Yeast infections and bacterial infections of the pelvis are a common occurrence, but I rarely see much conversation that talks about management, prevention strategies, and what to do with more recurrent issues.
Yeast infections, bacterial infections, and UTIs are some of the not fun conditions that can impact or pelvises, but there’s a whole world of treatments out there. We talked in our last article about risk factors for these infections, and I’ll repeat them here:
Risk factors include things that introduce bacteria into the pelvis and urethra such as:
A shorter distance between the urethra and the vagina
Wiping from back to front (brings bacteria from the anus toward the anterior pelvis)
Drops in estrogen, hormone shifts.
Certain types of birth control, like sprayable spermicides because they alter the microbiome and change the pH.
Recurrent use of antibiotics: When you take oral antibiotics, they wipe out bacteria all over, from your gut to your pelvis.
High alcohol and sugar intake: this increases your blood sugar, and promotes those pesky bacteria to grow.
Boric acid washes: these kill bacteria indiscriminately, including the good ones, leaving you vulnerable to the infection causing kind to bloom.
Use of “feminine washes:” these kill bacteria indiscriminately, including the good ones, leaving you vulnerable to the infection causing kind to bloom, and alter your pH.
Variations in urethra anatomy that can encourage blockages and backing of urine to the bladder
Utilizing a toy, body part, or tool in contact with the anus and then immediately placing it in contact with other body parts without washing it.
Sex without a shower or wash routine beforehand
I want to emphasize this last one. Many individuals report that “having sex” can exacerbate infections, but I don’t want you to think sex is bad, or that having an infection is just ‘part of it.’ I also don’t like it when people say “Increased sexual activity leaves you at risk for infections,” because I absolutely don’t want any shame or hinting that sex is bad. What kind of sex are you having? That’s the better question.
If you’ve had a sweaty day, worked outside, haven’t washed your hands, you’ve got more bacteria on your skin, different type than usual, and if you jump right into sticking those into your more vulnerable places, that just means more bacteria/yeast being introduced, and therefore greater likelihood of the note fun ones flourishing.
This is why I typically recommend individuals shower prior to sex. To be clear, you don’t need to get the soap into your vagina, the opening. What I’m recommending is hot water around the vulva; feel free to use soap around the anus, as more bacteria tend to come out of there. If you want to use soap are the labia and vulva, or the penile head, make sure it’s a “gentler” soap. I’ve had good luck with the Dr. Bronner soap, because it’s essentially just lye with some essential oils. However, that’s my experience; I strongly recommend using what soaps feel best to you.
Now, I want to dive more into some of the above I mentioned, include antibiotics, boric acid washes, and those bullsh*t feminine washes. (Purity culture, femininity; I can rant about why I hate these for an extensive period of time).
Taking oral antibiotics will impact your whole system; most antibiotics prescribed are systemic, which means they’ll fight bacteria everywhere, from the bad ones, to the good ones. Ever taken antibiotics and had an upset stomach for the weeks after? That’s because the bacteria of your gut have gotten killed off, and they’re key for our digestion. Same thing for the pelvis. When we take oral and systemic antibiotics, they’re also going to kill off the healthy bacteria in the vaginal canal, which then leaves you vulnerable to the not fun ones.
So, recurrent antibiotics can leave you more prone to infections because the good bacteria are killed off, making it easier for the infectious ones to bloom.
I also mention boric acid because it does the same thing. Boric acid has been shown to reduce infections in the short term and reduce bacterial count by essentially wiping out the “biofilm.” It’s the kill all strategy. However, “long term treatment” means regularly using boric acid, with treatments varying to 1x a month or a few times a week. IE, you’re simply just killing off each round of bacteria as they grow back. This is what I call treating the symptoms, not the cause. Additionally, killing the good bacteria isn’t necessarily a win either; we’re designed to coexist with these bacteria; they help fight off other infections, they help maintain pH, and promote proper lubrication. Additionally, this kind of regular treatment can eventually lead to adaptations and resistance. So, boric acid is an option, but I hope you can see it’s a short term solution.
As for feminine washes, let’s put aside the notion that the vagina or vulva need to be “cleaned,” or smell like flowers or beaches. You are a mammal, you are a human, your body is going to have a smell that is uniquely you, and that’s amazing. We are meant to have naturally occurring secretions, bacteria, and yeasts living on our insides, on our skin, and it keeps us healthy. Washing them away can cause problems, so let’s leave those little buggers alone to do their thing.
Now, say you do have an infection. What exactly are you supposed to do? You can absolutely take a vaginal anti-fungal or anti-biotic, and for many people, this is an important step for treatment and management of symptoms. However, I hope you can understand the side effects, and can tune into, what you can use to complement to support your pelvic microbiome!
