Joel stood leaning against the bedroom doorway, thinly disguising his disappointment. Jane had a yeast infection. Again. Their relationship was beginning to feel the toll of this microscopic invader: Candida albicans. Struggling not to weep, because of the deep, raw, itching pain inside that felt like her womanhood was on fire, Jane whispered, “Let’s get some help.”

Candida albicans is a fungus which naturally inhabits, in a controlled quantity, the human intestinal tract. In infants, an overgrowth produces “diaper rash.” In the throat, an infestation is called “thrush,” seen only in immuno-compromised individuals. Candida albicans does not belong in the vagina. It most certainly does not belong in the blood stream. A predominant cause of Candida albicans overgrowth, sometimes refered to as Candidiasis, but most often simply called a yeast infection, is antibiotic abuse.

All mucous membranes of the body, including the vagina, host a mix of various healthy bugs (bacteria). With the ingestion of an antibiotic (such as Bactrim, Septra, Amoxicillin, Erythromycin, Penecillin) presumably given for a bacterial infection, all bugs, good, bad and indifferent, are eradicated. This creates a prime opportunity for fungal infestations to arise. No longer impeded by competition with bacteria for space or nutrients on the mucous membranes, the fungus can proliferate rapidly. In the “old days” anti-fungals were routinely given when antibiotics were dispensed. For some reason, not only has this practise gone by the wayside, but antibiotics are dispensed readily, almost casually, in many conventional medical settings.

What you can do to minimize antibiotic overuse is to use them sparingly, and only for infections that have been specifically identified as bacterial, and which are not responsive to other measures. First try increased fluids and Vitamin C, increased rest and elimination of dairy products, anti-bacterial herbal therapies including Echinacea and Golden Seal, eat lots of garlic, apply hot and cold compresses, etc. And if you must use an antibiotic please have your doctor choose one that is as specific as possible for the bug targeted (AVOID broad spectrum antibiotics), and take an anti-fungal concommitantly. Some readily available anti-fungals are discussed below.

What the doctor explained to Jane and Joel is that the vagina is a very precise ecosystem, supporting a specific set of healthy flora (friendly bacteria) which require a very specific pH. The vagina needs to be quite acidic — pH 4.5. The range of acidity is from 1 (extremely acidic, such as the stomach right after a meal) to 14 (extremely alkaline, such as lye). Since the vagina is relatively exposed (compared to the inside of the penis, for example) the optimal acidity protects the delicate mucous membranes against unwelcome bacteria. These bacteria might migrate around from the anus; they may be on your towels or sheets; they may be on your lover’s hands. Many vaginal yeast infections are associated with reduced acidity, in which the environment is too alkaline to effectively protect against “bad bugs.” Sperm is quite alkaline and so women prone to yeast infections are advised to douche with a mild, acidifying liquid after ejaculatory sex. My favorite recipe, which can be pre-prepared and kept in the bathroom, is equal parts water, hydrogen peroxide and distilled white vinegar. Please don’t use apple cider vinegar in the vagina because it could ferment. Many of the health bacteria in the vagina are “peroxidase-producers,” meaning they produce hydrogen peroxide as a way to keep the vaginal ecosystem intact.

Jane wasn’t in the habit of using antibiotics casually, but she does love sweets and beer. So does Candida albicans. “Sweets” isn’t just the white stuff some people sprinkle in hot drinks, but a general term for simple carbohydrates. To minimize yeast overgrowth Jane was advised to avoid pasta, breads, other baked goods, most fruits and ketchup. Also, because she uses a diaphragm for birth control, Jane was exposed to her lover’s ejaculate. The sweets, beer, and alkalinity of the sperm all added up to disturbed mucosal pH. Besides the post-sex douche, Jane’s doctor advised her to practice impeccable sexual hygiene (clean hands, mouth and genitals before retiring), to maintain regular bowel elimination, clean her diaphgram properly (in a dilute vinegar soak for 6 hours after each use) and to cut way back on beer and sugary foods. In addition, Jane was advised to avoid dairy products, which irritate mucous membranes, and any other known food allergens. This is a whole separate topic, but if you suspect that certain foods produce bad reactions be advised that this warrants exploring. Chronically ingesting foods that are not properly digested is a drag on the immune system, and will absolutely weaken your defenses.

