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Vaginal itching
Change in vaginal discharge
White discharge
Vaginal pain
Vaginal irritation
Swollen vulva
Painful urination
Thick white discharge
Thick white discharge no smell
Foul smelling vaginal discharge
Sudden increase in vaginal discharge
Swollen vaginal glands
Not seeing your symptoms? No worries!
This is a fungal infection by Candida that affects the vaginal area. Candida normally exists on skin and vaginal linings without issues. An infection occurs when the skin or vaginal lining changes in character, promoting Candida overgrowth. People with weakened immune systems or on birth control pills may be at increased risk.
Your doctor may ask these questions to check for this disease:
This is usually treated with antifungal drugs, which can be given through a vaginal cream or an oral antifungal medicine.
Reviewed By:
Scott Nass, MD, MPA, FAAFP, AAHIVS (Primary Care)
Dr. Nass received dual medical degrees from the David Geffen School of Medicine at UCLA and Charles R. Drew University in Medicine and Science. He completed Family Medicine residency at Ventura County Medical Center with subsequent fellowships at Ventura, University of North Carolina-Chapel Hill, George Washington University, and University of California-Irvine. He holds faculty appointments at Keck School of Medicine of USC, Loma Linda University School of Medicine, and Western University of Health Sciences.
Seiji Kanazawa, MD, PHD (Obstetrics and Gynecology (OBGYN))
Dr. Kanazawa graduated from the Niigata University Faculty of Medicine and received his Ph.D. from the Tohoku University Graduate School of Medicine. He is working on the front line of the General Perinatal Center, including the Tokyo Tama General Medical Center and the National Center for Research in Fertility Medicine, where he provides maternal and fetal care and undertakes clinical research. At Ubie, Dr. Kanazawa has been designing the Ubie AI Symptom Checker and has taken on the role of general obstetrics and gynecology consultation at FMC Tokyo Clinic by providing fetal ultrasound and prenatal consultation.
Content updated on Dec 13, 2024
Following the Medical Content Editorial Policy
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Q.
Still Itching After Monistat? Why Your Body is Reacting & Medically Approved Next Steps
A.
Persistent itching after Monistat is common and may reflect normal healing, a sensitivity to miconazole, a different condition such as bacterial vaginosis or an STI, resistant or recurrent Candida, or lingering inflammation. There are several factors to consider; medically approved next steps like when to watch and wait, when to stop and seek care, urgent red flags, and which tests or treatments to request are outlined below, and the details below could change the best next step for your care.
References:
* Pal, K., Roy, D., & Nayak, D. (2021). Recurrent vulvovaginal candidiasis: An update. *Indian Journal of Dermatology*, *66*(4), 381–386.
* Pirotta, M., & Heller, P. (2022). Vaginitis: Diagnosis and Treatment. *Australian Journal of General Practice*, *51*(1-2), 17–22.
* Denning, D. W., Kneale, M., Sobel, J. D., & Rautemaa-Richardson, R. (2021). Vulvovaginal candidiasis: Diagnosis, treatment, and prevention. *BMC Infectious Diseases*, *21*(1), 1279.
* Sharma, M., Garg, S., Dahiya, P., & Verma, S. (2023). Vulvovaginal candidiasis: The current understanding of its pathogenesis, diagnosis and management. *Mycology*, *14*(1), 22–33.
* Pires, B., Moreira, D., & Rodrigues, A. G. (2021). Antifungal Resistance in Candida Species Causing Vulvovaginal Candidiasis. *Journal of Fungi (Basel, Switzerland)*, *7*(9), 717.
Q.
Still Itching? Why Diflucan Isn’t Working & Medically Approved Next Steps
A.
If symptoms persist after Diflucan, there are several factors to consider: it may not be a yeast infection, the yeast could be a non albicans species less responsive to fluconazole, you may need more than one dose, the infection may be recurrent, the tissue may still be irritated, or there may be rare absorption issues. See below to understand more, including the expected timeline for relief and other causes that could change the right next step. Medically approved next steps include confirming the diagnosis before retreating, considering alternative or longer antifungals such as topical azoles or boric acid, addressing contributors like diabetes or recent antibiotics, and seeking care if symptoms last beyond 7 days or are severe such as fever, pelvic pain, foul odor, sores, or pregnancy.
References:
* Achkar, J. M., & Sobel, J. D. (2019). Candidiasis in women. Clinical Obstetrics and Gynecology, 62(4), 670-679. pubmed.ncbi.nlm.nih.gov/31568289/
* Sobel, J. D. (2018). Vulvovaginal candidosis—new insights into an old problem. Medical Mycology, 56(suppl_1), S103-S114. pubmed.ncbi.nlm.nih.gov/29325000/
* Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, J. S., Muzny, P. M., Reno, M., ... & Centers for Disease Control and Prevention. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR. Recommendations and reports: Morbidity and mortality weekly report. Recommendations and reports, 70(4), 1-187. pubmed.ncbi.nlm.nih.gov/34292926/
* Pappas, P. G., Kauffman, C. A., Andes, D. R., Baden, B. R., Bradsher, S. F., Crothers, P. A., ... & Infectious Diseases Society of America. (2016). Clinical practice guideline for the management of candidiasis: 2016 update by the Infectious Diseases Society of America. Clinical Infectious Diseases, 62(4), e1-e50. pubmed.ncbi.nlm.nih.gov/26602611/
* Edwards, L., & Lynch, P. J. (2017). Differential diagnosis of vulvar dermatoses. Clinical Obstetrics and Gynecology, 60(2), 295-303. pubmed.ncbi.nlm.nih.gov/28362615/
Q.
Still Itching? Why Your Flora Is Failing & Boric Acid Medical Next Steps
A.
Persistent itching or discharge after antifungals or boric acid often means the issue is misdiagnosed, due to BV or dermatitis, or involves resistant non-albicans yeast. Boric acid can help in recurrent or resistant yeast by restoring acidic pH, but it is not a cure-all, is for vaginal use only, and should be avoided in pregnancy without medical guidance. The right next steps are to get a vaginal swab to identify the organism, use targeted therapy, and address contributors like diabetes, hormones, or irritants, with urgent care for severe pain, fever, foul odor, or lesions; there are several factors to consider, and key details that could change your plan are explained below.
