If you’re guilty of reaching for over the counter (OTC) antifungals, as soon as you feel a prickly vulva sensation come on — you’re not alone. That irritating itch is a yeast infection’s signature symptom and waltzing into a pharmacy, grabbing a suppository off the shelf, and popping it up there at home is simple enough. On the other hand, booking an OB-GYN appointment and waiting, itchy and uncomfortable, is a bigger hassle.
But sometimes OTC yeast infection treatment doesn’t help—this could be because you don’t have a yeast infection at all.
If you find yourself in this position, you may wonder, could my symptoms be the beginning of a urinary tract infection (UTI) instead, then?
When experiencing vulva irritation, it’s not uncommon to suspect one or the other.
Yeast infections and UTIs are two of the most well known genital tract infections. But, despite their shared frequency and name-brand recognition amongst people with a vagina, they typically don’t share that many symptoms.
We go over the key differences between a yeast infection and a UTI, as well as other conditions with similar symptoms below, so you can have a better sense of what *might* be up down there.
What are the symptoms of a yeast infection?
A yeast infection is usually caused by an overgrowth of Candida albicans, a yeast strain, but other Candida strains can cause symptoms too. It’s important to note that a weakened immune system, antibiotic use, uncontrolled diabetes, PCOS, insulin resistance, pregnancy, and damaged vulva skin make it easier for Candida species to multiply.
Symptoms of a vaginal yeast infection include:
- Thick, white (or creamy) discharge, that doesn’t smell
- Itching, irritation and soreness around the vagina
- General vulvar itching, between the labia
- Soreness or stinging during sex, and when urinating
OTC treatments not working? Your yeast infection may not be caused by Candida albicans.
Most yeast infections, possibly up to 90%, are caused by the fungal strain Candida albicans. OTC treatment is only effective on this type of Candida. But yeast infections caused by other Candida strains happen too and they’re on the rise. They are treated using different types of antifungals than Candida albicans, which aren’t as easy to get hold of. Vaginal infections with a Candida strain other than Candida albicans, or frequent yeast infections, are sometimes known as chronic, atypical or complicated yeast infections.
Because OTC antifungals are only effective against Candida albicans, you might not find any relief with treatment if you have an atypical yeast strain. If you suspect that your yeast infections aren’t caused by Candida albicans, it may be helpful to try an Evvy test as it would pick up on atypical Candida strains, (plus any Candida strains present). You can also track yeast infection recurrences over time, to find out whether an atypical strain was just a one off or not.
What are the symptoms of a UTI?
A UTI is normally caused by bacteria from the anal tract or faeces, that gets into the urinary tract. Typically a UTI is a bacterial infection while a yeast infection is fungal. Pregnancy, kidney stones, dehydration, a weakened immune system, some types of medication (like antidepressants, and medication used to treat ADHD), and the use of a catheter can all increase the risk of bacteria in the urinary tract.
Symptoms of a UTI include:
- A burning sensation when urinating
- Pain when urinating
- A frequent and sudden urge to urinate
- Needing to urinate more often, especially during the night
- Blood in your urine
- Lower back or lower tummy pain
- A high temperature
- Fever, feeling hot and shivering
Recurrent UTIs and the vaginal microbiome
For some women, recurrent UTIs may be due to UTI-causing bacteria colonizing the vaginal microbiome and then traveling into the urethra.
These pesky microbes include:
- Escherichia coli a.k.a E. coli — these bacteria are responsible for 75% of UTIs in cisgender women
- Proteus mirabilis
- Klebsiella pneumoniae
- Enterococcus faecalis
- Pseudomonas aeruginosa
- Gardnerella vaginalis — while Gardnerella is typically known for its role in bacterial vaginosis (BV), the presence of G. vaginalis in the urethra may also cause a UTI
If you’re someone who has struggled with recurrent UTIs, it may be worth testing your vaginal microbiome!
This can help illuminate whether a reservoir of disruptive bacteria in your vaginal microbiome could be contributing to your UTIs.
Additionally, there are a few things that can make it easier to develop UTIs that come back again and again including: menopause, a history of UTIs, and contraception.
Yeast infections and most sexually transmitted infections can both cause vulvar itching and soreness whereas typically , a vulvar itch isn’t a symptom of a UTI.
However it is possible to have a UTI and yeast infection at the same time! To complicate matters even more, though rare, you can get a fungal UTI infection (rather than bacterial), with the same Candida strains that cause vaginal yeast infections — most commonly, Candida albicans. Stinging, burning or soreness when urinating is a key symptom of a UTI, and the one symptom it shares with a yeast infection.
If it’s not a Yeast Infection or a UTI, what else could it be?
