Most of us with a vagina will deal with a yeast infection at some point — it's one of those annoying realities of life. Around 75% of people will experience one, and while they’re uncomfortable, they usually don’t last long. 

But what happens when a vaginal yeast infection just won't budge? It’s frustrating, to say the least. In fact, up to 28% of people will deal with recurrent yeast infections within a year. If you've found yourself asking, "Why won’t my yeast infection go away?" you're not alone.

The truth is, there are several reasons why a vaginal infection might keep coming back, and understanding what's going on down there is key to finally getting it under control.

Let’s dive into the seven reasons your vaginal infection might be sticking around longer than it should.

1. You’ve been misdiagnosed

Vaginal infections are extremely common, but they’re also commonly misdiagnosed. Being misdiagnosed actually happens more often than being correctly diagnosed. In a study of 220 people with vaginal symptoms, 61% of BV and 77% of yeast infection diagnoses were incorrect. 

We aren’t much better at diagnosing ourselves, either. A different study that involved 546 cisgender women showed self-diagnoses of BV were correct only 56% of the time. Even more interestingly, 69% of those who thought they had a yeast infection actually had something else. 

One reason why diagnosis can be tricky is because many vaginal conditions have similar symptoms. Abnormal vaginal discharge and vaginal itching are common yeast infection symptoms, but they can also be a sign of a host of other conditions such as BV, cytolytic vaginosis (CV), and some sexually transmitted infections (STIs). A test is necessary in order to know what bacteria or yeast may be present, which might not be an option if you’re being treated over the phone or getting medications via an online form. 

It’s essential to get your symptoms tested properly before taking any medication. Otherwise, you may be treating the wrong thing.

2. You’re taking the wrong medication

Even if you are diagnosed correctly, you may be taking medication that isn’t working on the pathogen (disease-causing microbe) that’s causing your infection. 

Identifying the best antifungal for yeast infections

Much like BV, yeast infections also respond differently to treatment depending on the type of Candida causing the problem. 

While up to 85% of yeast infections are due to overgrowth of Candida albicans, other strains of yeast such as Candida glabrata and Candida tropicalis can be the culprits. Standard antifungal medication is not as effective on these strains, and longer treatments, different antifungals, or alternative solutions like boric acid may be more effective. 

Unless you know which bacteria or yeast you are dealing with, antibiotic or antifungal medication may feel a bit like trial and error. Tracking your vaginal health with tools like Evvy can help you identify which microbes are most associated with your symptoms and spark conversations about the best treatment options with your doctor.

Identifying the best antibiotic for BV 

Antibiotics such as clindamycin and metronidazole are first-line treatments for BV. However, each works better on some strains of bacteria compared to others. 

For example, metronidazole has been shown to be less effective than clindamycin for treating both Gardnerella vaginalis and Atopobium vaginae, which are two primary BV-causing bacteria. Meanwhile, metronidazole is more effective than clindamycin against other bacteria, such as Prevotella.

But the type of disruptive microbes isn’t the only factor when considering what antibiotic might be best. It’s also important to consider whether there are protective bacteria present in the microbiome and how to preserve them. 

You may know that some antibiotics can kill off protective bacteria in addition to pathogenic ones. That’s why clinicians often prescribe metronidazole instead of clindamycin, as clindamycin eradicates protective vaginal bacteria called Lactobacilli. 

However, if you have no lactobacilli present and the bacteria that is present is resistant to metronidazole, then the logic to use metronidazole to preserve lactobacilli doesn’t hold. (This is why our Vaginal Health Test identifies all bacteria and fungi — including the protective types.) 

3. You took antibiotics 

Antibiotics are intended to kill disruptive bacteria, but sometimes, they don’t work as well as we’d like or in ways we’d expect. 

If you’re taking antibiotics for any reason (vaginal or not), they can actually increase the chances of a yeast infection developing. Yeast infections are more common in people who are taking antibiotics and, not so fun fact, antibiotics are actually the most frequent and predictable cause of a yeast infection. 

Within a month, antibiotics clear up to 85% of bacterial vaginosis cases, yet for over half of these patients, BV will return within six months. This is thought to be in part because the antibiotics don’t fully eradicate the pathogenic microbes, leaving BV-associated bacteria to regrow in the vagina following treatment. As mentioned above, certain antibiotics can also eliminate protective bacteria in addition to pathogens — which can leave you vulnerable to another infection. 

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4. Disruptive microbes have formed a biofilm 

Like all of us, bacteria are just out here trying to survive. One of their strategies is forming what’s called a biofilm, where they attach to the surface of an environment and form a protected community. Bacteria in a biofilm can survive in this self-sustaining structure, making it harder to eradicate them. 

The ability of BV-causing bacteria to potentially form a biofilm may explain in part why BV has such a high recurrence rate. However, the exact role that biofilm plays in the development of BV is still somewhat unclear. 

Candida also has the ability to form biofilms, which can make your yeast infection resistant to treatment with antifungal medication, too. 

Based on your unique vaginal microbiome, Evvy’s personalized reports can help you determine whether or not the microbes in your vaginal are prone to producing biofilm that enables resistance and/or recurrence.

5. Sex is disrupting your vaginal microbiome

While yeast infections aren't considered STIs, certain sexual behaviors can create conditions that trigger them again and again. And the same goes for BV. (Kind of a buzzkill, we know.)

The jury is still out on how exactly sex and BV are linked, but associations have been made between BV and new partners, multiple partners, and inconsistent or lack of condom use.

There’s also a possible link between reinfection and staying with the same sexual partner before and after treatment. Research has shown that infection was two to three times more likely to come back for cisgender women with ongoing cis male partners. For sex between people with vulvas, BV has also been associated with new partners, having a partner with BV, and receptive oral sex. 