References:
* Amato J, Pizzoferrato M, De Vincentis S, Tini A, Vitale SG, Caponnetto S, Del Forno R, Saccone G, Amore L, De Franciscis P. The Vaginal Microbiome and Its Role in Health and Disease: A Comprehensive Review. J Clin Med. 2023 Mar 1;12(5):2032. doi: 10.3390/jcm12052032. PMID: 36903173; PMCID: PMC10003057.
* Russo R, Saed-Nguyen VA, Paolillo M, Ammar K, Khoury M, Gomaa M, Gomaa E, Ghoneim R, Abdou F, Labib F, Hamdi F, Saleh D, Taktak S, Moussa A, Balaha M, Abdelhamid AA, Fadda L, Hamad MA, Abdelazim I, Hassan M, Abousheashaa A, Hamad S, Salem F, Di Vito M, Abdelazeem A, Labib R, Ghoneim M, Hassan MF, Alsayed A, Elbadry MA, Soliman B, Amara M, Labib D, Saed-Nguyen H, Abousheashaa MA. The Vaginal Microbiome in Health and Disease: State of the Art and Future Perspectives. Front Cell Infect Microbiol. 2022 Aug 10;12:968120. doi: 10.3389/fcimb.2022.968120. PMID: 36034179; PMCID: PMC9401736.
* Mendling W, Brasch J, Cornely OA, Gutschmidt K, Heiligensetzer C, Hoffmann R, Schaller G, Schwaiger M. Boric acid and vaginal infections: a comprehensive review. Arch Gynecol Obstet. 2021 Jul;304(1):21-27. doi: 10.1007/s00404-021-06103-6. Epub 2021 Jun 10. PMID: 34114250; PMCID: PMC8191965.
* Reichman O, Aroutcheva A, Sajadi E, Faro S, Gergely L, Faro J, Sobel JD. Boric acid for recurrent vulvovaginal candidiasis: a review. J Womens Health (Larchmt). 2009 Jun;18(6):859-67. doi: 10.1089/jwh.2008.1001. PMID: 19572851.
* Swidsinski A, Verstraelen H, Swidsinski S, Loening L, Loening-Baucke V. Boric Acid and Metronidazole for Recurrent Bacterial Vaginosis. J Clin Microbiol. 2023 Apr 18;61(4):e0147922. doi: 10.1128/jcm.01479-22. Epub 2023 Mar 28. PMID: 36971520; PMCID: PMC10108953.
Q.
Yeast Infection Discharge? Why Your Body Reacts & Medical Next Steps
A.
Yeast infection discharge is typically thick, white, and odorless with itching, caused by Candida overgrowth triggered by antibiotics, hormonal changes, high blood sugar, or moisture, and is usually treatable with antifungals. There are several factors to consider, including look-alike infections and red flags that change next steps; see below for how to tell it apart, when to use OTC meds vs see a clinician urgently, and key prevention tips.
References:
* Mendling, W., & Lacey, C. J. N. (2021). Candida vulvovaginitis: a clinical guide. *Mycoses*, *64*(5), 499–507.
* Donders, G. G. G., Bellen, G., & Dekeersmaecker, A. (2023). Current treatments for vulvovaginal candidiasis: a clinical review. *Expert Opinion on Pharmacotherapy*, *24*(3), 305–319.
* Rosati, D., Bruno, M., & Jaeger, M. (2021). Immunopathology of Vulvovaginal Candidiasis: From Susceptibility Factors to Host-Pathogen Interaction. *Journal of Fungi*, *7*(7), 585.
* Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, C. A., Reno, H., ... & Bolan, G. A. (2023). Sexually Transmitted Infections Treatment Guidelines, 2021. *MMWR. Recommendations and Reports*, *72*(RR-2), 1–187.
* Fidel, P. L. (2019). Immunity to Candida albicans in the vagina. *The Journal of Infectious Diseases*, *219*(S2), S98–S106.
Q.
Is Your Yeast Infection Back? Why Nystatin Is Key + Medically Approved Next Steps
A.
Nystatin can be a safe, effective way to treat a returning yeast infection, especially in pregnancy or when azoles are not tolerated, and is typically used for 7 to 14 days as part of a complete course. There are several factors to consider, like confirming it is truly yeast, ruling out look-alikes, addressing triggers, and knowing when recurrent symptoms need extended therapy. See the medically approved next steps below for diagnosis, treatment options, maintenance plans, and urgent warning signs that could change what you should do next.
References:
* Fidel PL Jr. Recurrent Vulvovaginal Candidiasis: An Overview. Mycoses. 2022 Mar;65(3):234-243. doi: 10.1111/myc.13401. Epub 2022 Jan 10. PMID: 34964177; PMCID: PMC8940822.
* Sobel JD. Nystatin for the treatment of vulvovaginal candidiasis. Expert Opin Pharmacother. 2020 Jan;21(1):15-20. doi: 10.1080/14656566.2019.1691230. Epub 2019 Nov 22. PMID: 31755734; PMCID: PMC6908428.
* Marrazzo JM, Nyirjesy P, Schwebke JR. Management of Recurrent Vulvovaginal Candidiasis: A Review. JAMA. 2023 Oct 3;330(13):1280-1288. doi: 10.1001/jama.2023.18128. PMID: 37782181.
* Jeanmonod R, Jeanmonod D. Diagnosis and Treatment of Vulvovaginal Candidiasis: A Review. J Womens Health (Larchmt). 2022 Mar;31(3):364-372. doi: 10.1089/jwh.2021.0366. Epub 2022 Feb 16. PMID: 35167664.
* Al-Hammadi M, Elkhizzi N. Nystatin-resistant Candida albicans: a review of the literature. Mycoses. 2020 May;63(5):427-434. doi: 10.1111/myc.13063. Epub 2019 Dec 5. PMID: 31804253.
Q.
Is It Normal? Why Your Vagina Is Itching & Medically Approved Next Steps
A.
Vaginal itching is common and can be normal when mild and short lived, but persistent or intense itch can signal yeast infection, bacterial vaginosis, STIs, skin conditions, hormonal changes, or irritation from products or hygiene habits. Immediate steps include stopping potential irritants, keeping the area dry, avoiding scratching, and using OTC antifungals only if you are sure it is yeast; see a clinician if symptoms are severe, unusual, recurrent, or involve fever, pelvic pain, sores, foul odor or discharge, or bleeding. There are several factors to consider, and important details that could change your next steps are explained below.
