Self-Care Measures for the Treatment and Prevention of Vulvovaginal Candidiasis

Vulvovaginal candidiasis (VVC), commonly known as a yeast infection, is one of the most common causes of vulvovaginal itching and abnormal discharge.^1-3 Moreover, VVC is one of the most prevalent vaginal infections encountered in clinical practice.^1,2 Candida albicans accounts for 90% of cases, with most of the remaining cases caused by Candida glabrata.^1,2

Because OTC treatments are easily accessible and commonly used to treat these types of infections, the incidence of VVC is often underreported, so the exact incidence is unknown.¹ Available statistics indicate that an estimated 70% to 75% of women report at least 1 episode in their lifetime, and recurrent infections occur in an estimated 5% to 8% of women.^1,2

Clinical Presentation

The signs and symptoms associated with VVC vary extensively but commonly may include 1 or more of the following^1,3:

• Abnormal vaginal discharge (ranging from a slightly watery, white discharge to a thick, white discharge with no odor)
• Normal pH (VVC typically does not alter vaginal pH, so a pH greater than 4.5 may indicate bacterial vaginosis or trichomoniasis)
• Pruritus, irritation, and intense burning, especially upon urination
• Inflammation, including erythema, swelling, and discomfort of the vulvar skin

Although anyone with a vagina can develop VVC, several factors increase susceptibility due to disrupting normal vaginal flora or impairing immune defenses, increasing the likelihood of both initial and recurrent VVC episodes. Examples of these risk factors include uncontrolled diabetes, pregnancy, posttransplant status, compromised immune systems, and use of high-dose combined oral contraceptives, estrogen therapy, broad‑spectrum antibiotics (recent), sodium-glucose cotransporter-2 inhibitors (SGLT2s), or medications that suppress the immune system, including systemic corticosteroids, immunosuppressive agents, and antineoplastic therapies.^1-8

Self-Treatment, Goals of Treatment, and Prevention

According to the American Pharmacists Association’s Handbook of Nonprescription Drugs, self-treatment with OTC antifungal therapy is considered appropriate in individuals with mild, infrequent, and uncomplicated infections.² Patients with a history of recurring episodes of VVC, those with severe symptoms, and those with preexisting medical conditions should be referred for further medical evaluation and treatment.^2,3 Recurrent infections are defined as at least 4 documented infections in 1 year, although some sources indicate 3 or more infections are sufficient for this classification.^1,3

Health experts indicate that when in doubt, especially for those who have never had a yeast infection, pharmacists should encourage patients to consult their primary care providers to determine whether self-care is appropriate.

In general, the goals of therapy for VVC infections include symptomatic relief, resolution of infection, and restoration of normal vaginal flora.² For the majority of uncomplicated infections, a single course of therapy is effective, although patients with recurrent or persistent symptoms often require prolonged therapy and/or therapy at higher doses as recommended by their primary health care provider.²

Currently, the FDA-approved OTC treatment options for uncomplicated VVC include clotrimazole (Canesten; Bayer), miconazole (Monistat; Insight Pharmaceuticals, LLC), and tioconazole (Vagistat-1; Combe Inc), which are available as creams, suppositories, or tablets (ovules) for intravaginal use depending on the product.² Formulations are available in 1-, 3-, and 7-day treatments, depending on the product, and some products are marketed as combination packs containing an external vulvar cream for pruritus and a suppository or ovule. Several generic formulations are also available.

During counseling, pharmacists should ensure that patients understand the proper use of the selected product and remind them of the importance of completing the full course of therapy as indicated by the manufacturer’s instructions—even if symptoms appear to improve —because nonadherence to the recommended duration is a primary factor in recurring VVC episodes.² The Table² highlights key information pharmacists can relay to patients when using these OTC products.

Patients should be advised to seek further medical care if symptoms do not improve or worsen after self-treatment. Pharmacists can also identify patient populations who should avoid self-treatment and advise them to seek medical attention instead, such as the following²:

• Those with a first occurrence of VVC or an unconfirmed diagnosis
• Those who are pregnant
• Patients younger than 12 years
• Those experiencing fever or pain in the pelvic area, lower abdomen, back, or shoulder
• Those using medications that could predispose an increased risk of VVC, such as steroids and chemotherapy
• Individuals with a history of recurrent VVC (more than 3 episodes per year or within the past 2 months)
• Those with medical conditions that increase VVC risk, such as HIV infection or uncontrolled diabetes

The American College of Obstetricians and Gynecologists recommends several preventive measures, including keeping the vulvar area dry after showering or swimming; cleansing the vulva gently with warm water only; wearing breathable cotton underwear; avoiding wearing tight-fitting pants; supporting healthy flora by taking probiotics or eating yogurt containing live cultures; avoiding douching; and discussing the use of preventive treatment with a primary care provider when taking antibiotics.⁹

Conclusion

Pharmacists can be instrumental in assisting women with VVC by guiding appropriate self‑care, ensuring correct use of selected OTC antifungals, and recognizing when referral is needed. By reinforcing prevention strategies and encouraging medical evaluation for first‑time, recurrent, or complicated cases, pharmacists help promote effective management and reduce the risk of recurrent infections and related complications.

REFERENCES

1. Jeanmonod R, Chippa V, Jeanmonod D. Vaginal candidiasis. In: StatPearls. StatPearls Publishing; 2024. Accessed April 10, 2026. https://www.ncbi.nlm.nih.gov/books/NBK459317/

2. Lodise N. Vaginal and vulvovaginal disorders. In: Krinsky DL, Ferreri SP, et al., eds. Handbook of Nonprescription Drugs: An Interactive Approach to Self-Care. 21st ed. American Pharmacists Association; 2024.

3. Sobel JD. Candida vulvovaginitis in adults: recurrent infection. UpToDate. Updated 2024. Accessed March 16, 2026. https://www.uptodate.com/contents/candida-vulvovaginitis-in-adults-recurrent-infection

4. Unnikrishnan AG, Kalra S, Purandare V, Vasnawala H. Genital infections with sodium glucose cotransporter-2 inhibitors: occurrence and management in patients with type 2 diabetes mellitus. Indian J Endocrinol Metab. 2018;22(6):837-842. doi:10.4103/ijem.IJEM_159_17

5. San Juan Galán J, Poliquin V, Gerstein AC. Insights and advances in recurrent vulvovaginal candidiasis. PLoS Pathog. 2023;19(11):e1011684. doi:10.1371/journal.ppat.1011684

6. Lobo M, Cerqueira C, Rodrigues AG, Lisboa C. Recurrent vulvovaginal candidiasis and its underlying mechanisms: a systematic review. J Fungi (Basel). 2025;11(5):357. doi:10.3390/jof11050357

7. Sobel JD. Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol. 2016;214(1):15‑21. doi:10.1016/j.ajog.2015.06.067

8. Forman JL, Mercurio MG. Vulvar pruritus in postmenopausal diabetic women with candidiasis secondary to sodium-glucose cotransporter receptor-2 inhibitors. J Low Genit Tract Dis. 2023;27(1):68-70. doi:10.1097/LGT.0000000000000704

9. Think you have a vaginal infection? here’s what you need to know. American College of Obstetricians and Gynecologists. December 2025. Accessed March 16, 2026. https://www.acog.org/womens-health/experts-and-stories/the-latest/think -you-have-a-vaginal-infection-heres-what-you-need-to-know