Why Do I Keep Getting Yeast Infections?

You’re at the pharmacy checkout holding the same box you bought in the spring. The cashier doesn’t look up. You slide it under the shampoo anyway, and you wonder how this became a routine.

What it feels like

OWH¹ names extreme itchiness in and around the vagina as the main sign, along with burning, redness, swelling and a thick, white discharge that looks like cottage cheese. The NHS³ adds soreness during sex or when you pee. MedlinePlus⁴ says discharge can range from watery to thick.

Those symptoms overlap with other conditions. OWH¹ says the signs of a yeast infection are a lot like the symptoms of other, more serious infections, which need different treatments. If you want to compare what you’re seeing, our article on vaginal discharge lists what changes are typical and what changes aren’t.

Why a guess isn’t enough

The CDC’s² treatment guidelines are blunt on this. It says even women who have previously been diagnosed with a yeast infection by a clinician are not necessarily more likely to diagnose themselves correctly. A clinician can look at a sample under a microscope. MedlinePlus⁴ describes a wet mount and KOH test, and says cultures are taken if treatment fails or the infection recurs.

The CDC² adds a point that surprises people: finding Candida on a culture, with no symptoms, isn’t a reason to treat. It says 10% to 20% of women have these organisms and no problem.

What raises the odds

Several sources list the same short set of risk factors.

• Antibiotics. All of the NHS³, OWH¹ and MedlinePlus⁴ list them.
• Diabetes. OWH¹ and the NHS³ say uncontrolled or poorly controlled diabetes. MedlinePlus⁴ lists diabetes and obesity.
• Pregnancy.
• A weakened immune system.
• Hormones. The NHS³ lists hormone therapy and OWH¹ lists hormonal birth control with high estrogen.
• Douching. OWH¹ lists it.

That’s a reason to mention your medicines and your blood sugar when you ask for help with repeat infections. If odor is your main symptom instead, our article on vaginal odor covers it.

What helps

Skip the irritants. OWH¹ says to avoid douching and scented products. The NHS³ says to skip douches and deodorants on the genital area, use water and an emollient instead of soap, dry thoroughly after washing and avoid tight clothing.

Dress for dryness. Both OWH¹ and the NHS³ recommend cotton underwear. OWH adds changing out of wet clothes promptly and wiping front to back.

Manage your blood sugar if you have diabetes, OWH¹ says.

Treatment for a single infection. OWH¹ says yeast infections are usually treated with antifungal medicine, in creams, tablets or suppositories, or a prescription pill taken by mouth. MedlinePlus⁴ lists miconazole, clotrimazole, tioconazole and butoconazole. The NHS³ says treatment usually clears an infection within 7 to 14 days and that you shouldn’t use antifungal medicine more than twice in 6 months without speaking to a pharmacist or doctor.

If you’re pregnant, OWH¹ says to use vaginal creams or suppositories only, and warns that the oral fluconazole tablet may cause birth defects.

If they keep coming back. OWH¹ says four or more infections a year is a reason to ask your doctor about longer antifungal treatment, up to six months. The CDC² defines it as three or more symptomatic episodes in a year and says treatment starts with a longer course, followed by weekly oral fluconazole for 6 months. MedlinePlus⁴ mentions weekly preventive doses too.

Probiotics. The evidence is split in what we read. MedlinePlus⁴ lists taking probiotics during antibiotics as a prevention strategy. The CDC² says probiotics lack evidence of effectiveness. If you want to try them, mention it at your appointment.

Partners. The CDC² says treating a sex partner isn’t indicated for an uncomplicated yeast infection.

The play

Try this: a repeat-infection log

For your next appointment, write down the dates of each episode, the symptoms, what you used and how long it took to clear.

Add any antibiotics you took in the weeks before, and your latest blood sugar result if you have one.

A page like that shows a clinician the pattern fast.

When to get checked

MedlinePlus⁴ says to contact a provider for first-time symptoms, symptoms that persist after over-the-counter treatment, symptoms that get worse, or possible STI exposure. The CDC² agrees that persistent symptoms after over-the-counter treatment need clinical evaluation. The NHS³ says to see a GP if thrush keeps coming back, meaning more than 4 times in 12 months, or if you’re under 16, over 60, pregnant or have a weakened immune system.

Book an appointment if any of these fit:

• This is your first time with these symptoms
• Over-the-counter treatment hasn’t cleared it
• You’ve had three or four infections in a year
• Your symptoms are getting worse
• You’re pregnant, or you have diabetes or a weakened immune system
• There’s any chance the symptoms are from a sexually transmitted infection

The next box doesn’t have to go under the shampoo. Bring the log, get a test, and find out what you’re treating.