Vaginal Bleeding from Yeast or Fungal Infections
Yeast and fungal infections do not typically cause vaginal bleeding. The classic symptoms of vulvovaginal candidiasis are pruritus (itching), vaginal discharge, vulvar burning, dyspareunia, and external dysuria—but bleeding is not a characteristic feature 1.
Typical Presentation of Vulvovaginal Candidiasis
The CDC guidelines consistently describe the following symptoms for yeast infections:
- Primary symptom: Pruritus (itching), which is the most specific symptom for VVC 1
- Discharge characteristics: White, thick "curdled" appearance—not bloody 2
- Associated symptoms: Vaginal soreness, vulvar burning, dyspareunia, external dysuria 1
- Physical findings: Erythema in the vulvovaginal area, hyperemic vagina, excoriated vulva 2
- Vaginal pH: Normal range (<4.5), typically 3.8-4.2 1, 2
None of these symptoms include vaginal bleeding 1.
When Bleeding Occurs: Look Elsewhere
If a patient presents with vaginal bleeding and suspected yeast infection, consider these alternative or concurrent diagnoses:
Other Infectious Causes
- Trichomoniasis: Can cause punctate cervical microhemorrhages in 25% of cases, which may present as spotting 2
- Cervicitis from STIs: Chlamydia or gonorrhea can cause mucopurulent cervicitis with bleeding 1
Non-Infectious Causes
- Mechanical/chemical irritation: Can cause vulvar inflammation mimicking infection 1, 3
- Atrophic vaginitis: Particularly in postmenopausal women 3
- Cervical pathology: Polyps, ectropion, or malignancy
- Pregnancy complications: As noted in one case report, Candida chorioamnionitis was associated with missed abortion and bleeding, but this represents intrauterine infection with foreign body (IUD), not typical vaginal candidiasis 4
Clinical Pitfall to Avoid
Do not attribute vaginal bleeding to a yeast infection. If bleeding is present alongside symptoms suggestive of VVC, perform a thorough evaluation including:
- Speculum examination to visualize the cervix and identify bleeding source 1
- pH testing (elevated pH >4.5 suggests trichomoniasis or bacterial vaginosis, not candidiasis) 1, 2
- Wet mount microscopy to identify trichomonads (which can cause microhemorrhages) 2
- Consider cervical testing for gonorrhea and chlamydia 5
- Pregnancy test if appropriate 4
Diagnostic Confirmation
The diagnosis of VVC requires either:
- Wet preparation or Gram stain showing yeasts or pseudohyphae, OR
- Positive culture for yeast species 1
Culture remains the gold standard for diagnosis 1. Approximately 10-20% of asymptomatic women harbor Candida species, so identifying yeast without symptoms does not warrant treatment 1.