Recurrent vaginal yeast infections: the microbiota connection
Could it be that recurrent vaginal yeast infections, also called recurrent vulvovaginal candidiasis, depend not only on the fungus responsible but also on the balance of the vaginal microbiota? A recent review examines this question and the approaches currently being explored.
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About this article
Between 70% and 75% of women will experience at least one vaginal yeast infection, or fungal vulvovaginitis, also called vulvovaginal candidiasis, in their lifetime. Nearly 8% will experience recurrent infections,1 representing nearly 138 million women worldwide.2
Fungal vulvovaginitis :
Infection of the vulva and vagina caused by an opportunistic yeast, primarily Candida albicans or Nakaseomyces glabratus, often called vulvovaginal candidiasis.
Most often caused by Candida albicans (63% to 70% of cases),3 it typically causes vulvar irritation, itching and unusual discharge. These symptoms are similar to those of another common vaginal infection, bacterial vaginosis, and certain other forms of vaginitis. A recent study1 examines an often-overlooked factor in these vaginal infections: the vaginal microbiota, a cornerstone of women’s health.
A common symptom associated with vulvovaginitis (redness, itching or a burning sensation).
A general term for any infection of the vaginal mucosa, whether bacterial, fungal or parasitic, that may be accompanied by unusual discharge.
The community of microorganisms that live naturally in the vagina, whose composition and balance are associated with vaginal health.
A balanced state of the vaginal ecosystem, associated with healthy mucosa and the absence of symptoms or abnormal inflammation.
An overlooked ally in the vaginal microbiota
Candida albicans can be naturally present in the vagina without causing candidiasis or symptoms. Contrary to what you might think, Candida albicans, the yeast most often involved, can be naturally present in the vagina without causing candidiasis or symptoms, thanks to the balance of the surrounding microbiota. A protective bacterium, Lactobacillus crispatus, plays a key role: it makes the vaginal environment more acidic and produces substances that can limit the growth of certain microorganisms, including yeasts.Other bacteria, such as L. iners, play a more complex role: they sometimes help maintain stability but can also contribute to imbalance and certain vaginal infections.
Certain unsuitable or irritating hygiene products or recent antibiotic use can disrupt this balance. Once the balance is disrupted, dysbiosis, an imbalance in the vaginal flora, can develop and be associated with certain vaginal infections, including fungal infections such as candidiasis.
Imbalanced vaginal flora :
Disruption of the usual protective dominance of lactobacilli, promoting certain vaginal infections and dysbiosis.
What lives in the vaginal microbiota ?
Lactobacillus crispatus : bacterium often dominant in a healthy vaginal microbiota—helps maintain acidity and limit the growth of certain microorganisms.
Lactobacillus iners : ambivalent role—sometimes stabilizing, sometimes contributing to imbalance depending on the strain.
Candida albicans : yeast that may naturally be present in the vagina without causing symptoms but can proliferate and cause candidiasis.
Nakaseomyces glabratus (formerly Candida glabrata) : less conspicuous yeast, more often associated with recurrent yeast infections.
Gardnerella vaginalis : a bacterium commonly associated with bacterial vaginosis, a dysbiosis distinct from candidiasis. A possible link to certain recurrent fungal infections is currently being discussed.
Why yeast infections keep coming back
For recurrent candidiasis, the study also points to another yeast that is less well known than Candida albicans but just as involved: Nakaseomyces glabratus (formerly Candida glabrata). It does not attack tissues in the same way. Instead, it persists through several mechanisms, including biofilm formation and immune evasion, which may contribute to recurrences and make treatment more difficult. The authors raise another possibility: recurrent bacterial vaginosis, characterized by an imbalance in the vaginal microbiota, could disrupt the local balance and, in turn, promote the development of a yeast infection and certain recurrences. The two vaginal conditions may therefore be more closely linked than previously thought, particularly in certain mixed or successive infections.
Treatment for vaginal infections based on basil essential oil
If symptoms recur despite following treatment as directed, it is best to seek medical care to confirm the diagnosis and adjust treatment rather than repeatedly self-treat with antifungal medications. Restoring lasting balance to the vaginal microbiota, particularly through still-experimental approaches involving microbiota transplantation or modulation, is another avenue of research. Its effectiveness against fungal vulvovaginitis remains to be demonstrated.
Vaginal microbiota transplantation (VMT) :
An experimental approach involving the transfer of microbiota from a healthy donor to restore vaginal balance. Its value as a treatment for fungal vulvovaginitis remains to be confirmed.
1. Ruiz-Higareda, Alvarez-Salas, García-Juárez et al. (2026). Vaginal Microbiota Dynamics as a Key Determinant of Pathogenesis in Fungal Vulvovaginitis. Current Fungal Infection Reports, 20:3. DOI 10.1007/s12281-026-00522-5.
2. Sobel JD, Sobel R. (2018). Current treatment options for vulvovaginal candidiasis caused by azole-resistant Candida species. Expert Opinion on Pharmacotherapy, 19(9):971-977. DOI 10.1080/14656566.2018.1476490.
3. Makanjuola O, Bongomin F, Fayemiwo SA. (2018). An update on the roles of non-albicans Candida species in vulvovaginitis. Journal of Fungi, 4(4):121. DOI 10.3390/jof4040121.
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