Yeast Infection and Lichen Sclerosus: How to Know Which is Which?

Introduction

Have you ever sat there wondering, “Is my itchy vulva due to a yeast infection or lichen sclerosus”? Perhaps you thought, “Maybe I'll head over to the pharmacy and get some OTC yeast cream”? If so, you are not alone. I've wondered this countless times. In today's blog post, I'm going to be discussing yeast infections and lichen sclerosus. Specifically, I look at what yeast is and when it becomes an infection, symptoms of a yeast infection, yeast and steroids, and what to do if you aren't sure if your itch is due to yeast or lichen sclerosus.

What's the Deal with Yeast?

Yeast is a fungus that can be found on your skin and in your digestive tract. It is completely normal to have certain amounts of yeast. However, if the yeast grows too much, it can cause a yeast infection (also known as candidiasis). A common place for this infection to occur is the vagina, but you can also get an oral yeast infection or a vulvar yeast infection.

Most yeast infections are caused by Candida Albicans fungus, however, infections caused by Candida Glabrata fungus is on the rise (Goldstein, Pukall, and Goldstein, 2011). Approximately 75% of folks with vulvas/vaginas will experience a yeast infection in their lifetime (Journal of Infectious Diseases & Therapy).

Symptoms of Yeast Infection

Symptoms of yeast infection differ depending on the location of the infection. So, let's go over the main two that relate to lichen sclerosus: vaginal and vulvar yeast infections.

Vaginal Yeast Infection Signs and Symptoms

• White, clumpy discharge from the vagina
• Itching
• Burning
• Redness
• Vaginal irritation
• Pain when urinating
• Pain with sex

Vulvar Yeast Infection Signs and Symptoms

• Itch
• Burning
• Fissures – often between the labia or on the perineum
• Redness
• Rash of small dots or bumps called ‘satellite lesions'
• Pain when urinating
• Pain with sex

How is a Yeast Infection Diagnosed?

Yeast infections are – and should be – diagnosed by swabbing discharge/secretions and examining it under a microscope (aka a wet mound) and measuring the PH of the vagina (Goldstein, Pukall, and Goldstein, 2011).

Important Notes on Yeast Infection Diagnoses

You'll notice the majority of the symptoms overlap, but the main differentiating factor is the lack of vaginal discharge for vulvar yeast infections.

This distinction is important because healthcare providers (ideally) confirm the diagnosis by swabbing inside the vagina and examining it under a microscope or sending it to the lab for analysis. However, if they only swab the vagina, they may tell you your sample came back negative for yeast, which is true for a vaginal yeast infection but not necessarily true for a vulvar yeast infection.

If you suspect a yeast infection, be sure to ask your doctor to swab/test both the vagina and the vulva!

And Another Thing!

There is a possibility of a false negative with this kind of testing. If you suspect a yeast infection despite a negative result, ask your doctor for a fungal culture to confirm.

The Bottom Line with Testing

Regardless if it's a swab/wet mount, a vaginal PH test, or a fungal culture, be sure to have a test performed to confirm the infection. Clinical diagnosis without testing – i.e., just basing the diagnosis on the symptoms and appearance of the vulva/vagina – can lead to misdiagnoses, which only prolongs suffering. A study by Lowe et al. (2009) showed that health care providers who give a clinical diagnosis of a yeast infection are wrong more than 20% of the time!

But Wait…Symptoms of a Yeast Infection Sound Like Symptoms of Lichen Sclerosus: What's the Deal?

One of the most frustrating things about lichen sclerosus is how many symptoms it overlaps with. Itch, soreness, and burning are symptoms of LS and are also symptoms of:

• Lichen Planus
• Lichen Simplex Chronicus
• Yeast infection
• Vulvar atrophy
• Genitourinary Syndrome of Menopause (GSM)
• Hypertonic pelvic floor
• Desquamative Inflammatory Vaginitis (DIV)
• Plasma Cell Vulvitis
• Contact dermatitis
• And more

When a symptom can be caused by more than one thing, it can be really frustrating. How are you to know what is going on? Well, the truth is, knowing what is causing your itch isn't always clear-cut. For the purposes of this post, we are just going to focus on figuring out if the itch is from yeast or lichen sclerosus. However, please note that itch in the vulva can be other things than a yeast infection or lichen sclerosus. Let me know if you would like other posts on other vulvovaginal conditions that can cause itch.