References:
* Workman, B. C., & Maxted, T. (2023). Vaginitis: Diagnosis and Treatment. *American Family Physician*, *107*(4), 393-401.
* Paladine, H. L., & Desai, U. (2020). Vulvovaginitis: New insights into an old disease. *Postgraduate Medical Journal*, *97*(1143), 20-27.
* Denk, S. P., & Denk, J. J. (2021). Current Perspectives on the Epidemiology, Diagnosis, and Treatment of Vulvovaginal Candidiasis. *Infection and Drug Resistance*, *14*, 1063-1073.
* Bakalov, V., Vasileva, M., & Vasileva, T. (2020). Bacterial vaginosis: a review of current knowledge. *Journal of Global Health*, *10*(2), 020420.
* Kissinger, P. (2020). Trichomoniasis: Updates on Epidemiology, Pathogenesis, Diagnosis and Treatment. *Current Infectious Disease Reports*, *22*(1), 3.
Q.
Itching or Odor? Why You Have Vaginitis and Medically Approved Next Steps
A.
There are several factors to consider. Itching without odor most often suggests a yeast infection, a fishy smell points to bacterial vaginosis, and frothy yellow green discharge with soreness can indicate trichomoniasis, but causes overlap and some cases are due to irritants or low estrogen; see the complete guidance below for medically approved next steps on assessment, when to use OTC treatment versus get testing and prescriptions, partner treatment for STIs, prevention, and urgent red flags.
References:
* Workowski KA, Bachmann LH, Chan PA, et al. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34292926.
* Paavonen J, Donders G. Diagnosis and Treatment of Vaginitis. Ann Med. 2016;48(8):574-583. doi: 10.1080/07853890.2016.1264887. PMID: 27903102.
* Hillebrand CS, Garcia-Blackwood A, Caddy S, Workowski KA. Bacterial Vaginosis: An Update for the Clinician. Obstet Gynecol Surv. 2020 Jan;75(1):1-10. doi: 10.1097/OGX.0000000000000744. PMID: 31876793.
* Pappas PG, Kauffman CA, Andes DR, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. PMID: 26637644.
* Schwebke JR, Muzny CA. Trichomoniasis. Clin Infect Dis. 2021 Aug 16;73(4):681-689. doi: 10.1093/cid/ciaa871. PMID: 32678887.
Q.
Itching Won’t Stop? Why Your Yeast Infection Persists & Medical Next Steps
A.
Itching that will not stop after yeast infection treatment usually has a clear cause and solution, most often a wrong diagnosis, resistant yeast, too short or missed doses, or contributors like recent antibiotics, diabetes, hormones, or irritants; there are several factors to consider, with important details below. If symptoms last more than 3 to 5 days, worsen, or occur during pregnancy or with diabetes or immune problems, see a clinician for an exam and swab to confirm the cause and get targeted therapy, and review the testing steps and home care guidance below.
References:
* Sobel JD. Recurrent Vulvovaginal Candidiasis: An Overview of Pathogenesis, Diagnosis, and Management. Am J Obstet Gynecol. 2016 Dec;215(6):663-671. doi: 10.1016/j.ajog.2016.06.009. PMID: 27320005.
* Donders G, Bellen G, Mendling W. Host and microbial factors in recurrent vulvovaginal candidiasis: a comprehensive review. Curr Infect Dis Rep. 2017 Aug;19(8):28. doi: 10.1007/s11908-017-0581-z. PMID: 28656578.
* Denning DW, Arendrup MC, Araiza J, et al. Vulvovaginal Candidiasis: Current Concepts in Pathogenesis and Clinical Management. Clin Infect Dis. 2021 Apr 15;72(8):1633-1641. doi: 10.1093/cid/ciaa1653. PMID: 33179782.
* Mahmoudi S, Khodadadi H, Zargar M, et al. Recurrent vulvovaginal candidiasis: An updated review of etiology, diagnosis, and management. Microb Pathog. 2023 Apr;177:106037. doi: 10.1016/j.micpath.2023.106037. PMID: 36796447.
* Workowski KA, Bolan EB, Centers for Disease Control and Prevention. Sexually Transmitted Infections Treatment Guidelines, 2015. MMWR Recomm Rep. 2015 Jun 5;64(RR-3):1-137. PMID: 26042815. (Note: Specific VVC section is pages 33-37 within these larger guidelines, but the PMID refers to the entire document).
Q.
Persistent Itching? Why Your Body Is Reacting & Medically Approved Yeast Infection Next Steps
A.
Persistent vulvar or vaginal itching is often from a yeast infection caused by Candida, with hallmark signs of intense itch, burning, redness, and thick white discharge without a strong odor; triggers include recent antibiotics, hormonal shifts, high blood sugar, tight or damp clothing, scented products, and a weakened immune system. Start with medically approved antifungals and avoid irritants while keeping the area dry, but see a clinician if it is your first episode, you are pregnant, symptoms are severe or recurrent, there is odor or pelvic pain, or you do not improve within a week; there are several factors to consider, and important timing, prevention, and diagnosis details are explained below.
References:
* Workowski KM, Bachmann LL, Chan PA, Johnston CM, Muzny PJ, Reno RK, Schmidt MA, Secura GM, Bolan GA. Sexually Transmitted Infections Treatment Guidelines, 2021. MMWR Recomm Rep. 2021 Jul 23;70(4):1-187. doi: 10.15585/mmwr.rr7004a1. PMID: 34292926; PMCID: PMC8344968.
* Pérez-Ruiz A, Mones X, Ferrer C. Recurrent vulvovaginal candidiasis: An update. J Mycol Med. 2023 Apr;33(2):101375. doi: 10.1016/j.mycmed.2023.101375. Epub 2023 Feb 18. PMID: 36809756.
* Murciano C, Cárdenas-Delgado VM, Gómez-León P, Galán-Diez M, Galán-Diez M, Gómez-García C, Gancedo C, Arroyo J, Nombela C. Vulvovaginal Candidiasis: Molecular Mechanisms of Virulence and Host-Pathogen Interaction. Pathogens. 2022 Sep 27;11(10):1108. doi: 10.3390/pathogens11101108. PMID: 36297379; PMCID: PMC9609657.
