What is a vaginal yeast infection and how does it affect the pelvic floor?

Vaginal candidiasis, also known as vulvovaginal candidiasis or a vaginal yeast infection, is a genital infection caused by fungi, especially Candida albicans. Vaginal infections are more common than we think: practically one in two patients I see in my clinic has had a Candida infection at some point in her life, or symptoms consistent with a vaginal yeast infection. And most of them have had recurrent infections, meaning more than 3 infections in the same year. Why do Candida infections keep coming back? How does a yeast infection affect our pelvic floor?

Vaginal yeast infections start in the intestinal tract

The symptoms of a vaginal Candida infection are just the after-effects of a larger ‘invasion’ of the intestinal lining by the fungus. Candida albicans is present in our intestines in very small amounts. In a healthy body, the ‘bad’ fungus is present but causes no harm, because the ‘good’ bacteria and fungi keep a balance between all the microorganisms living in our body.

The problem starts when the ‘bad fungus’, Candida albicans, multiplies and spreads into the deeper layers of the intestine. If Candida dominates the gut flora, this can trigger infections in the lining of the vagina, anus, bladder, urethra or mouth. So a vaginal yeast infection is one of the after-effects of intestinal candidiasis, and it must be treated as a whole, not just with a vaginal antibiotic.

How does a vaginal yeast infection affect the pelvic floor?

With recurrent vaginal yeast infections, women commonly have vaginal pain, pain during sex, vulvar hypersensitivity or chronic pelvic pain. Chronic fungal infection causes inflammation of the whole urogenital tract. The pelvic floor muscles ‘respond’ to this inflammation by contracting or going into spasm, causing a gradual narrowing of the vaginal canal.

It’s something we see almost every time in patients who have had several infections in a row. There’s excess muscle tone, tension in the pelvic floor fascia, pain on examination and discomfort during sex. To improve these symptoms, it’s necessary to treat the infection locally (vagina) and as a whole (intestines). And then retrain the pelvic floor muscles to recover normal tone.

What other symptoms can chronic candidiasis cause?

The most common symptoms of a Candida infection are:

• Diarrhea or chronic constipation.
• Excessive sugar cravings.
• Vaginal pain, vulvar hypersensitivity.
• Bad breath.
• Muscle and joint pain (symptoms similar to fibromyalgia).
• Anxiety, depression.
• Skin rashes.
• Abdominal pain.
• Insomnia.
• Premenstrual tension.
• Low sex drive.
• Dry mouth or throat.

What is the treatment for chronic candidiasis?

The most important thing to know is that Candida feeds mainly on sugar. So before starting antibiotic treatment, you need to start an antifungal diet, cutting out all sweets completely. It’s recommended to drink plenty of mineral water and, if possible, change the type of water every week to get different minerals. It’s also important to reduce stress levels to improve our immune system.

Next, the specialist doctor will prescribe antibiotic treatment to get rid of the fungus. During this treatment we should continue the antifungal diet and drink plenty of mineral water. Moderate-intensity exercise is recommended to improve joint mobility and muscle tone.

In cases of vaginal infection, after treatment, urogynecological physiotherapy is introduced to normalize pelvic floor tone and reduce symptoms of incontinence, pelvic pain and dyspareunia. When there’s pelvic floor hypertonia and pain that prevents penetrative sex, treatment is based on:

• Myofascial release through the vagina.
• Gradual pelvic floor stretching with vaginal dilators.
• Vaginal biofeedback.
• Reverse Kegel exercises.
• Pelvic mobility exercises, hypopressive exercises, dynamic stretches.