Vaginal care

Candida Albicans is the most common cause of vaginal complaints. It is a fungus that occurs naturally in everyone. Normally this fungus is perfectly controlled by the 'good' bacteria, but for various reasons the balance is disturbed and the fungi still have a chance to grow. It is not yet clear in science why this is happening, but at least it is not due to contamination.

Approximately 75% of the women have to deal with a candida infection at some point in their lives. This is not an STD, it is not transferable, but a consequence of reduced resistance, which gives the already present fungus the chance to develop. Other causes of vaginal complaints may include bacterial vaginosis and vaginal dryness. There are also a number of sexually transmitted diseases, such as trichomoniasis, chlamydia and gonorrhoea.

In this article we discuss candida and bacterial vaginosis.

Candida is the shorter name for the condition candidiasis. This condition is caused by the yeast candida albicans, which turns into a mould form. That is why candida is also called fungal infection. Candida albicans is most common in the vagina and/or intestines, but can also occur in the mouth and/or throat, on the penis and simply on the skin. If, for example through the use of antibiotics, an unhealthy diet, stress or a weakened immune system, the flora becomes unbalanced and the number of 'good bacteria' is greatly reduced, it can happen that the yeast candida grows into a fungal infection, with all its nasty consequences.

A candida infection can cause all kinds of additional health problems, such as fatigue, insomnia, bloating and weight gain. More than three infections per year, at least once confirmed by research, are referred to as recurrent candida infection.

Bacterial vaginosis, like candida, can occur when the flora in the vagina is out of balance, due to an increasing pH value. A difference with candida is that the ratio between the different bacteria seems to be more important than which bacteria are found. This causes a discharge with an unpleasant odour.

Both candida and bacterial vaginosis can disappear spontaneously, or you can undergo treatment. It is not noticeable when the symptoms recur over time.

For both infections, the disturbance in the acidity paves the way for an infection. We will go into that in more detail below:

• A diet rich in sugar and carbohydrates: a yeast, such as candida, needs sugars in order to be able to reproduce.
• Medicinal use: antibiotics are a known cause of candida. It kills all bacteria, including the good ones. This allows the candida to develop into a fungus. Contraceptive pills and corticosteroids are also known to promote fungal growth.
• A weakened immune system: as a result of a flu or other illness, the number of 'good' bacteria can be greatly reduced, which disturbs the balance and increases the risk of fungal infections.

Environmental factors: it is not always possible to prevent contact with so-called toxic substances. These include air pollution such as fine dust, but also pesticides and emissions from intensive livestock farming. You may also be exposed to heavy metals at work or in your environment. These factors cause an imbalance in the body's acidity (pH value). The pH value of the vagina is usually between 3.8 and 4.5. This can vary due to hormonal fluctuations during menstruation or menopause. If this pH value is disturbed, yeasts and moulds can be given free rein and candida or bacterial vaginosis can develop.

• Use of perfumed or unscented soaps can also upset the balance, allowing candida to develop. The vagina can keep itself perfectly clean. This makes it sufficient to clean the external genitalia (labia for example) with warm water, and soap is unnecessary, and even harmful to the protective pH value of your vagina.
• Women with diabetes are also known to be more susceptible to vaginal fungi such as candida.

Often, however, there are no such circumstances. Science is not yet fully aware of how vaginal fungi such as candida are formed. In any case, there is no evidence that wearing tight clothing, panty liners or tampons increases the risk of fungal infections.

Vaginal disorders can be divided into three groups, the first group is the subject of this article:

There are the yeasts and bacteria that live naturally around the vagina, which can grow into fungal infections such as candida and bacterial vaginosis when there is an imbalance due to, for example, a reduced resistance.

In addition, there may be vaginal dryness.

Finally, there are a number of sexually transmitted diseases, such as trichomoniasis, chlamydia and gonorrhoea.

Candida is usually easy to recognise by the following symptoms:

• Itchy, burning feeling
• An odourless white, crumbly yogurt like secretion
• If the mucous membrane of the vagina irritated and red
• The absence of other complaints, such as abdominal pain or a bloody discharge

With bacterial vaginosis most of the complaints are similar, but you have a strong smelling discharge that is grey/white in colour, no pain and there are no inflammations.

It is possible to reduce the risk of a vaginal fungus. Normally, with a healthy flora, the yeast / moulds will be kept in check by the good bacteria. You can also do your bit with the following tips:

Although candida and bacterial vaginosis are not caused by synthetic fabrics, tight trousers and panty liners, these fabrics do create a sultry, humid and warm environment. And that is what these moulds like. Washing with clean water is generally sufficient for the pubic area.