* Denning DW, Rautemaa-Richardson R, Sobel JD. Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis. 2018 Nov;18(11):e390-e404. doi: 10.1016/S1473-3099(18)30344-X. Epub 2018 Sep 28. PMID: 30279144.
* Biondi L, Balice Y, Piaserico S, Belloni Fortina A, Peserico A. Chronic Pruritus: A Literature Review of Current and Future Therapies. J Clin Med. 2023 Feb 24;12(5):1842. doi: 10.3390/jcm12051842. PMID: 36902919; PMCID: PMC10003056.
Q.
Still Itching? Why Yeast Infection Treatment Fails & Medical Next Steps
A.
Persistent itching after yeast infection treatment often means it was not yeast, the yeast species is resistant, the course was too short, the infection is recurrent due to risk factors like antibiotics or diabetes, or ongoing skin irritation or another condition is causing symptoms. Medical next steps include seeing a clinician for a vaginal swab and pH testing to confirm the cause and guide targeted or longer therapy such as boric acid, nystatin, or maintenance treatment, plus skin care and prevention tips; there are several factors to consider, and important details that can shape your plan are outlined below.
References:
* Paladin C, Larcher R, Zucol B, Prisco D, Capobianco G, Donà G, Spinillo A. Recurrent Vulvovaginal Candidiasis: Epidemiology, Etiology, and Management. Pathogens. 2024 Apr 24;13(5):372. doi: 10.3390/pathogens13050372. PMID: 38787834; PMCID: PMC11124618.
* D'Alessandro R, Caramello A, De Pascale MR, Calonico C, Cavallero S, Allizond V, De Seta F, Sciacchitano S, Fasce R, Ivaldi F, De Leo A, Cichero P, Rossi E, Berruti G, Mattioli F, Bruzzone B. Mechanisms of azole resistance in Candida species: An overview. New Microbiol. 2022 Oct;45(4):185-197. PMID: 36282367.
* Kim J, Kim HS. Recurrent Vulvovaginal Candidiasis: Clinical Manifestations, Diagnosis, Pathogenesis, and Management. J Fungi (Basel). 2023 Dec 16;9(12):1214. doi: 10.3390/jof9121214. PMID: 38138760; PMCID: PMC10744655.
* Rosati D, D'Ambrogio A, Panella L, Giocondo A, Fici G, Pericolini E, Sali M. New therapeutic options for recurrent vulvovaginal candidiasis. Expert Rev Anti Infect Ther. 2022 Nov;20(11):1365-1377. doi: 10.1080/14787210.2022.2133099. Epub 2022 Oct 11. PMID: 36219321.
* Rosati D, Panella L, D'Ambrogio A, Fici G, Pericolini E, Sali M. The vaginal microbiota and recurrent vulvovaginal candidiasis: more than just Candida. New Microbiol. 2023 Apr;46(2):83-92. PMID: 37119046.
Q.
Still Itching? Why Your Body Is Growing a Vaginal Yeast Infection & Next Steps
A.
There are several factors to consider; see below to understand more. Vaginal yeast infections happen when Candida overgrows after antibiotics, hormonal shifts, high blood sugar, moisture and friction, irritants, or immune changes, leading to intense itching, burning, redness, and thick white discharge. Next steps include keeping the area dry, avoiding scented products and douching, considering an OTC antifungal if this matches a past confirmed infection, and seeking care if symptoms are severe, recurrent, atypical, occur in pregnancy, do not improve, or include fever, pelvic pain, foul odor, or poorly controlled diabetes, since other conditions can mimic yeast and may need different testing and treatment outlined below.
References:
* Sobel JD, et al. Vulvovaginal Candidiasis: Epidemiology, Pathogenesis, and Management. Front Cell Infect Microbiol. 2023 Aug 15;13:1238478. doi: 10.3389/fcimb.2023.1238478. PMID: 37637500; PMCID: PMC10461830.
* Yáñez-Pirela G, et al. Immune Responses to Candida albicans in Vulvovaginal Candidiasis. Immunity. 2023 Aug 15;56(8):1753-1770. doi: 10.1016/j.immuni.2023.07.009. PMID: 37604169.
* Pal M, et al. Current Therapeutic Strategies for Vulvovaginal Candidiasis. J Fungi (Basel). 2022 Feb 28;8(3):241. doi: 10.3390/jof8030241. PMID: 35261314; PMCID: PMC8954203.
* Denning DW, et al. Recurrent Vulvovaginal Candidiasis: An Overview of Pathogenesis, Diagnosis, and Management. J Fungi (Basel). 2022 Feb 28;8(3):240. doi: 10.3390/jof8030240. PMID: 35261313; PMCID: PMC8954202.
* Rosati D, et al. Vulvovaginal candidiasis: Risk factors, diagnosis and management of recurrent infection. Eur J Clin Microbiol Infect Dis. 2020 Apr;39(4):611-624. doi: 10.1007/s10096-019-03738-w. Epub 2019 Dec 11. PMID: 31828479; PMCID: PMC7055913.
Q.
Still Itchy? Why Your pH is Failing & Medically Approved Boric Acid Steps
A.
Persistent vaginal itching often signals a disrupted pH; for recurrent or treatment resistant yeast infections, clinician guided vaginal boric acid suppositories can restore acidity and relieve symptoms when standard antifungals fail. There are several factors to consider. See below for the exact medically approved steps, dosing and timing, who should not use boric acid, other conditions that mimic yeast, and preventive habits that could shape your next healthcare decisions.
References:
* D'Ippolito S, et al. Vaginal pH and Microbiome in Health and Disease. *Microorganisms*. 2022 Jan 19;10(2):220. doi: 10.3390/microorganisms10020220. PMID: 35058787; PMCID: PMC8874136.
* De Backer E, et al. The Role of Boric Acid in Gynecologic Health: A Comprehensive Review. *Cureus*. 2024 Jan 12;16(1):e52077. doi: 10.7759/cureus.52077. PMID: 38344074; PMCID: PMC10858177.
