How Do Vaginal Antifungals Work?

Vaginal antifungal drugs are used to treat vaginal yeast infections in women. Vaginal flora is a combination of beneficial bacteria such as Lactobacilli and other harmful organisms such as the fungus Candida. The hormone estrogen is essential for the growth of Lactobacilli; they maintain a healthy vagina by balancing the pH. If the pH of the vagina is not maintained by any means, Candida may grow out of proportion and cause yeast infection known as candidiasis.

Factors that cause vaginal yeast infection include:

• The use of antibiotics may kill Lactobacilli in the vagina and may disrupt the pH of the vagina.
• Hormonal imbalance is seen during menopause, pregnancy, lactation, few days before period or use of birth control pills may change the pH of the vagina.
• Uncontrolled diabetes: increased sugar in the mucus secreted in the vagina may help the yeast to grow.
• Eating foods that are high in sugar content
• Stress
• Over-the-counter vaginal products such as sprays and douches may change the pH balance of the vagina.
• Weak immunity: women with a weak immune system or any immune system disorders are prone to yeast infection.
• Sex: yeast infection is not considered a sexually transmitted disease, but it may transfer through sexual contact.

There are multiple vaginal antifungal agents; they work by depleting ergosterol, a compound that resides in the cell membrane and maintain the integrity of the cell membrane. The absence of ergosterol disrupts the structure and functionality of the cell membrane, leading to inhibition of growth or killing of the fungi. However, each drug has its unique mechanism of action to cause depletion in ergosterol.

Candida albicans cause most yeast infections and are easy to treat. However, if there are recurrent yeast infections or no relief with conventional treatment, a lab test is done to identify the causative Candida and then treated accordingly.

Vaginal antifungals are available as oral pills, oral suspensions, vaginal suppositories, topical creams, gels, or ointments and are used to treat:

• Vaginal yeast infections
• Vulvovaginal candidiasis
• Candidal vulvovaginitis (inflammation of vagina and vulva)

Side effects of vaginal antifungals include:

• Nausea and vomiting
• Headache
• Abdominal pain
• Vaginal burning or itching
• Soreness and swelling in the vagina
• Vulvar edema
• Dysuria (pain during urination)
• Nocturia (excessive urination at night)
• Dyspareunia (pain during intercourse)
• Vaginal discharge
• Dryness of vagina
• Desquamation of vagina (shedding of outer layers of the skin)
• Allergic reactions
  • Skin rash
  • Swelling of face, throat, or tongue
  • Breathing difficulties
  • Dizziness

The information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of vaginal antifungals include:

• Butoconazole (Femstat 3, Gynazole 1)
• Miconazole vaginal (Femizol M, Monistat-1 Combination Pack, Monistat-3 Combination Pack, Monistat-7 Combination Pack, Monistat-7 Vaginal Cream, Monistat-7 Vaginal Suppositories, Vagistat-3 Combination Pack)
• Nystatin vaginal
• Terconazole vaginal (Terazol, Terazol 3, Terazol 7)
• Tioconazole (Vagistat 1)