Though they aren’t talked about as much, believe it or not, common vaginal infections can mimic the same symptoms as UTIs or yeast infection. These include:
What is BV?
Bacterial vaginosis (BV) is one of the most common vaginal infections in people with vulvas of reproductive age. In fact, it’s estimated that one in three American women will experience a BV infection at some point in their lives.
Common symptoms include a foul or strong fishy smell, especially after or during sex, and grayish, watery discharge.
Marketing and societal pressure has created the misconception that vulvas should look and smell sweet and fruity. It’s no wonder then that BV is less openly discussed and often stigmatized for its signature, fishy smell.
The truth is, anything that disrupts vaginal pH levels, and the vaginal microbiome’s balance, can result in BV. Recently, the CDC pointed out that it is also sexually transmitted but more research into the effectiveness of partner treatment is needed.
With sex as a risk factor for BV, as it stands, misogynistic stigma around “cleanliness” and women’s sexual behavior already follows suit. We don’t need more stigma on that topic. What we do need is education and research that will teach people how to appreciate and care for their vaginas, regardless of the bacteria living in them.
How do its symptoms differ from a yeast infection?
While it isn’t usually a symptom of BV, some people do report experiencing itching. And though an increased amount of vaginal discharge can be common with all types of vaginal infections, a yeast infection is more likely to present with a thick, creamy (off yellow), cottage cheese-like discharge, than BV or an STI. You can read more about the difference between yeast infections and BV in our article, Bacterial Vaginosis vs. Yeast Infections: What’s the Difference?
Antibiotics, bacterial vaginosis, and yeast infections
BV is most often treated with antibiotics, which can often result in a yeast infection. Researchers still aren’t sure why this happens but it’s thought that healthy and unhealthy vaginal flora are wiped out by antibiotics — giving way to Candida overgrowth, because of the lack of Lactobacillus strains left though no single study has confirmed this theory.
Plus, a 2019 review on the link between antibiotic use and vaginal yeast infections, found that women with low levels of vaginal lactobacilli weren’t more likely to get a yeast infection. Nor were women dealing with recurrent yeast infections, more likely to have lactobacilli deficient vaginal microbiomes. In case you need a refresher, lactobacilli are the local heroes of the vaginal microbiome, ensuring that the vaginal environment is inhospitable for potential pathogens.
The same review suggests that maybe antibiotics don’t impact lactobacilli at all. But instead, they trigger a change in the cells of the vaginal wall, which allows a Candida overgrowth to take place. However, more research is also needed to set this theory in stone!
The vulva and skin irritation
At the first sign of vulvar itching, we often suspect a yeast infection is to blame and with good reason as it’s the most common cause of vaginal and vulvar itching!
It just so happens that the second most common cause of vulvar itching — dermatitis (most often, lichen sclerosus or vulvar eczema) — isn’t as well known.
Because the skin of the labia minora is similar to the skin on the inside of the cheek, vulvar dermatitis does not present the same way it does on the rest of the body. For example, skin flaking, and redness might not be noticeable in the same way.
Preventing vulvar skin irritation
Laundry detergents, fabric softeners and scented products may be triggers for vulvar dermatitis, so try switching to an unscented soap if you suspect any of these could be a culprit! Genital hair removal, vitamin deficiencies, and the use of panty liners can also play a role, though only a small amount of evidence alludes to this.
Only using water to wash the vulvar area is the right method for most people, but for those who continue to experience dryness or irritation of the vulvar skin, ointments and emollients may help.
Thicker, greasier types of ointment creams are recommended for after bathing, to protect the area throughout the day. Try putting a thin ointment (like coconut oil, vaseline, or a silicone-based lubricant)and apply a thin layer (no slathering). It all sounds a bit time consuming. It is, take it from someone who does this ‘cleanse and protect’ process every day (but finds it surprisingly effective).
Next time you’re about to clear the pharmacy shelves of vaginal suppositories, and UTI relief sachets, not so fast…
We’ll go out on a limb and say, most of the time, if you have a full blown UTI, you’ll know about it. That burning, bladder-doesn’t-feel-quite-empty, even though you’ve hit the restroom six times in the last hour, feeling, is almost unmistakable. If you’re not so sure though, don’t automatically charge towards the pharmacy shelves, hunting for yeast infection treatment (perhaps, unnecessarily), either (though it’s unlikely to cause any harm, other than to your wallet).
An itchy, irritated vulva could be caused by a number of things, like dermatitis. While unusual, excessive discharge could be any type of vaginal infection, from a yeast infection, to BV or an STI. Or possibly, a normal shift in discharge consistency as your menstrual cycle goes through the motions.