Steroids and Yeast: What the Research Says

I must admit, there aren't a whole lot of studies looking at steroid use and yeast infections. That said, I'll share what I found from a few studies.

A 2001 study was conducted by Smith and Quint where the authors investigated the efficacy in children with vulvar lichen sclerosus. Their study included 15 children in the trial. Of the 15 children, 1 of them developed a vulvar yeast infection due to Clobetasol use.

A 2004 paper by Renaud-Vilmer et al. analyzed the efficacy of Clobetasol for remission and reducing the risk of vulvar cancer. This prospective study, which was conducted between 1981 and 2001, included 83 people with vulvar lichen sclerosus. In assessing adverse effects of Clobetasol, only 1 patient out of 83 developed a yeast infection from the medication.

In a 2018 review paper by Lee and Fischer, the authors note steroid therapy can in some cases cause yeast infections. They note this is commonly controlled with antifungal therapy such as oral or topical nystatin.

Thus, it seems that in a small subset of folks with vulvar lichen sclerosus, yeast infections can be a side effect. Of course, more research is needed, but this is an important thing to be mindful of.

PSA: You Can Still Get a Yeast Infection and Have LS Regardless of Steroids

Importantly, you can still get a yeast infection if you have LS. Even if you do not use steroids, or it's not a side effect of your steroids, you can still get one. Having vulvar lichen sclerosus does not make us immune to having other vulvovaginal issues. Therefore, if you are experiencing a new itch, do not automatically assume it is lichen sclerosus.

What To Do If You Suspect Yeast?

Alright, the tricky question. Let's say your itch has been pretty tame for a few months now, and then all of the sudden, bam! Now, you might be thinking, “Damn! I'm in a flare”. P.S. if you aren't sure on what an LS flare is, click this hyperlink to watch my YouTube video where I explain the term. The truth is, you could be in a flare. But, as I mentioned above, your itch doesn't always mean lichen sclerosus. If you treat the potential flare with your steroids and see no improvement after a week, it could be a yeast infection. However, before running to your local pharmacy and grabbing an OTC yeast treatment, you may want to confirm with your doctor that it is indeed yeast.

Call your doctor and be sure to ask your doctor:

• Can you do a vaginal and vulvar swab test for yeast?
• Are there other tests that could be run to determine if the itch is LS or something else?

Recurrent Yeast Infections, Steroids, and Lichen Sclerosus

A one-off yeast infection can happen to anyone, LS or not. However, if you are experiencing recurrent yeast infections and suspect it could be a side effect of your steroid medication, it is important to discuss this with your doctor. A doctor who is well versed in lichen sclerosus should be able to work with you to find a solution that works for you.

For example, your doctor can:

• Prescribe a preventative, monthly, oral anti-fungal.
• Prescribe a topical anti-fungal.
• Have a topical anti-fungal compounded into your steroid medication.
• Reduce the potency of your steroid medication.
• Reduce the frequency of your steroid medication.
• Prescribe an alternative treatment to topical corticosteroids such as calcineurin inhibitors (e.g., Pimecrolimus or Tacrolimus).

This list is not exhaustive. Discuss these options and your concerns with your doctor to come up with a solution that works for you and your body.

Conclusion

In sum, it can be hard to know whether your itch is from yeast or lichen sclerosus. If you experience a sudden increase in your regular itch symptoms and suspect yeast, be sure to contact your doctor and ask for a vaginal and vulvar yeast swab.

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1:1 Lichen Sclerosus Peer Support Calls with Me

I will now be offering 1:1 LS Peer Support calls. I'm offering this as many folks tell me they aren't ready for support groups because they are:

1) Not ready mentally to hold space for others and their own hurt

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So, after getting asked by many to set this up, I am finally ready!

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Reach Out to Me

If you want to chat with me about yeast or lichen sclerosus, I can be reached at:

Instagram: @thelostlabiachronicles

Facebook: @TheLostLabiaChronicles

Email: lostlabiachronicles@gmail.com

Sources Cited

“When Sex Hurts: A Woman's Guide to Banishing Sexual Pain” by Goldstein, Pukall, and Goldstein.

On clinical diagnoses of yeast infections

2011 Smith and Quint study

2004 Renaud-Vilmer study

2018 Lee and Fischer study