Can sexual intercourse cause vaginal candidiasis (yeast infections)?

Can Sexual Intercourse Cause Yeast Infections?

Yes, sexual intercourse can contribute to yeast infections (vulvovaginal candidiasis), although it is not typically considered a sexually transmitted disease. While Candida albicans (the most common cause of yeast infections) is not primarily transmitted sexually, certain sexual behaviors can increase the risk of developing vulvovaginal candidiasis 1.

Relationship Between Sexual Activity and Yeast Infections

• The CDC notes that vulvovaginal candidiasis is not usually transmitted sexually, but it is included in STD treatment guidelines because it is a common infection among women being evaluated for STDs 1
• Sexual behaviors rather than the mere presence of Candida species in the male partner appear to be associated with recurrences of yeast infections 2

Sexual Risk Factors:

• Recent cunnilingus (oral-vaginal contact) increases the risk of yeast infections (hazard ratio 2.94) 2
• Knowing a sexual partner for a shorter period of time is associated with higher risk (odds ratio 1.56 for 1 year vs. 5 years) 3
• Male partner's use of saliva during sexual activity can increase risk of recurrence (hazard ratio 3.68) 2

Diagnosis of Vulvovaginal Candidiasis

Typical symptoms of vulvovaginal candidiasis include:

• Pruritus (itching) and erythema in the vulvovaginal area
• White discharge
• Vaginal soreness
• Vulvar burning
• Dyspareunia (painful intercourse)
• External dysuria (pain during urination)

Diagnostic criteria:

• Normal vaginal pH (≤4.5) - distinguishing it from bacterial vaginosis and trichomoniasis 1
• Visualization of yeast or pseudohyphae in wet preparation or Gram stain 1
• Positive culture for Candida species 1

Treatment Recommendations

For uncomplicated vulvovaginal candidiasis, the CDC recommends:

Intravaginal options:

• Clotrimazole 1% cream 5g intravaginally for 7-14 days 1
• Clotrimazole 100mg vaginal tablet for 7 days 1
• Clotrimazole 100mg vaginal tablet, two tablets for 3 days 1
• Clotrimazole 500mg vaginal tablet, one tablet in a single application 1
• Other azole options (miconazole, butoconazole) are also effective 1

Important considerations:

• Topical azole drugs are more effective than nystatin 1
• Treatment with azoles results in relief of symptoms and negative cultures in 80-90% of patients who complete therapy 1
• For patients who fail azole therapy, lipid-based amphotericin B gel may be effective 4

Prevention Strategies

To reduce the risk of yeast infections related to sexual activity:

• Avoid use of spermicides, which may disrupt vaginal flora 5
• Be aware that condoms and diaphragms may be damaged by some antifungal products 5
• Avoid sexual intercourse during treatment for yeast infection 5
• Consider that certain sexual behaviors (particularly those involving saliva) may increase risk 2, 3

When to Seek Medical Care

The FDA recommends consulting a healthcare provider if:

• You have vaginal symptoms for the first time
• You have lower abdominal, back, or shoulder pain
• You experience fever, chills, nausea, vomiting, or foul-smelling discharge
• You have frequent yeast infections (once a month or 3 in 6 months)
• Symptoms don't improve within 3 days of treatment
• Symptoms last more than 7 days
• You develop a rash, hives, or abdominal pain 5

While sexual intercourse itself doesn't directly cause yeast infections, certain sexual behaviors can disrupt the vaginal environment and increase susceptibility. Understanding these risk factors can help in prevention and prompt treatment of vulvovaginal candidiasis.