We all know those tell tale signs, the itchiness, the redness, the agony; the instant you notice them you run to the nearest pharmacy and grab an over the counter pill and cream and go about your day waiting for the discomfit to pass. Then the next infection hits and you’re going through the same thing all over again. We just assume it truly was a yeast infection because the anti-fungal medication sort of works, and well, we really hope it’s not anything else! But, what about when it doesn’t work? What about when you keep getting them over again and no amount of Canesten or Monistat is doing the trick? In these cases the yeast infection you think you have may actually be cytolytic vaginosis.
It sounds scary, cytolytic vaginosis, but it really isn’t! It’s just an overgrowth of the normally occurring, protective bacteria in the vagina called lactobacilli. What’s the difference between this and a yeast infection? A yeast infection (candidiasis) is fungal overgrowth, but cytolytic vaginosis is bacterial overgrowth. Confusingly, the symptoms are exactly the same! When you have too many lactobacilli in the vagina they produce extra lactic acid and hydrogen peroxide, which cause the itchiness, redness, and white curdy discharge that look and feel exactly like a yeast infection! It can be caused by a hormonal imbalance, or a more local concern.
Yeast Infection vs. Cytolytic Vaginosis
- BOTH present with irritated and itchy vulva and vagina
- BOTH present with profuse white and thick discharge that has no smell
- BOTH present with a vulva that is red and swollen
- BOTH present with a vaginal pH that is less than 4.5 (optimal vaginal pH is 3.8-4.5)
- ONLY a yeast infection will present with a positive swab for candida, if you have cytolytic vaginosis the candida swab will be negative
Neither a yeast infection nor cytolytic vaginosis are sexually transmitted, meaning you don’t typically “catch” them from your partner, however sex can lead to imbalance in the vaginal and penile flora so both partners (same sex or opposite sex) can develop similar symptoms. Both the penis and vagina depend on steadily controlled, protective flora in order to stay healthy.
Here is a list of some of the factors that affect our flora and predispose us to developing vaginal infections:
- Oral antibiotics – These can wipe out the healthy bacteria in the vagina
- Unprotected sex (with a male partner) – Semen is acidic and can irritate the vaginal mucosa.
- Protected sex (with a male partner) – But on the other hand, latex condoms and condoms with spermicides may irritate the vagina and eradicate good bacteria.
- Oral sex – Saliva is not the most hygienic of lubricants, but it can also interfere with the pH of the vagina (which should be 3.8-4.5). I wouldn’t ever suggest taking this away from you; just take a little break if you’re prone to infections!
- Low vitamin D – Vaginas need sunshine too!
- Vaginal creams – The vagina is self-cleaning, that’s why you have daily discharge, so there’s no need to use any store bought cleaning products.
- Scented toilet paper and tampons (and wearing daily pads for that matter) – Even though Tampax makes a pumpkin spice tampon it is not our friend!
- Food sensitivities and too much sugar – Food intolerances affect the gut flora, which often translate to the vaginal flora. Sugar is also a motivating fuel source for pathogens.
- Not letting the vagina breathe- G-strings and skinny jeans aren’t doing as any favours, but going commando at every opportunity will!
If you’re suffering from the symptoms of a yeast infection but the vaginal swab comes back negative, you should suspect cytolytic vaginosis.
Here’s what to do to get rid of it:
Twice daily baking soda sitz baths. Fill your bathtub (or a large bucket) with a small amount of warm water and add two tablespoons of baking soda per litre of water in the tub. Sit in the bath and read a book for at least 30 minutes. The purpose of this treatment is to decrease the acidity of your vagina and reduce the lactobacilli. You should be feeling better in no time!
Book an appointment with Dr. Sumner
Sobel, J. D. (2016). Recurrent vulvovaginal candidiasis. American journal of obstetrics and gynecology, 214(1), 15-21.
Yang, S., Zhang, Y., Liu, Y., Wang, J., Chen, S., & Li, S. (2016). Clinical Significance and Characteristic Clinical Differences of Cytolytic Vaginosis in Recurrent Vulvovaginitis. Gynecologic and obstetric investigation.
Ahmad, A., & Khan, A. U. (2009). Prevalence of Candida species and potential risk factors for vulvovaginal candidiasis in Aligarh, India. European journal of obstetrics & gynecology and reproductive biology, 144(1), 68-71.
Suresh, A., Rajesh, A., Bhat, R. M., & Rai, Y. (2009). Cytolytic vaginosis: A review. Indian journal of sexually transmitted diseases, 30(1), 48.