After all, it is always wise to wipe yourself from front to back after going to the toilet. Otherwise you might accidentally introduce bacteria from the intestine into the vagina, causing another disturbance.

When considering preventive therapy, the Pharmacotherapeutic Compass recommends the following three treatments:

• On demand treatment. The following products are recommended: miconazole vaginal capsule, single (preferred), or fluconazole (oral), single. A stock of three treatments can be given for use if necessary.
• Preventive vaginal. For this purpose it is advised to prescribe a single miconazole vaginal capsule, to be taken on day 5 of the menstruation, during 3-6 months. In case of insufficient efficacy, this can be given up to 1×/week.
• Preventive oral. Fluconazole (oral) is prescribed once. On day 5 of menstruation to take, for 3-6 months. In case of insufficient efficacy up to 1×/week.

Candida can be treated both locally and systematically. This is preferred locally because the medicine is not absorbed or absorbed less by the body and can therefore cause fewer side effects.

With a vaginal (local) treatment you put a pill or capsule in the vagina:

• Miconazole once
• Clotrimazole once or three days
• Butoconazole three days

Systematic treatment takes the form of an oral pill, usually fluconazole. In case of external itching, this may be supported by a cream with miconazole or clotrimazole.

Medications are used to treat the symptoms, which means that the symptoms disappear. But as long as you do not tackle the cause, there is a good chance that fungal infections will continue to cause recurring discomfort.

Candida needs sugars, moulds and yeasts to grow. A change in your diet is therefore a very effective method to permanently get rid of vaginal yeast infections.

You can change your diet in steps, or do it all in one go.

• First step: stop with sugars. Yeasts and moulds live on sugars, so removing the breeding ground is a no-brainer. In the supermarket, pay attention to the ingredients, you will be surprised how often there are so-called 'hidden' sugars in the products.
• Step 2: One step further is to completely ban the ready-made packaging. Since you have now regularly read the ingredient lists, you have probably already discovered that packages, bags and ready-made packaging have already been lost due to all the sugars and additives, so this is a small next step. A bonus is that, by cooking fresh, you get many more healthy ingredients. You will soon notice that you get a lot more energy!
• Step 3: Now it is time to avoid the fungi and yeasts as well. This is necessary to get rid of the vaginal fungi, so over time you can just bring the mushrooms back into your diet.

In addition to your diet, you can also think of removing other causes. Disbalance in your vagina and/or intestines can also be caused by excessive stress and a weakened immune system. Therefore, in case of recurrent vaginal fungal infections, it is wise to look at your lifestyle and adjust it where possible. Possibilities are:

• Yoga and meditation. A yoga session every morning, or ten minutes of meditation during a break at work, will help to reduce your stress levels.
• Daily sports or a long walk. During a sports session or a walk in nature you can let your thoughts run free so that your head is empty for a while. Moreover, exercise is always good for you.
• Get a good night's sleep. A rested mind and a rested body are much better able to control stress and keep the immune system intact.

Dutch Care Institute (z.j.) Vulvovaginale candidiasis, consulted on 4 May 2019, on https://www.farmacotherapeutischkompas.nl/bladeren/indicatieteksten/vulvovaginale_candidiasis

Burg, Yvonne van de (z.j.), Candida; invisible source of physical complaints, consulted on 5 May 2019, at https://energiekevrouwenacademie.nl/candida-onzichtbare-bron-lichamelijk-klachten/?fbclid=IwAR1_mvgcG7LQst526JMr7S4QMSBkE7MLl99YCy9L4UceqZsBYo5p3juLe6s

Velde, J. v.d. (2016), Candida test based on 56 symptoms, consulted on 4 May 2019, at https://jessevandervelde.com/candida-test-aan-de-hand-van-56-symptomen/?fbclid=IwAR3zui50B-IiXyOzd9lGg2MfPnrzxCwPVkYni2gQlL3JR6SjSc9j0ig7hA

RIVM (2018), Candida, consulted on 4 May 2019, at https://www.rivm.nl/candida

Nederlands Huisartsen Genootschap (2016), I have a vaginal yeast infection, consulted on 4 May 2019, at https://www.thuisarts.nl/vaginale-afscheiding/ik-heb-vaginale-schimmelinfectie

Vrij-Mazee, Drs. H (2019), Candida, consulted on 4 May 2019, at https://www.gezondheidsplein.nl/aandoeningen/candida/item33189

Nederlands Huisartsen Genootschap (z.j.), NHG-Standaard Fluor vaginalis, consulted on 5 May 2019, at https://www.nhg.org/standaarden/volledig/nhg-standaard-fluor-vaginalis