* Georgiev V, et al. Vaginal use of boric acid for recurrent candidiasis and bacterial vaginosis: a systematic review. *Arch Gynecol Obstet*. 2022 Dec;306(6):1741-1748. doi: 10.1007/s00404-022-06786-2. Epub 2022 Oct 11. PMID: 36340209.
* Pruthi V, et al. Boric Acid as a Treatment for Recurrent Bacterial Vaginosis. *J Womens Health (Larchmt)*. 2020 Jan;29(1):16-18. doi: 10.1089/jwh.2019.8102. PMID: 31835952.
* Iavazzo C, et al. Boric Acid for Recurrent Vulvovaginal Candidiasis. *J Low Genit Tract Dis*. 2018 Jul;22(3):218-221. doi: 10.1097/LGT.0000000000000392. PMID: 29845020.
Q.
Is it Thrush? Why Your Body is Itching & Medically Approved Next Steps
A.
Thrush can cause intense genital itching with burning, redness, and a thick white cottage cheese discharge with little odor, but many other conditions can mimic it. If symptoms are familiar and mild, over the counter antifungals can help; see a clinician if it is a first episode, you are pregnant, symptoms are severe or recurrent, there is strong odor, fever or pelvic pain, you have diabetes or immune issues, or you do not improve. There are several factors to consider, and key details that could change your next steps are explained below.
References:
* Pappas PG, Kaufman CA, Andes DR, Betschel GA, Cordero CA, Fischer MA, et al. Clinical Practice Guideline for the Management of Candidiasis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis. 2016 Feb 15;62(4):e1-50. doi: 10.1093/cid/civ933. PMID: 26680313.
* Denning DW, Hosseini SM, Fraczek MG, Koohsari E, Abastabar M, Taj-Aldeen SJ, et al. Vulvovaginal Candidiasis: Epidemiology, Diagnosis and Treatment. J Fungi (Basel). 2021 Jul 15;7(7):577. doi: 10.3390/jof7070577. PMID: 34282582. PMCID: PMC8304245.
* Akpan A, Dattilo JK, Yost E, Kolar J, Caceres M, Fegley M, et al. Oral Candidiasis: A Review of the Current Literature. J Fungi (Basel). 2021 Mar 26;7(4):259. doi: 10.3390/jof7040259. PMID: 33801261. PMCID: PMC8065074.
* Moeenig G, Sayegh S, Mhanna C, Hlais S. Pruritus: An Updated Review. Diagnostics (Basel). 2022 Oct 27;12(11):2631. doi: 10.3390/diagnostics12112631. PMID: 36384725. PMCID: PMC9650369.
* Akpan A, Dattilo JK, Yost E, Kolar J, Caceres M, Fegley M, et al. Cutaneous Candidiasis: A Comprehensive Review. J Fungi (Basel). 2022 Aug 18;8(8):866. doi: 10.3390/jof8080866. PMID: 36011311. PMCID: PMC9411909.
Q.
Internal Fire? Why Your Yeast Infection Won’t Quit & Medically Approved Next Steps
A.
There are several factors to consider: persistent yeast-like symptoms often mean it is not yeast, the Candida species is resistant, or triggers like antibiotics, high blood sugar, hormonal shifts, immune issues, or irritants are driving it; medically approved next steps are to stop repeating OTC treatments, get an exam and swab for accurate diagnosis, then follow a full targeted treatment and address triggers. See the complete guidance below for urgent warning signs, specific testing and treatment timelines, and prevention strategies, since these details can change the best next steps in your care.
References:
* Orozco-Vazquez, R., Zuniga, G., Giammarini, C., Flores-Diaz, M., & Vazquez-Zapien, G. J. (2022). Recurrent Vulvovaginal Candidiasis: An Update on Pathogenesis, Clinical Management, and Future Perspectives. *Frontiers in Cellular and Infection Microbiology*, *12*, 1073868.
* Sobel, J. D. (2021). Recurrent vulvovaginal candidiasis: current perspective of prophylactic management. *Journal of Obstetrics and Gynaecology Research*, *47*(9), 3121–3126.
* Blostein, F., & Sobel, J. D. (2021). Vulvovaginal candidiasis: complex pathogenesis, complicated therapy, and challenges in developing novel therapeutic agents. *Virulence*, *12*(1), 2962–2975.
* Ben Rejeb, F., Sellami, M., Chaaben, R., Ben Hadj Taieb, N., & Sellami, H. (2023). Antifungal Resistance in Candida albicans: Molecular Mechanisms and Novel Therapeutic Approaches. *International Journal of Molecular Sciences*, *24*(7), 6701.
* Fan, S. R., Yang, H. J., Li, Y. Z., & Wang, Y. (2023). Immunological mechanisms underlying recurrent vulvovaginal candidiasis: a comprehensive review. *Journal of Fungi (Basel, Switzerland)*, *9*(12), 1184.
Q.
Yeast Infection Relief for Women 30-45: Your Essential Next Steps
A.
Essential next steps for women 30 to 45: confirm your symptoms really point to a yeast infection, treat with an appropriate OTC or prescribed antifungal, soothe with breathable cotton and cool compresses, avoid scented products, and see a clinician if symptoms are severe, last more than 7 to 10 days, or recur. There are several factors to consider, including conditions that mimic yeast infections and special situations like pregnancy, perimenopause, diabetes, and high estrogen birth control that change the safest treatment and prevention plan. See below to understand more, including prevention habits, red flags, and when longer therapy is needed.
References:
* Workowski, K. A., Bachmann, L. H., Chan, P. A., Johnston, C. M., Muzny, L., Reno, H., ... & Bolan, G. A. (2021). Sexually Transmitted Infections Treatment Guidelines, 2021. *MMWR. Recommendations and Reports*, *70*(4), 1-187. doi:10.15585/mmwr.rr7004a1.
* Marchaim, D., & Sobel, J. D. (2022). Vulvovaginal Candidiasis: Practical Clinical Considerations. *Infectious Disease Clinics of North America*, *36*(1), 173-189. doi:10.1016/j.idc.2021.10.007.
* Rosati, D., Bruno, M., Sepulveres, D., & Fegatilli, A. (2022). Vulvovaginal Candidiasis: Recurrence, Prevention, and Treatment. *Journal of Clinical Medicine*, *11*(16), 4697. doi:10.3390/jcm11164697.
