Treating Vaginal Infections: Yeast, BV, and the Root Causes Many Doctors Miss

Vaginal infections are incredibly common, yet many women find themselves stuck in a frustrating cycle where symptoms return again and again despite repeated treatments. The problem is that not all vaginal infections are the same, but they often are treated as if they are. While yeast infections and bacterial vaginosis (BV) can look similar, they require completely different approaches. 

When the wrong treatment is used, or when treatment focuses only on the infection itself rather than the underlying factors influencing the vaginal microbiome, symptoms likely will not improve or will quickly return. We must consider the deeper drivers of these infections to truly resolve vaginal infections at their root.

Why Vaginal Infections are Often Misdiagnosed

Oftentimes, symptoms like itching, irritation, or abnormal discharge are automatically associated with vaginal yeast infections. However, bacterial infections or bacterial vaginosis (BV) are also quite common. It’s estimated that 75% of women will get at least one yeast infection in their lifetime, whereas roughly 1 in 3 women will experience BV. 

If the underlying infection isn’t correctly identified and the wrong treatment is used, symptoms may improve slightly, but the problem is never fully resolved. You cannot treat a bacterial infection (BV) with antifungals as if it’s a yeast infection. Similarly, fungal yeast infections cannot effectively be treated with antibiotics.

Far too often, women receive the wrong treatment for their vaginal infections. This is one main reason that many women don’t respond to treatment and experience recurrent infections.

Types of Vaginal Infections: Yeast versus BV

We’ve established the importance of identifying the type of infection in order to treat it appropriately. And while symptoms can overlap, there are some key differences between yeast infections and BV.

Yeast infections:

• Thick, white, clumpy discharge
• Significant itching and irritation
• Usually odorless
• Typically related to overgrowth of Candida albicans, which is why yeast infections are sometimes referred to as vulvovaginal candidiasis (VVC)

Bacterial vaginosis:

• Thin gray or white discharge
• Typically minimal itching or irritation
• Distinct fishy odor
• Typically from overgrowth of Gardnerella species, Prevotella species, E. coli, Peptostreptococcus, or other bacterial species
• High recurrence rate (50%), defined as 3 or more episodes within one year

Both conditions reflect disruption and dysbiosis within the vaginal microbiome, where protective Lactobacillus bacteria decline and these opportunistic microbes take over. Let’s explore the deeper root of why these infections occur.

4 Factors That Shape Vaginal Health and Influence Recurrent Infections

From a functional perspective, we view chronic vaginal infections as opportunistic infections, meaning they tend to occur when the body’s systems are under stress or the immune system lacks the energy to maintain microbial balance. Rather than being the root problem themselves, they are often a signal of deeper immune issues impacting the vaginal microbiome. By addressing the following key factors, we can help prevent recurrent infections. 

1. Glycogen Levels and Blood Sugar Balance

Glycogen is the stored form of glucose and serves as a key fuel source for beneficial Lactobacillus bacteria within the vaginal microbiome. These microbes convert glycogen into lactic acid, helping maintain the acidic environment that protects against pathogens and overgrowth.

When glycogen levels are too low, often due to low estrogen levels or nutrient insufficiencies, Lactobacillus populations decline, decreasing acidity and increasing susceptibility to overgrowth of organisms like Candida, Gardnerella, and E. coli. Interestingly, low vitamin D levels have also been associated with reduced glycogen availability and a higher risk of BV. Vitamin D deficiency is also known to impair antimicrobial immune defenses. 

On the other hand, excessive glycogen from chronically elevated blood glucose, blood sugar dysregulation, or insulin resistance is also problematic. Excess glycogen in vaginal tissues provides an overabundance of fuel for opportunistic microbes, making it easier for yeast and pathogenic bacteria to proliferate.

2. Estrogen and Hormone Balance

Estrogen plays a central role in maintaining vaginal health by regulating glycogen production within vaginal tissues. When estrogen levels drop, glycogen levels fall as well, reducing Lactobacillus concentrations and acidity within the vagina, creating a more favorable environment for yeast and bacterial overgrowth. This is one reason vaginal infections often become more common during peri- and post-menopause as hormone levels decline. 

However, excessively high estrogen levels can also contribute to imbalance, as elevated estrogen, such as during pregnancy or with certain hormonal contraceptives, can promote yeast overgrowth in particular. 

We should also consider the role of progesterone for supporting a balanced vaginal microbiome. Research suggests progesterone can inhibit Candida biofilm formation and reduce fungal colonization of vaginal tissues.

3. Gut Health and Microbial Translocation

Individuals with higher levels of BV-associated bacterial species, such as Gardnerella and Prevotella, within the gut microbiome are at higher risk of developing BV. Conversely, individuals with higher levels of certain Lactobacillus strains in the gut are more likely to maintain a healthy vaginal microbiome. 

The gut and vaginal microbiomes are closely connected through microbial transfer and immune signaling. Microbial translocation from the gut to the vaginal microbiome can also increase vaginal short-chain fatty acid (SCFA) production. While SCFAs within the gut microbiome are typically beneficial and anti-inflammatory, an overabundance within the vaginal microbiome may disrupt the normal microbial ecosystem. 

4. Chronic Stress and Immune Regulation

Chronic stress can significantly impact the vaginal microbiome by suppressing immune function and disrupting hormone balance. When the body is under prolonged stress, cortisol and other stress hormones shift immune signaling and reduce the body’s ability to regulate microbial ecosystems effectively. 

This weakened immune surveillance can allow opportunistic organisms like Candida or BV-associated bacteria to proliferate more easily. Stress can also indirectly influence other factors that affect the vaginal microbiome, including hormone balance, blood sugar regulation, and gut health, making it a key contributor to recurrent infections.

The FFN Approach to Identifying Root Causes of Vaginal Infections

For women with recurrent infections, identifying the root drivers is key. At Functional Fueling, we assess a wide variety of contributing factors to understand your larger health picture and why these infections keep returning.

Testing that we utilize in practice to support these goals may include:

• Vaginal microbiome swabs to identify yeast or bacterial imbalances
• Micronutrient testing to assess insufficiencies impairing immune and metabolic health
• Stress hormone panels to evaluate cortisol patterns
• Stool analysis to investigate the gut microbiome and digestive health

By addressing the broader terrain, including hormones, gut health, nutrient status, and immune resilience and regulation, we can support a more stable vaginal microbiome and reduce infection recurrence over time. If you’re looking for personalized guidance to ensure your healing plan is designed to support all aspects of your health, apply to our 1:1 coaching program to work with us today!

Written by Romana Brennan, MS, RD