There is consistent and good evidence (randomized control trials) that highly how oral and vaginally applied bacteria can help reduce the severity of BV and yeast infections.
These are namely lactobacillus rhamnosus GR-1 and lactobacillus reuteri RC-14. There's one particular study about using a capsule and applying it vaginally, and they found good short term benefits in reducing symptoms, but unfortunately, they didn’t assess long term microflora, nor did they look at recurrence of infections over the long term. In fact, I haven’t found any of this particular blend that assesses long term rate of recurrence following treatment with probiotics, except for those funded by the company themselves. And, well, that’s data, but I’m going to be suspect because the company paid for the research, and there’s a potential conflict of interest there.
There's an oral probiotic that includes these two, but the study essentially broke the capsule and applied them intravaginally.
There is consistent evidence out there that oral Lactobacillus can help reduce vaginal infections, but I want to note something important about this particular study; these individuals were taking really high doses; 10 billion CFUs per day. Most single pills are somewhere are 2-3, so you’d probably end up take 3-4 of those pills to achieve the dosage that the study found to be effective.
With these high doses, it’s not just any species either. They're talking specifically about these three species as well, in that high dosage Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1, and Lactobacillus fermentum RC-14, two of which are in the oral probiotic I link above. However, you'd need to take 4 of those a day to see vaginal effects. It could be worth a shot if you don't want to break the pill and apply it intravaginally, to dose high orally, but I know you mentioned you have a sensitive stomach! Secondly, they also did this over a longer period of time. It’s estimated that oral probiotics take about 30-60 days for a truly noticeable and symptomatic effect.
There's also good research that use a particular yeast strain was able to promote clearance of the yeast infection, and reducing symptoms. In particular, it was the live yeast S. cerevisiae that had the most benefit in helping stabilize the microbiome. This is baker's yeast. Now, I'd be a little leery about throwing some baker's yeast into your pelvis just yet; the data is good in mice, but nothing's being marketed just yet, and these aren't necessarily human studies, so total amount of dosage isn't certain. You can find it here, but again, not exactly something I’d recommend. But in a few years, I bet you’ll start seeing yeast based vaginal probiotics.
Other important strategies for managing recurrent infections is to look at your diet; there’s solid evidence that high intake of sugar, artificial sweeteners, and alcohol can modify your microbiome. High sugar diets in humans can reduce your gut microbiome’s diversity, promote leaky gut syndrome, and promote growth of bacteria that don’t support your digestion or overall health. In mouse studies, we’ve consistently found that high sugar diets promote the growth of Candida, one of the key bacterial species responsible for yeast infections.
We’ve demonstrated that oral consumption of probiotics (in high doses for long periods of time) will also change your vaginal microbiome. Therefore, other things that enter our gut over a prolonged period of time can also impact our vaginal microbiome. This is conjecture, but I would be willing to bet that high sugar diets also wreck our vaginal microbiome.
This conjecture is playing out in mice models; mice that have been fed high sugar diets, or diets high in sugar alcohols have increased bacteria that cause the symptoms of yeast and bacterial infections. In a few years, I imagine we’ll see RCTs that look at high sugar diets vs. low sugar diets. However, it is also the first thing a pelvic floor PT will tell you when it comes to managing an infection is reducing your sugar intake. Particularly, cut out cane sugar and high fructose sugar. Fruit sugars often don’t has as much a blood sugar spike.
There’s some theories that candida is responding to high blood glucose in particular, so you can work to avoid those spikes by eating fruits and limited sugars with protein and fats, which will slow your glucose spike, and still allow you to savor a yummy treat now and then.
Alcohol is the other big kicker that we recommend avoiding while you have an active infection, or to prevent recurrent one. Alcohol has been shown to alter our microbiome, which makes sense; it’s a toxin, after all, and has been associated with increased bacterial infections. You can use gin to clean a wound of microbes, and you can drink it. It makes sense drinking it alters the gut microbiome. They found an indirect correlation between alcohol consumption and healthy bacteria; that is, the more alcohol consumed, the fewer in number the healthy species were.
So, when it comes to dealing with recurrent infections, or an active one, the big things seem to be 1) Try an oral probiotic with the big three popular species in high doses for at least 60 days Lactobacillus acidophilus, Lactobacillus rhamnosus GR-1, and Lactobacillus fermentum RC-14, 2) Reduce your sugar intake, 3) Reduce your alcohol intake.
Now, bear in mind I’m not an OBG-YN, an immunologist, and nutritionist. This is an amateur’s interpretation of the literature I have read, so before you make any major changes, contact a licensed professional to support you in handling your infections.