Mend Physical Therapy Blog and Injury Information

Recurrent yeast infections: the importance of the vaginal microbiome and how physical therapy can help

December 17, 2022

Vaginal yeast infections, also called candidiasis, are an uncomfortable and common issue most women will deal with at some point in their life. According to The American Academy of Family Physicians (AAFP), 3 out of 4 women will experience candidiasis at least once, if not twice, in their lifetime.

As a pelvic floor specialist, we often see women experiencing recurrent or chronic vaginal infections, which is defined as 4 or more episodes of vulvovaginal candidiasis in the previous year1. Multiple theories exist as to why some women experience recurrent yeast infections. In one study, some yeast was shown to remain in the vagina even after treatment and with the right conditions the yeast increased in number and a new episode of infection began. Another theory suggests the sexual partner may be the host and contributing to reinfection, however one particular study treated the partner and recurrent infections were still present, thus this type of treatment is not recommended. Currently, researchers are looking more closely at the vaginal microbiome and concluding when the organisms (including bacteria and normal levels of yeast) are out of balance, symptoms develop. More specifically, the levels of lactobacillus tend to change and contribute to the overgrowth of yeast which causes itching, burning, and discharge as the body’s immune response kicks in to rid the area of the abundant organisms.

What causes the levels of lactobacillus to change?

Research suggests lactobacillus can be essentially wiped out with use of antibiotics. Antibiotics can be necessary to treat a current yeast infection, but the “good” bacteria can also be eliminated changing the vaginal microbiome and decreasing the natural defense of lactobacillus. In addition, a diet high in sugar, hormonal changes, and stress help the yeast proliferate. This causes our body to protect against the “threat” by activating the sympathetic nervous system, commonly known as “fight or flight.” Our pelvic floor muscles tighten and causes a cascade of effects: blood flow becomes restricted which impedes the tissue from getting adequate oxygen and leads to development of myofascial trigger point and the accumulation of biochemicals that trigger inflammation and pain responses. Further, the nerves in the pelvis become irritated and respond by sending pain signals to the brain, which causes the cycle of sympathetic nervous system upregulation to perpetuate.

What if the doctor doesn’t find any yeast?

Interestingly, some patients present to physical therapy with the common symptoms of a yeast infection (burning, itching, painful sex, painful urination) but no yeast is found in the culture. These patients typically have developed pelvic floor dysfunction, similar to the above scenario, though the mechanism of onset may be different. Stress may also be a contributing factor, but others present with insidious onset, or an unknown specific reason or cause.

What can I do to treat recurrent infections or symptoms not associated with infections?

Pelvic floor physical therapy will address the symptoms associated with muscle tension, nerve irritation, and nervous system upregulation. We work on manual therapy techniques to reduce tension, improve blood flow and oxygenation, and decrease the irritation on the peripheral nerves. Specific exercises are prescribed to help with downregulation of the nervous system and reducing the “flight or fight” response. It is also important to address the vaginal microbiome; using a lactobacillus probiotic has been shown to restore the good flora and balance the microbiome to reduce recurrence.

Click here to learn more about how our pelvic floor specialists can help treat symptoms and reduce recurrence of infections. And you can schedule an evaluation with a pelvic health physical therapist at Mend in Boulder or Lafayette, Colorado.