to thrive, leading to an inflammation."

https://www.ncbi.nlm.nih.gov/books/NBK543220/

And this WebMD info that talks in several places about how moisture can help bring on an infection:

https://www.webmd.com/women/guide/10-ways-to-prevent-yeast-infections

And I know the internet is not a doctor, but honestly on most any other website I find when doing a search for what causes a yeast infection, I find similar info. (Monistat site, etc.)

So.... I'm confused. :)

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None of what you linked to is a study, it is all low quality expert opinion. Vaginal yeast infections are not due to any external -- meaning vulvar-- environmental changes except those people who take diabetes medications where very large amounts of glucose come out in the urine and touch the skin. And with these women the yeast is clearly on their vulva, not in the vagina. Moisture in skin folds (under the breasts and in the groin) is liked with intertrigo, which is a different condition and can affect yeast. For garments to change moisture and temperature they must be occlusive, think diapers with plastic backing. There is no quality data linking modern menstrual pads or underwear with changes in the microenvironment of the vulva. In fact, studies show they don't.

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OK, thank you. Are the studies that show there's no relation between moisture (or moisture-controlling garments) and yeast infections available to the public? If so I'd love to read them if you're able to send a link, just for my own education. Thanks.

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What do you mean by a moisture controlling garment? We know that occlusive garments, like diapers, increase the risk of vulvar yeast infections, not vagina. This is diaper rash. There are studies that show pads don't affect the microenvironment of the skin and that thongs don't either. There are actually no studies that link any kind of underwear with yeast infections or other infections. That was something someone once wrote and has become an old wives tale.

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I was just referring to the "menstrual pads" and "underwear" you mentioned in the last couple lines of your previous comment: "There is no quality data linking modern menstrual pads or underwear with changes in the microenvironment of the vulva. In fact, studies show they don't."

I was asking if these studies that show they don't are available to see. Thanks.

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Why do you mention iron and thyroid levels, is there a direct connection to yeast infections? I've been unable to get rid of what was suspected to be yeast and I know my iron is very low.

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Low iron is associated with recurrent yeast and with itch. A low thyroid can be associated with skin conditions (dry skin).

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great summary and reminder for me as GP. When you mentioned about checking thyroid and iron levels I also thought about diabetes - do you think association with diabetes and yeast infection?

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Diabetes is associated with yeast infections, but it is really rare to pick up diabetes based on recurrent yeast alone. The connection is more complex than the glucose control as that doesn't seem to be related to risk, with the exception of the medications that work by excreting large amounts of glucose into the urine. Those are definitely associated with vulvar yeast infections.

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My god Dr, wish I had this information years ago! My chronic infection ended when 2 events happened: stopped the pill and had a subsequent hysterectomy. Not sure which (if either) was responsible. I still have a vagina. Either way I'm relieved to get off that wheel of misery. Thank-you again for a fantastic no-nonsense article on a subject of such concern for many of us.

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