`Not another yeast infection!" thought Hannah, who at 44 hadn't suffered from that vaginal pain, intense itching and clumpy discharge since her early 20s. But for some inexplicable reason, she'd had two within the past six months. Her periods were becoming slightly irregular too, which clued her doctor in to the fact that she was in perimenopause--the time when the body is gearing up (or winding down) toward menopause. As estrogen levels drop with age, the lining of the vagina begins to thin, leaving it more vulnerable to infection. Hannah's doctor prescribed a cream to clear up the current infection, but to prevent recurrence, he told her she would have to make some lifestyle changes. To replace what her body was losing during perimenopause, she added natural estrogens like soy and flax to her diet. She also switched her daily snack of cola and cookies to a cup of plain yogurt and a glass of unsweetened cranberry juice. That was two years ago; Hannah's stuck to her new habits and has been infection-free ever since.

Yeast infections are caused by an overgrowth of Candida albicans, which essentially are good yeast (called Candida) gone bad. Yeast are microscopic fungi that naturally live within the human body. In fact, Candida exist everywhere--in our food, in the air and in soil. And because yeast flourish in warm, moist, dark places and feed on sugars and proteins, they thrive in our intestinal tract. What's important to understand is that most of the time yeast are harmless. This is because its population is kept in balance by friendly "helper bacteria" (called flora), which live in our bodies and help us digest food and ward off infections from other bacteria, viruses or parasites. And even though the "bad" yeast (Candida albicans) is always present, it's usually kept in check by these friendly bacteria. But under certain conditions--such as pregnancy, antibiotics use or contracting diseases like diabetes and AIDS--Candida albicans is allowed to flourish unchecked, causing what is commonly known as a yeast infection, or candidiasis.

While we tend to think of yeast infections as a "female" problem, men and children get them, too. Men typically experience the infection as "jock itch," whereas babies can get it as they pass through the mother's birth canal. Eyes, ears, skin, nails and even lungs can be affected. And even though many conventional doctors feel that Candida albicans rarely spreads throughout the body and therefore cannot be responsible for widespread health problems, other experts contend that yeast infections are systemic and to blame for many maladies, including sugar cravings, poor memory, anxiety, indigestion and chronic fatigue.

The Female Factor

The fact of the matter is that yeast infections are most common among women, with as many as 75 percent of us contracting at least one during our lifetime. When an overgrowth of Candida albicans infects the vagina, it produces a telltale itch and lumpy, white discharge. You may feel a burning sensation, especially when you urinate. Women are most susceptible to yeast infections because the warm, dark, damp vagina is an ideal breeding ground for bacteria and because it's open to the outside world. And even though the vagina is self-cleansing and home to those same friendly bacteria that control yeast growth, the delicate balance can easily be tipped. "Birth control pills, hormone replacement pills, pregnancy and diabetes can all change the environment of the vagina," explains Kathy McManus, M.S., R.D., and director of clinical nutrition at Brigham and Women's Hospital in Boston. She adds that women seem even more prone to infection the week prior to menstruation. "It's clearly a hormonal fluctuation thing," she says, "but we're not exactly sure how it all works."

John McDougall, M.D., a holistic specialist at St. Helena Center for Health in Deer Park, Calif., believes that yeast infections are so prevalent in women today because of the way we eat. "Most American women have immune systems compromised by the standard American diet rich in fat, cholesterol, meat and vegetable oils," he says. Compounding the problem, he adds, is the incredibly high amount of refined sugar we consume. Sugar is what yeast feed on, so when we eat a lot of it the bad yeast flourish and throw our bacterial balance out of whack. This is when yeast infections occur. Sugar increases yeast production in a process similar to the making of pizza dough: You put a cup of warm water in a bowl, dump in a packet of dry yeast and add a tablespoon of sugar--the sugar feeds the yeast, helping it multiply.

Another reason yeast infections are so common has to do with our overuse of antibiotics. Antibiotics work wonders in fighting infections, but they aren't selective enough to know which bacteria to kill and which to let live. And so, explains McDougall, "antibiotics destroy the friendly flora that balance the yeast." If you are about to start taking antibiotics, you can reduce your chances of getting a yeast infection by eating one cup of plain yogurt with live cultures once a day throughout the course of the medication and for 10 days afterward. You can also take capsules of probiotics like acidophilus (available in natural food store refrigerators) to replace the flora killed by the antibiotics. Of course, the best prevention is to take antibiotics only when they are truly necessary.

Counter Attack

Until recently, if you suspected you had a yeast infection, you had to trek to the doctor's office to get a prescription to treat it. Today, however, you can buy many effective over-the-counter (OTC) antifungal treatments. But don't load up on them just yet; you could actually have another condition, such as bacterial vaginitis (inflammation of the vagina), or an STD, which won't respond to anti-fungals. Worse, the OTC remedy may mask symptoms (such as changing the consistency or odor of discharge), making it harder for your health care practitioner, if you go to one, to give a proper diagnosis. So while it is always a good idea to consult your doctor before you self-treat a suspected yeast infection, it's especially important if you've never had one before.