* Sobel, J. D., & Nyirjesy, P. (2020). Recurrent vulvovaginal candidiasis. *Journal of women's health (2002)*, *29*(5), 707–714. doi:10.1089/jwh.2019.8222.
* Fidel, P. L., Jr. (2023). New insights into the pathogenesis and management of recurrent vulvovaginal candidiasis. *International Journal of Gynaecology and Obstetrics*, *160*(Suppl 1), 6-12. doi:10.1002/ijgo.14660.
Q.
Effective Yeast Infection Treatment After 65: Fast Relief & Prevention
A.
Fast, effective relief after 65 often uses OTC azole treatments like clotrimazole or miconazole in 7 day courses, with prescription options such as fluconazole or extended regimens for tougher or recurrent cases, but evaluation is key since symptoms can mimic other conditions. See below to understand more. To prevent recurrences, focus on moisture control, diabetes management, careful antibiotic use, and discussing vaginal estrogen when appropriate, and know when to see a doctor if symptoms persist, recur, or include pain, sores, bleeding, fever, or pelvic pain. There are several factors to consider, including drug interactions and safety screening, so see below for important details that can guide your next steps.
References:
* Donders GGG, Bellen G, De Sutter P. Vulvovaginal Candidiasis in Postmenopausal Women. Int J Gynaecol Obstet. 2017 Jan;136(1):15-18. doi: 10.1002/ijgo.12009. Epub 2016 Nov 1. PMID: 27726194.
* Sobel JD. Vulvovaginal Candidiasis: Epidemiology, Diagnosis, and Management. Am J Obstet Gynecol. 2021 Jan;224(1):1-10. doi: 10.1016/j.ajog.2020.07.018. Epub 2020 Aug 6. PMID: 32777322.
* Pappas PG, Sobel JD. Recurrent Vulvovaginal Candidiasis: An Update on Epidemiology, Pathogenesis, and Management. Sex Transm Dis. 2020 Sep;47(9):561-568. doi: 10.1097/OLQ.0000000000001217. PMID: 32796468.
* Marra V, Ghasemian R, Donders GGG. Topical and Oral Antifungal Agents for the Treatment of Vulvovaginal Candidiasis: A Review of Efficacy and Safety. Pharmaceuticals (Basel). 2023 Apr 15;16(4):597. doi: 10.3390/ph16040597. PMID: 37111005.
* Donders GGG, Ravel J, Bellen G, Van der Meersch E. Estrogen and Fungal Infection: A Complex Relationship. J Fungi (Basel). 2022 Nov 22;8(12):1224. doi: 10.3390/jof8121224. PMID: 36556100.
Q.
Vaginal Yeast Infection After 65: Causes, Relief & Prevention
A.
After 65, vaginal yeast infections are common and usually treatable; they are often driven by lower estrogen, medicines like antibiotics or steroids, diabetes or immune issues, and extra moisture from pads or briefs, and can cause itching, burning, dryness, or thick white discharge. Relief typically starts with confirming the diagnosis, then using antifungal creams or pills; if thinning and dryness contribute, low dose vaginal estrogen may help, and prevention includes breathable underwear, gentle unscented care, prompt changing when damp, and good blood sugar control. There are several factors to consider, including when to seek care for first-time or persistent symptoms, recurrent infections, or red flags like bleeding, severe pain, or fever; see the complete answer below for key details that can guide your next steps.
References:
* Patel, N., Langan, C. M., Ma, L., & Zevallos, C. (2023). Vulvovaginal candidiasis in postmenopausal women: A review of the literature. *Current Opinion in Obstetrics & Gynecology*, 35(1), 77-83.
* Costa, C., Ramalho, M., Neves, M., & Neves, A. (2022). Recurrent Vulvovaginal Candidiasis in Postmenopausal Women: A Systematic Review. *Journal of Clinical Medicine*, 11(24), 7368.
* Wu, M., Cheng, X., Zhang, W., & Li, S. (2020). Risk Factors for Recurrent Vulvovaginal Candidiasis in Postmenopausal Women: A Retrospective Study. *Journal of Lower Genital Tract Disease*, 24(1), 89-92.
* Singh, N. (2022). Genitourinary Syndrome of Menopause and Vulvovaginal Candidiasis: The Interplay. *Sexual Medicine Reviews*, 10(1), 15-20.
* Ogrich, L., & Schick, M. R. (2023). Vulvovaginal candidiasis: Updates on epidemiology, clinical manifestations, and management. *Current Fungal Infection Reports*, 17(4), 119-128.
Q.
Best Yeast Infection Treatments: A Woman's Clinical Guide
A.
The most effective yeast infection treatments are antifungal medications: over the counter clotrimazole or miconazole for mild cases, and prescription fluconazole for moderate to severe symptoms, with vaginal options preferred in pregnancy. There are several factors to consider, including confirming the diagnosis, when to see a clinician, how to manage recurrent infections, what home remedies to avoid, and prevention steps. See the complete guidance below to understand important details that could change your next steps.
References:
* Rosati D, Bruno M, Rubino B, Borgo F, Vecchione A. Vulvovaginal Candidiasis: Epidemiology, Pathogenesis, Diagnosis, and Management. Clin Microbiol Rev. 2020 Feb 26;33(2):e00086-19. doi: 10.1128/CMR.00086-19. PMID: 32102871; PMCID: PMC7048705.
* Denning DW, Colombo AL, Haglund M, Houbraken J, Melchers WJ, Nucci M, Rautemaa-Richardson R, Wiederhold N. Vulvovaginal candidiasis: a common, annoying, and sometimes complicated infection. BMC Womens Health. 2020 Apr 6;20(1):77. doi: 10.1186/s12905-020-00951-6. PMID: 32252758; PMCID: PMC7136367.
* Ilkit M. Clinical Management of Vulvovaginal Candidiasis. J Fungi (Basel). 2021 Jun 25;7(7):508. doi: 10.3390/jof7070508. PMID: 34208460; PMCID: PMC8308479.
* Sobel JD. Recurrent Vulvovaginal Candidiasis: An Update. Curr Fungal Infect Rep. 2021 Jun;15(2):100-106. doi: 10.1007/s12281-021-00392-1. Epub 2021 May 18. PMID: 34007137.
