When I lived in Miami, I had a regular patient (aka Janet) that would come in and talk with me about her dogs (my favorite subject!) She had been in New York for a few weeks for work. Before she had left for her trip, she had picked up a prescription for Diflucan (fluconazole)-a treatment for a yeast infection.
Janet came into the pharmacy and barely mentioned her new puppy (Charlie). She seemed upset and irritated. She was picking up another Diflucan prescription. So, I asked her what was up.
She was at wits end- she had been treating a yeast infection for about 2 months. At first, she self treated with OTC medications then with her physician. Janet’s physician gave her some prescription creams and then Diflucan.
Janet said she felt horrible and was super frustrated. The on-going issue had even affected her relationship with her husband.
Once we started talking, all of Janet’s concerns came flooding out…
We talked about how you get a yeast infection…
All women naturally have a small amount of yeast in the vagina. The infection occurs when there is too much of the yeast. This can happen anytime –it is usually caused by medications (like antibiotics), injury, stress or other sickness.
What the symptoms are…
Symptoms range from none to swollen, red, itchy, irritated vaginal/vulvar tissues, discharge and odor –or any combination.
Even once the infection is treated and cleared up (about 3-5 days) the symptoms can remain for up to 14 days –this is a problem because many women think that they still have an active infection.
How is it treated?…
OTC vaginal creams and suppositories (such as Monistat) –they usually come in 1-day, 3-day and 7-day treatments. Quite often the 1-day treatment is not quite enough to get rid of the infection. I usually recommend a 3-day treatment for most women.
Prescription vaginal creams and suppositories (like Gynazole) –these are not usually any better than the OTC creams.
Helpful Hint: Be careful –the creams can breakdown condoms and make them useless.
Diflucan (fluconazole) is a prescription oral medication. Usually 1 tablet is taken once. Sometimes, one tablet will be taken right away and then an additional tablet is taken 3 days after. The tricky thing about the pill is that although it is often only one tablet, the symptoms still take about 3 days to go away (you can use an OTC cream to help).
Helpful Hint: When you have a yeast infection, if you have vaginal sex –you can give it to your partner (not usually a big deal for him) but he can give it back to you (so you would be re-infected)!
Boric acid vaginal suppositories –this is what Janet and I talked about mostly because she had already been through all the other options. She wanted to know why it had to come down to some random treatment she had never even heard of. There are three main reasons
1) There are different kinds of yeast that can cause infections. Most kinds of infections can be taken care of with typical treatments. But there are some yeast infections that can ONLY be treated with boric acid.
2) Sometimes the infection is not caused by yeast but by a bacteria…none of the anti-fungal will help but boric acid can treat yeast and bacteria.
3) Sometimes, when a woman with a yeast infection uses a bunch of different treatments, the vagina just gets “unbalanced” –boric acid corrects the pH and kinda gives the vagina a “re-boot” back to baseline.
The regular dose is 600mg boric acid (in type 0 capsules) inserted vaginally at bedtime for 14 days. They need to be compounded so –you need a prescription and a compounding pharmacy.
Back to Janet- I printed out some info about boric acid that she could show her physician. She had to go back up to New York for another month but she called a couple of times to update me on her progress –she said her doctor looked at her like she was crazy at first but after reading about it gave her the prescription.
She then said it had been difficult to find a compounding pharmacy but eventually she got the suppositories and they had worked great for her. She is all back to normal, her husband is doing fine and Charlie (the pup) is getting along with the other two dogs (Charlie did eat a pair of her heels J).
So that is great…here is the funny part- a few weeks later, I had a woman come to the pharmacy and asked if we have boric acid. I started talking to her about how it needs to be compounded with a specific capsule so that it will absorbed in the vagina because yadda yadda yadda…
Her face was frozen in confusion and a bit of fear…I stopped talking and she said, “I…uhhh….just wanted some boric acid powder,” pause while we both looked at each other puzzled. She then continued, “You know…for cleaning.”
Boric acid for cleaning….who knew?! J
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This was an email we received from a reader, Beth:
I read about boric acid for recurrent yeast infections and thought I’d share my experience. I too suffered from multiple yeast infections. After time, I started to notice they always seemed to occur the same time in
my cycle (mid) so I began to question why. When I started looking for possible triggers I found that my tampons had rayon in them. Many years ago I was told by an allergist that I’m allergic to rayon. I never gave it any thought ’cause I’ve worn rayon clothing without a
noticeable reaction. And I NEVER thought it would be in a tampon. Long story short, I switched to organic cotton tampons and no longer have yeast infections (over 3 years so far). May be something to consider
next time a patient is complaining of recurrent infections.
We have received a few emails concerning…
“Can I make my own boric acid capsules at home?”
Yes, technically you can make vaginal boric acid capsules at home. However, it is often difficult to find boric acid and 00 capsules. More importantly, measuring and packing capsules at home can be very inaccurate (even with the proper scale).
It would be really helpful to talk with your physician first because boric acid is typically used only for persistent infections that have already been treated with antifungal and antibacterial medications.
We received this question in an email
I filled a prescription for boric acid vaginal suppositories 3 months ago but have not used them yet. They have been in my fridge this whole time. Is it still ok to use them? Has the potency changed in the last 3 months?
Once boric acid suppositories are compounded they are good for 6 months. They can be stored at room temp or in the fridge. So, your suppositories are fine to use.
Boric acid has worked very well for me. After months of discomfort which my doctor initially attributed to Sjogren syndrome, I had relief within about 24-48 hours. Works well when they can’t find the bug. Makes a lot more sense than trying many antibiotics and hoping one will work. This treatment avoids the problem of resistance.