Jane also learned about a variety of effective anti-fungal remedies, all of which are readily available without a prescription. Mostly the anti-fungals work by acidifying the vaginal mucosa. Occasionally this approach won’t work; check with your holistically-oriented health provider. Capryllic acid and undecynic acid are similarly derived naturally acidic compounds that have been encapsulated by a number of manufacturers for use by mouth, or as vaginal inserts. Boric acid works really well for many women, and is readily available and inexpensive. Yes, it’s the same stuff that can be used, diluted, as an eyewash, and full-strength to kill cockroaches. Most pharmacies carry boric acid powder. Take 10 or so “OO” size empty gel caps, fill with boric acid and insert two vaginally each night for five nights in a row. You might need to wear a pad to prevent dripping. Ideally abstain from intercourse during the five days of treatment. In addition, eat lots of garlic. Chop it fine for salad dressings, to put in soup or serve up with steamed vegetables. You can swallow a peeled clove whole for several days in a row if your companions don’t mind “garlic-breath.” You can also insert a peeled clove of garlic vaginally but don’t leave it in more than 24 hours.

A newer approach to combatting yeast infections is by volatile oils. Mostly the anti-fungal oils (especially thyme and oregano — very potent, and to a certain extent tea-tree oil) are too caustic to apply directly to mucous membranes such as the vagina. Recently, these volatile oils have become available in capsule form for oral use; ask you health care provider. To give an example of how else you might use this information, consider the mold that grows along windowsills of damp climates. I like to take a thin rag or Q-tip and apply thyme oil all around the edges of the window frame and in the corners of my bathroom and closets. Not only does this smell great, but it dramatically reduces mold build-up. Mold is another form of yeast, or fungus.

One last category of anti-fungal treatments worth discussing is the berberine-containing herbals. Berberine is an alkaloid (alkaline active compound), and would be a good choice therapeutically for women in whom acid products don’t seem to work. Berberine has a distinct bright mustard color and is most vividly present in the plant Hydrastis canadensis, commonly known as Golden Seal. Golden Seal, like all berberine alkaloids, is specifically healing for mucous membranes. It works well for mild diarrhea (stomach bug), for a runny nose or congested lungs, and as a mouth wash for oral ulcers. Beware! Golden Seal is very bitter. That’s partly how it works. Like other bitters, berberine-containing compounds cause enhanced secretion of the mucous membranes, thus flushing them out and discouraging bacteria or fungii from setting up housekeeping.

To summarize, keep the immune system strong by avoiding excess sugar, dairy products, other food allergens, antibiotics and the birth control pill. Maintain regular bowel elimination and practise immaculate sexual hygiene. Learn to have a cooperative relationship with your vaginal ecosystem and this friendship will be rewarded!

Prevention & Treatment Summary

1. Avoid beer, sugar and all other refined carbohydrates such as pasta, and most baked goods including breads. Avoid dairy products. Avoid antibiotics and oral contraceptives. All of these will compromise the immune system’s ability to overcome an overgrowth of Candida albicans.
2. Re-acidify the vagina after ejaculatory sex with a gentle douche of 1/3 vinegar, 1/3 hydrogen peroxide and 1/3 water. Always pee after sex, and wash hands, mouth and genitals before sex.
3. Eat 2-3 cloves of garlic daily; ideally chopped into salad dressing or soups. Baked is OK. Encapsulated health food store brands are OK, but not as potent as the real thing.
4. If your yeast infection is also causing digestive problems (lots of flatulence, malodorous or runny stools, abdominal cramps) use Golden Seal and Echinacea, a classic combo to heal disrupted mucous membranes, until your “gut” feels back to normal. Doses should range from 150-250 mg of Golden seal (in tincture or capsule form, avoid tablets which are not as effective) and 250-500 mg of Echinacea (glycerite, tincture or capsule form) for 5 to 15 days.
5. To directly treat the vaginal yeast, apply powdered Boric acid in gel caps or pressed into “troches” (large tablets). Place 1-2 grams directly into the vagina at night for 2-5 nights in a row. Ideally abstain from intercourse during this treatment; you may need to wear a pad to prevent leaking.
6. Undecynic acid or Capryllic acid are available for oral use to fight Candida; take 15 mg of either 3-4 times daily preferably not with food, for 5 to 21 days.
7. Other women will find more rapid relief from a mix of oregano oil extract (0.5 mL daily) plus thyme oil extract (0.25 mL daily) for 3 to 10 days. While these volatile oils have long been known to be potent anti-fungals, their availabilty in gel caps in relatively new. Ask your doctor to help you find this product if your local health food store can’t. Do not try to take the oils straight — the requisite therapeutic quantities are too caustic to be applied directly in the mouth.