* Rylander A, Caddy S. Emerging therapeutics for vulvovaginal candidiasis. Expert Opin Emerg Drugs. 2022 Sep;27(3):361-370. doi: 10.1080/14728214.2022.2109867. Epub 2022 Aug 4. PMID: 35929624.
Q.
Safe Yeast Infection Relief for Seniors: Medical Options
A.
Safe relief for seniors includes OTC antifungal creams or suppositories like clotrimazole or miconazole, typically in 7-day courses, with prescription options such as fluconazole or stronger vaginal therapies for persistent or recurrent symptoms; proper diagnosis is crucial since look-alike conditions are common, and urgent care is warranted for fever, pelvic pain, bleeding, or worsening symptoms. There are several factors to consider, including drug interactions, kidney or liver issues, postmenopausal tissue changes that may benefit from low-dose vaginal estrogen, diabetes management, and care for skin or oral yeast. See below for complete guidance on when self-care is reasonable, how to manage recurrences, prevention tips, and what treatments and home remedies to avoid.
References:
* Li A, Zhou S, Chen D, Shen T. Candidiasis in Older Adults: A Narrative Review. *J Fungi (Basel)*. 2022 Aug 1;8(8):796. PMID: 35921609.
* Akpan A, Morgan R. Oral Candidiasis in the Elderly. *Postgrad Med J*. 2017 May;93(1099):296-302. PMID: 28575005.
* Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R. Recurrent vulvovaginal candidiasis in postmenopausal women: a review of the literature. *Mycoses*. 2019 Jul;62(7):599-606. PMID: 31336040.
* Patel V, Singh P, Madaan V, Madaan R. Antifungal Agents in the Geriatric Population: A Narrative Review. *J Fungi (Basel)*. 2021 Jul 20;7(7):577. PMID: 34299946.
* De Ryck R, Van Hecke S, Boussery K, Van der Kuyph D. Drug-drug interactions with azole antifungals: an update. *Expert Opin Drug Metab Toxicol*. 2021 Sep;17(9):1043-1055. PMID: 34190772.
Q.
Over 65 Starting Farxiga? What to Watch in the First 2 Weeks
A.
If you’re over 65 and beginning Farxiga, the first two weeks often bring more urination and thirst; watch for dizziness, low blood sugar if you also use insulin or a sulfonylurea, and early signs of genital yeast infections or UTIs. Seek urgent care for severe dehydration, reduced urination, fever or confusion, or possible ketoacidosis signs like nausea, belly pain, rapid breathing, or fruity breath; review diuretics, NSAIDs, blood pressure pills, insulin or sulfonylureas with your doctor, stay hydrated, monitor sugars, and pause and call your doctor if you develop vomiting or diarrhea. There are several factors to consider. See below for important details that can guide your next steps.
References:
* Tang W, Wu Y, Lu Y, Sun H, Huang M. Safety and tolerability of dapagliflozin in elderly patients with type 2 diabetes mellitus: a systematic review and meta-analysis. Aging Clin Exp Res. 2020 Feb;32(2):227-236. doi: 10.1007/s40520-019-01229-2. Epub 2019 May 14. PMID: 31087132.
https://pubmed.ncbi.nlm.nih.gov/31087132/
* Lertwattanarak R, Sripetchanda S, Wattanakitkrileart C, Ngamchuea K. Real-World Safety of Sodium-Glucose Cotransporter 2 Inhibitors in Elderly Patients With Type 2 Diabetes Mellitus: A Systematic Review. J Clin Med. 2023 Apr 1;12(7):2690. doi: 10.3390/jcm12072690. PMID: 37050013; PMCID: PMC10094916.
https://pubmed.ncbi.nlm.nih.gov/37050013/
* Zhang W, Xie H, Zhang G, Li Y. Early Adverse Events of SGLT2 Inhibitors and GLP-1 Receptor Agonists: A Systematic Review and Meta-Analysis. Front Pharmacol. 2021 Mar 1;12:646395. doi: 10.3389/fphar.2021.646395. PMID: 33737871; PMCID: PMC7960688.
https://pubmed.ncbi.nlm.nih.gov/33737871/
* Sun M, Zhao Z, Cui Z, Jia T. Risk of acute kidney injury with SGLT2 inhibitors: an updated systematic review and meta-analysis. Front Pharmacol. 2023 Feb 1;14:1062071. doi: 10.3389/fphar.2023.1062071. PMID: 36816049; PMCID: PMC9931346.
https://pubmed.ncbi.nlm.nih.gov/36816049/
* Palmer SC, Ruospo M, Palmer B, Strippoli GF, Jardine MJ, Navaneethan SD. Effects of sodium-glucose co-transporter 2 inhibitors on blood pressure and cardiorenal outcomes in older adults with type 2 diabetes: a systematic review and meta-analysis. Lancet Healthy Longev. 2022 Jan;3(1):e27-e39. doi: 10.1016/S2666-7568(21)00249-X. PMID: 36056976.
https://pubmed.ncbi.nlm.nih.gov/36056976/
Q.
The Real Reason Farxiga Can Make You Pee More (and When That’s Not Normal)
A.
Farxiga often makes you pee more because it blocks SGLT2 in the kidneys, so glucose is lost in the urine and water follows, a normal osmotic diuresis that is usually most noticeable early on and often comes with larger volumes and increased thirst. It is not normal if this comes with dehydration signs, burning or urgency, genital itching or discharge, waking many times at night, or serious symptoms like nausea, vomiting, shortness of breath, confusion, or extreme fatigue, in which case you should seek care. There are several factors to consider and practical steps that can change your next best move, so see the complete answer below.
References:
* Scheen AJ. SGLT2 inhibitors: mechanisms of action and effects on the kidney. Curr Opin Nephrol Hypertens. 2018 May;27(3):195-201. doi: 10.1097/MNH.0000000000000407. PMID: 29555437.
* Wilding JP, Cannon CP, Perkovic V, et al. SGLT2 inhibitors: clinical perspectives. Lancet Diabetes Endocrinol. 2019 Jul;7(7):545-562. doi: 10.1016/S2213-8587(19)30154-0. PMID: 31032333.
* Anjana Y, Unnikrishnan R, Madhu SV. Sodium-glucose cotransporter 2 inhibitors (SGLT2i) in cardiovascular, renal, and metabolic diseases: A review of clinical trials. Indian J Endocrinol Metab. 2021 Nov-Dec;25(6):448-456. doi: 10.4103/ijem.ijem_473_21. PMID: 35055577.