6. Your hormone levels are in flux

Shifts in hormone levels can affect the vaginal microbiome — and in some cases, make it more susceptible to infection. 

Wondering how this happens? It often comes down to estrogen levels. That’s because estrogen promotes the production of a sugar called glycogen. Glycogen acts as the main form of sustenance for protective bacteria, which helps maintain a healthy vaginal pH and keep pathogens at bay. When there is less estrogen present, there is less glycogen to feed the lactobacilli, which leaves an opportunity for BV-causing bacteria to overgrow. 

On the other hand, glycogen is also food for yeast cells, so estrogen levels that are higher than normal can encourage Candida to multiply — bringing on a yeast infection. 

That’s right: not enough estrogen could create an opportunity for BV, while too much estrogen could encourage a yeast infection (we really can’t win.)

As our hormones change throughout the month, as well as when we get pregnant, give birth, and go through menopause, the risk of bacterial or yeast infections change. This also happens when switching birth control or dealing with a hormonal condition or imbalance. If you are managing consistent or recurring hormonal changes, vaginal issues may follow suit.

This is just the tip of the iceberg regarding all the ways hormones can influence the microbiome but you can read more about this relationship here.

7. You’re going through menopause 

A person enters menopause when they have gone 12 consecutive months without a menstrual cycle (the time leading up to this, when cycles start to dwindle, is known as perimenopause). The menstrual cycle is the main source of reproductive hormones. As these hormones decline during menopause, there is an increased risk for certain vaginal infections. 

Remember how estrogen feeds protective bacteria that keep pathogens in check? Lowered estrogen means fewer Lactobacilli and therefore a less acidic, more vulnerable vaginal environment — which can invite BV-causing bacteria to overgrow.

A lack of estrogen can also cause atrophy or thinning of the vaginal tissue which can impact the physical structure of the reproductive system, leading to an increased risk of UTIs. When the vaginal environment is disrupted in this way, it opens the door for bacteria such as E. coli to colonize and travel up into the urethra, causing infection. Sometimes, the bacteria hang around in the vaginal microbiome and travel upwards now and again, potentially leading to recurrent bladder infections.

While yeast infections are generally less common during menopause, a common menopause treatment, estrogen-containing hormone replacement therapy (HRT) is considered a risk factor for yeast infections.

Get care for vaginal infections through Evvy

‍Our bodies may feel like a mystery, but that’s only because we don’t have all the information we need to understand them. Built with leading OB-GYNs, Evvy is the first-ever platform for vaginal healthcare that combines state-of-the-art testing, prescription treatment, and 1:1 coaching to create personalized care as unique as your vaginal microbiome.

For eligible testers, we offer first-of-its-kind clinical care, including an Rx treatment program developed by a provider, supportive coaching, and much more.

FAQ

What happens if a yeast infection won’t go away?

If a yeast infection just won’t go away, there could be a few reasons why. One possibility is that the treatment you tried isn’t strong enough or hasn’t been used consistently. Sometimes, the yeast causing the infection might be a type that doesn’t respond to over-the-counter medicines, and you might need a prescription antifungal instead. If you have conditions like diabetes or a weakened immune system, that could also make it harder to kick the infection. Another possible reason for your symptoms might be a misdiagnosis. Other conditions like bacterial vaginosis, trichomoniasis, or sexually transmitted infections (STIs) can have similar symptoms but require different kinds of treatment. So, getting the right diagnosis is really important for your health. If you’re dealing with repeated or ongoing symptoms, you might want to consider ordering an Evvy Vaginal Health Test. This test can give you helpful insights into your vaginal health and help pinpoint what might be causing your symptoms, which can lead you to the right treatment plan.

Why do I have a never-ending yeast infection?

If you’re dealing with frequent yeast infections, you’re definitely not alone, and there could be several reasons for it. Sometimes, the treatment you’re using just might not be strong enough. There are even strains of yeast that don’t respond to over-the-counter antifungal treatments and might need something stronger prescribed by a doctor. In other cases, ongoing yeast infections might be tied to underlying health issues, like diabetes or a weakened immune system, which can make it tougher for your body to tackle the infection. Hormonal changes, whether from pregnancy or birth control, can also create an ideal environment for yeast to thrive. It’s important to note that sometimes the symptoms you're experiencing could actually be from other conditions that feel similar to yeast infections, like bacterial vaginosis or certain STIs. If you’re finding it hard to shake those symptoms off, it might be a good idea to consider a more detailed test, such as the Evvy Vaginal Health Test. This can really help pinpoint what’s going on and steer you toward the best treatment options. 

What worsens a yeast infection?

There are a few things that can make a yeast infection worse. One common issue is not finishing the full course of treatment or using medications that aren’t effective, which can allow the infection to stick around or come back. Wearing tight, non-breathable clothing (like synthetic fabrics) can also create a warm, humid environment that yeast loves. Plus, being in wet swimsuits or sweaty clothes for too long can add to the problem. Using scented products like soaps, deodorants, or douches might seem like a good idea, but they can actually throw off the natural balance of bacteria and yeast in your vaginal area, making things worse. Unprotected sex can play a role too. While yeast infections aren't typically considered sexually transmitted, sexual activity can irritate the area or introduce bacteria, which might contribute to the infection getting worse. Also, if you've been taking antibiotics, they can sometimes upset the balance of bacteria in your body, leading to an overgrowth of yeast. If your yeast infection keeps coming back or doesn't seem to get better, it’s a good idea to chat with a healthcare provider for some extra guidance.

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