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 discomfort 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 worked, 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 anti-fungal treatment is doing the trick? In these cases the yeast infection you think you have may actually be cytolytic vaginosis1.
The symptoms of a yeast infection and cytolytic vaginosis are quite similar.
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 symptoms2 are strikingly similar. 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!
Here's a breakdown of the symptoms you'll see in a yeast infection versus 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.
Are your vaginal flora (or your partner's penile flora) out of balance?
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 causing an imbalance.
- 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, and 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, or use a dental dam.
- 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 a pumpkin spice tampon does actually exist, it is not our friend! (Check out our roundup of wellness-friendly period accessories instead).
- Food sensitivities and too much sugar3: 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 us any favors, but going commando at every opportunity will!
Try this bath treatment if you suspect you have cytolytic vaginosis.
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 baths1. Fill your bathtub (or a large bucket) with a small amount of warm water and add two tablespoons of baking soda per liter 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!
While cytolytic vaginosis might be the cause of vaginal discomfort, there are many more imbalances and infections that could be contributing. Be sure to consult with your doctor to rule out some other possibilities, like bacterial vaginosis, desquamative vaginitis, gonorrhea, chlamydia, trichomoniasis, etc.
Dr. Sumner aims to educate individuals on their unique bodies and teach them how to make their bodies work for them. She is a strong proponent of the idea that simple and proactive health strategies make the greatest and long-lasting impact.