* Lillo SM, Lillo AM, Al-Khalidi S. Adverse effects of SGLT2 inhibitors and their management. Curr Opin Endocrinol Diabetes Obes. 2021 Apr;28(2):167-172. doi: 10.1097/MED.0000000000000624. PMID: 33431666.
* Deeks ED. Dapagliflozin: A Review in Type 2 Diabetes. Drugs. 2015 May;75(7):777-802. doi: 10.1007/s40265-015-0391-y. PMID: 25776269.
Q.
What Is Farxiga? How It Works, What It Treats, and Key Safety Warnings
A.
Farxiga (dapagliflozin) is an SGLT2 inhibitor taken once daily that lowers blood sugar by helping the kidneys excrete glucose and is also proven to reduce heart failure hospitalizations and slow chronic kidney disease progression, including in some people without diabetes. Key safety points include risks of dehydration and low blood pressure, rare ketoacidosis, urinary and genital infections, and kidney function changes, and it is not for type 1 diabetes or treating DKA. There are several factors and exceptions that could affect your next steps; see the complete indications, dosing, and safety guidance below.
References:
Kosiborod MN, et al. Dapagliflozin: A Review in Type 2 Diabetes, Heart Failure and Chronic Kidney Disease. Drugs. 2021 Jan;81(1):153-166. doi: 10.1007/s40265-020-01449-7. PMID: 33400262.
https://pubmed.ncbi.nlm.nih.gov/33400262/
Krum S, et al. Safety of Dapagliflozin: A Comprehensive Review of Clinical Trials and Post-Marketing Data. Curr Med Res Opin. 2020 Jul;36(7):1103-1113. doi: 10.1080/03007995.2020.1758953. PMID: 32308197.
https://pubmed.ncbi.nlm.nih.gov/32308197/
McMurray JJV, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction. N Engl J Med. 2019 Nov 21;381(21):1995-2008. doi: 10.1056/NEJMoa1911303. PMID: 31535829.
https://pubmed.ncbi.nlm.nih.gov/31535829/
Wiviott SD, et al. Dapagliflozin and Cardiovascular Outcomes in Type 2 Diabetes. N Engl J Med. 2019 Jan 24;380(9):831-841. doi: 10.1056/NEJMoa1812301. PMID: 30426816.
https://pubmed.ncbi.nlm.nih.gov/30426816/
Heerspink HJL, et al. Dapagliflozin in Patients with Chronic Kidney Disease. N Engl J Med. 2020 Oct 8;383(23):2219-2229. doi: 10.1056/NEJMoa2024816. PMID: 32970396.
Q.
How to get rid of a yeast infection in 24 hours?
A.
Rapid symptom relief within about 24 hours is realistic: take a single 150 mg fluconazole tablet or use an OTC intravaginal azole such as tioconazole or miconazole, and complete the recommended course even if you feel better. There are several factors to consider, including pregnancy and medication interactions, correct application, supportive steps like breathable underwear and no douching, and when to follow up if symptoms persist 48 to 72 hours; see the full guidance below.
References:
Pappas PG, Kauffman CA, Andes DR, et al. (2016). Clinical practice guideline for the management of vulvovaginal candidiasis: 2016 update by the Infectious… Clin Infect Dis, 27418564.
Workowski KA, Bolan GA. (2015). Sexually transmitted diseases treatment guidelines, 2015. MMWR Recomm Rep, 26068404.
Sobel JD, Rinaldi MG, Fazili T. (1999). Comparative evaluation of single‐dose oral fluconazole and topical imidazole therapy for acute vulvovaginal… Obstet Gynecol, 10305253.
Q.
How to treat yeast infection?
A.
Most uncomplicated yeast infections can be treated with over-the-counter azole antifungal creams or suppositories; if symptoms do not improve within a few days or recur, a clinician may prescribe oral fluconazole or alternatives like boric acid or nystatin. There are several factors to consider, including pregnancy, recurrent infections, diabetes or immunocompromise, and red flags like severe pain or fever; complete your treatment course and see the detailed guidance below for safe options, dosing, prevention tips, and when to seek urgent care.
References:
Zhang S, Liu P, Li C, Wu Y, & Zhang T. (2018). Treatment of uncomplicated vulvovaginal candidiasis: a system… BMC Infectious Diseases, 30358305.
Infectious Diseases Society of America. (2016). Clinical practice guideline for the management of candidiasis… Clinical Infectious Diseases, 26679614.
Sobel JD. (2007). Vulvovaginal candidiasis. Lancet, 17400038.
Q.
What causes yeast infection?
A.
Yeast infections occur when Candida albicans, a fungus that normally lives in the vagina, overgrows due to disruptions such as recent antibiotics that lower protective Lactobacillus and raise pH, higher estrogen levels, poorly controlled diabetes, weakened immunity, trapped heat and moisture, douching or scented products, high-sugar diets, and stress. There are several factors to consider; see below for key details that may change your next steps, including specific risk situations, prevention tips, typical symptoms, and when to seek medical care.
References:
Sobel JD. (2007). Vulvovaginal candidosis: pathogenesis, epidemiology, and… Lancet Infect Dis, 17448953.
Odds FC, Brown AJ, & Gow NA. (2003). Morphogenesis in Candida albicans: progress… Trends Microbiol, 12892967.
Richardson MD, & Lass-Flörl C. (2008). Changing epidemiology of systemic fungal infections. Clin Microbiol Infect, 18783023.
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Link to full study:
https://www.medrxiv.org/content/10.1101/2024.08.29.24312810v1Donders GG, Sobel JD. Candida vulvovaginitis: A store with a buttery and a show window. Mycoses. 2017 Feb;60(2):70-72. doi: 10.1111/myc.12572. Epub 2016 Sep 30. PMID: 27687503.
https://onlinelibrary.wiley.com/doi/10.1111/myc.12572Sobel JD. Candida vulvovaginitis. Semin Dermatol. 1996 Mar;15(1):17-28. doi: 10.1016/s1085-5629(96)80014-9. PMID: 8723820.
https://linkinghub.elsevier.com/retrieve/pii/S1085562996800149