I (Think I) Have a Yeast Infection…

After practicing gynecology for more than 15 years, I know that if you can treat a vaginal infection without having to call your friendly gynecologist, you’ll do that 10 out of 10 times.

With all of the over the counter (OTC) products available, it is tempting to head to your pharmacy.  However, more often than not, you’re treating the wrong thing.

Often women presume all vaginal itching, irritation, and/or discharge is caused by a yeast infection.  This presumption is FALSE.  Yeast is not the most frequent cause of vaginitis — bacterial vaginosis (BV) is.

Yeast infections

Most patients who have any type of vaginal discharge immediately think that they have a yeast infection.  Yeast infections are more common in women prior to menopause.  The most common symptoms are vaginal itching (sometimes on the external skin and sometimes inside the vagina) and a white, cottage-cheese like discharge.  Many of my patients think that having a white discharge means that they have a yeast infection.  This is NOT true.  White discharge, even if it appears cottage-cheese like, is common and does not mean that you have a yeast infection.  If you have itching along with the discharge, it is more likely to be a yeast infection.

So, you’re hanging out in the feminine hygiene aisle, looking at all of the different options for your presumed yeast infection.  There are 1-day, 3-day and 7-day treatment options.  Which one should you pick?


For a true yeast infection, effectiveness is reported to be in the 70% range.  Effectiveness is lower for the one day, a little higher for the three day and highest for the 7 day dosing.   I know it’s tempting just to get it over with in one day but I find that patients who use the 1-day OTC treatment often end up in our office 3-4 days later with persistent symptoms.


These medications are considered safe.  As with any medication, side effects can occur.  The most common side effects are burning and irritation and sometimes abdominal cramping.

However, with self-diagnosed “yeast”, the OTC treatments are less effective because many of these infections not actually caused by yeast and therefore the OTC treatments won’t work.

Bacterial vaginosis (BV)

As previously mentioned, BV is the most common cause of vaginal infections.  It is caused by an imbalance of bacteria in the vagina and causes and overgrowth of bacteria.  Bacteria is a normal, healthy, part of the vaginal flora.  However, if it overgrows, it can cause a gray, watery discharge that frequently has a fishy odor.  Some women note itching or burning in the vagina with BV (therefore it is often mistaken as yeast).  There is nothing over the counter to treat BV – DO NOT grab that douche – it will only make it worse!  A quick visit to the gynecologist can confirm the diagnosis and get you set up with a prescription to treat BV.

If you think you have a vaginal infection, do you absolutely need to see your gynecologist?  It’s usually a good idea to get to the root of the problem and get started on the most effective treatment.  However, if your symptoms are not recurrent, you do not have a new sexual partner, you have no vaginal odor and you don’t have diabetes or immunosuppression, you can give an OTC treatment a try.  If your symptoms are not straight forward or you’re just not sure, it is best to see your provider.

If any OTC product fails, then it would be recommended to be seen by a provider.