But if you've had yeast infections diagnosed in the past and are experiencing identical symptoms, it's probably safe to consider self-treatment with products like Monistat, Vagistat, Femstat 3 and Gyne-Lotrimin, which are available in almost any drugstore or supermarket. These creams contain antifungals, such as butoconazole nitrate, miconazole and tioconazole, that help get rid of the overabundance of bad yeast. (These creams are formulated for vaginal yeast only and should not be used for other types of yeast infections, such as jock itch or athlete's foot.) One-, three- and seven-day packages of cream are available. The simplest are the one-day creams, which are actually designed to stay in your body for the three days it takes to kill off an infection (the downside is that some cream can drip out of you and so may not work as effectively). The three-day versions ensure that you get a full dose each day. And the seven-day varieties are best for those who are about to start on a course of antibiotics and want to prevent an infection.

Bear in mind that it's important to see your doctor if the symptoms don't go away after three days, if they recur within two months or if at any time you experience abdominal pain, fever or a foul-smelling discharge. If OTC treatments don't work, you may have to turn to the stronger stuff only your doctor can prescribe, like Terazol cream or an antifungal pill, such as Diflucan (fluconazole).

Breaking the Cycle

When you do have a yeast infection, you'll be uncomfortable enough to want to treat it with some sort of medication. But once you've gotten rid of the infection, your next priority is to avoid a repeat performance. To do this, says McDougall, you need to keep your blood sugar in check with a plant-based diet rich in whole grains and vegetables and keep your intestinal bacteria in balance by taking probiotics like the acidophilus previously mentioned.

Indeed, nutrition plays a key role in preventing yeast infections. To help patients become--and stay--yeast-free, Susan Lark, M.D., author of nine books on women's health, as well as the Lark Letter: A Newsletter on Women's Issues, takes them off foods that yeast thrive on, such as alcohol, sugar, cheeses and moldy foods like mushrooms. Lark might also advise patients to eliminate common allergens, such as wheat or milk, to see if that helps, as people with known food allergies seem more prone to these infections. In addition to acidophilus, she recommends taking supplements of garlic oil and caprylic acid, a fatty acid that inhibits fungal growth. (Both can be found in natural food stores.)

Lark also suggests patients break open a capsule of vitamin E and apply the oil just inside the vagina, right where you feel the itching. Before doing this, however, she says you should do a patchtest on the outside of the vagina to make sure you aren't allergic to the oil. (Wait 24 hours to see if you have any adverse reactions to the oil, such as itching, redness or swelling.) Lark also counsels menopausal women to add natural estrogens to their diet with one tablespoon of flaxseed oil per day in shakes or drizzled over salads, or a quarter-cup of roasted soy nuts (or any soy food).

Your diet also can serve as an anti-infection weapon. Try a yeast-free regimen for at least a month, McManus suggests, avoiding all forms of sugar, cheese, alcohol, chocolate, grains containing gluten (wheat, oats, rye, barely), dried fruits, raw mushrooms and fermented foods (vinegar and soy sauce). You should also increase your water intake to 10 eight-ounce glasses a day. Once the yeast infection has been completely conquered, you can gradually reintroduce these foods back into your diet. Boosting your immune system will also help fight infections, so be sure to exercise regularly, get plenty of sleep and quit smoking. So rather than falling into a cycle of infection-cure-infection, you'll have reached a far more natural state: balance.

RELATED ARTICLE: dress to kill (infections, that is)

It's not just the foods you eat or the medicines you take that can cause yeast infections. It could also be the clothes you wear, the deodorants you apply or not changing out of your wet gym clothes after a workout. So if you're one of the many women who suffer from the discomfort and frustration of recurring yeast infections, the following few tips should come in handy.

* Always change out of sweaty gym clothes or wet bathing suits as soon as possible, since damp places are breeding grounds for bacteria.

* Wear cotton-crotch or all-cotton underwear-cotton absorbs moisture effectively. Minimize time spent in panty hose, tight pants and synthetic tights. And don't wear panties to bed; loose pajama bottoms or boxers are better.

* Take baths instead of showers. Soaking in a bath will help eliminate some of the yeast from your vaginal region. Using a washcloth with plain water to clean the area also helps. But don't use soap. Not only is it useless in fighting yeast, but it can actually make an infection worse since it washes away the good bacteria that keep yeast in balance.

* If you do shower, make sure you towel off thoroughly; you can even use a blow-dryer set on low heat.

* Avoid using chemicals, like those found in deodorant sprays and scented tampons or panty liners, near the vagina.

* Don't have sex if you have symptoms; you can give the infection to your partner, who in turn can reinfect you.

--A.R.

KATHRYN DRURY is a writer and editor living in New York City.

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