Q:

I frequently experience vaginal yeast infections from receiving oral sex, or similar situations where saliva enters the vagina. Usually a prescription (Diflucan) prevents symptoms but not always. I’ve tried boric acid suppositories but not consistently, and boric acid also prevents one from receiving oral sex after treatment so it’s not my preferred option. I’ve also tried oral probiotics without noticeable therapeutic or preventative treatment effects. Do you have any advice for medical options or otherwise? Any suggestions are appreciated.

A:

Hello! I am a person with a vagina who has experienced a lot of recurring yeast infections and bacterial vaginosis over the past decade, and I am a person who has tried many things to cure these infections, some of which have worked better than others. I am also notably NOT a doctor. Lucky for all of us though, I am close friends with a brilliant queer gynecologist — board certified OB/Gyn Dr. Liz Rubin.

This question is going to be answered with a combination of my own lived experience and Dr. Rubin’s professional advice, because I interviewed her for the occasion. I take yeast infection prevention very seriously, and I wanted to answer this question as thoroughly as possible!

General Yeast Infection Prevention

I know your specific question is about yeast infections caused by oral sex, but it’s late July and most of the United States is experiencing a major heatwave. You know what that means: it’s yeast infection season! So let’s talk about some general yeast infection prevention before diving in to your specific issue.

A good first step when trying to get to the bottom of why you’re experiencing a yeast infection or chronic yeast infections (or other vaginal infections like BV) is to examine your day to day behavior. Dr. Rubin recommended taking stock of all your habits to see if anything is potentially putting you at risk for an infection: do you wear tight underwear or non-cotton underwear, are you using heavily scented lotions, do you remove your pubic hair… if you do these things and they’re not bothering you, great, but if you are experiencing a lot of vaginal infections, it’s worth it to take inventory on these behaviors. Dr. Rubin explained that any time you have a lot of irritation of the vulva or the vagina, you’re putting yourself at risk for triggering an infection.

Dr. Rubin advised various ways to care for your vulva and vagina if it’s sensitive. She cautioned against using really caustic shampoo and conditioner and against using heavily scented soap for your body as all that stuff could eventually coalesce in the vagina during your shower. She recommends using a very gentle soap on the body, like Cetaphil or Cerave, and rinsing your vulva separately at the end of your shower. According to Dr. Rubin, the most common things she sees causing yeast infections are using soaps on the vagina, douching, and wearing tight underwear.

Like I said, I’m a person who has experienced a lot of yeast infections over the years, and I will share that I’m obsessive about the way I treat my vagina: no sitting in a wet bathing suit or damp undies after the gym, always use a very specific pH-balanced body wash, never switch up my laundry detergent… you get the idea. Is this kind of annoying? Honestly, yes. Is it more annoying to get a yeast infection? Also yes.

Sex-Caused Yeast Infection Prevention

So what if you take stock of all of the above and you’re like nope, it’s not any of that, it’s definitely related to oral sex. In this case, Dr. Rubin recommended doing some investigating into your oral sex partner’s saliva. What does that look like? An honest and open conversation about some of their habits.

What is in that person’s saliva regularly? Do they drink a lot of alcohol or sugary beverages? Did they just eat something with a lot of sugar before you started having sex? Do they have more sugar in their body in general? I had a friend in college who used to joke that if her date drank a beer and so much as breathed on her vagina, she would absolutely get a yeast infection. Is their toothpaste irritating you? Try to get to the bottom of it! Some of us are more sensitive to unexpected things entering our vaginas, so don’t be shy to ask the person you’re having sex with to rinse their mouth with a salt water rinse before they put their tongue anywhere near your vulva.

Again, I know your specific question is about oral sex, but I’d be remiss if I didn’t also note that anyone struggling with yeast infections should stay away from lube that contains glycerin or citric acid and from all flavored condoms, period.

You Might Be Prone To Yeast Infections

Okay so, you’ve carefully inspected your habits and your partner’s (or partners’) habits, and maybe you’ve made some changes here and there, but you’re still getting yeast infections. Here is the part no one likes to consider: it’s possible your body is just prone to yeast infections.

Dr. Rubin explained that if you’re immunocompromised you may be at a higher risk for yeast infections; if you have diabetes or pre-diabetes you may be at a higher risk for yeast infections. If you experience urinary incontinence (the loss of bladder control) and occasionally pee a little when you sneeze, it’s possible that urine will irritate the vulva and you’ll now be more at risk for an infection.

If you’re getting recurring yeast infections, even if the triggering incident is always oral sex, it is worth it to go see your doctor if possible and try to figure out together what is happening in your body specifically.

How To Treat Your Yeast Infections

In terms of treating your yeast infection, Dr. Rubin had some suggestions based on her career and education (and, if we’re being real, me texting her frequently to complain and seek advice about my own yeast infections!) and I have some suggestions based on really itchy and uncomfortable personal experience.

First of all, according to Dr. Rubin, Diflucan is a “big gun” medication — so you don’t want to be taking it if you don’t have to, and you certainly don’t want to use it as the solution to chronic yeast infections triggered by oral sex, especially if you enjoy oral sex and engage in it frequently. It’s absolutely fine to take Diflucan occasionally, but it’s not a sustainable ongoing solution.

If the boric acid isn’t working for you I wouldn’t continue with the suppositories. Sometimes I’ve had wild success with boric acid and sometimes it makes my symptoms worse. Dr. Rubin affirmed this experience, sharing that the data on boric acid as a treatment for yeast infections is really variable; apparently some doctors swear by it and some are unconvinced that it works. Dr. Rubin herself has a hard time prescribing them because the different suppositories that are sold have all different things in them, and sometimes they’re really irritating to people to use. She doesn’t want to prescribe her patients boric acid that comes in a sugar capsule, for example.

Dr. Rubin was supportive of oral probiotics in general, but cautioned that they often don’t do much for treating yeast infections once they’ve taken hold. She says she’s more likely to suggest her patients give them a try when they’re on antibiotics, or if they want to take something as part of a daily routine to sort of keep their equilibrium, because the truth is an oral probiotic won’t do much to stop the yeast once it’s there.

I will say that I have tried a truly huge sample of treatments for yeast infections, and the two that work for me are on opposite ends of the spectrum. One is “the big gun,” Diflucan. I wouldn’t take this regularly, but I have taken it often over the past decade. It clears up my yeast infections swiftly and thoroughly. The other is… putting a raw clove of garlic in my vagina. I peel the clove and put little slices in it and then I shove that thing up inside me for like 24 hours. I know it’s controversial, but it works for me, so I don’t know what to tell anyone involved in the controversy! Dr. Rubin also said if you want swift relief, there’s no harm in putting yogurt directly into your vagina to soothe it and potentially reset your ph balance — just make sure it’s completely plain and sugar free. Dr. Rubin prefers Stoneyfield brand.

What If It’s… Not A Yeast Infection

As you may have noticed, we’ve mentioned a few times in this article that Diflucan is a very serious major pill that will knock a yeast infection right out of your system. With that in mind, if the Diflucan is not always removing your symptoms, it’s possible that what you’re experiencing is not a yeast infection. Dr. Rubin emphasized that the rate of Diflucan-reistant yeast is incredibly low.

There are quite a few things that can happen to your vagina that feel like a yeast infection but in reality are not. I am constantly trying to figure out if I have a yeast infection or bacterial vaginosis (BV) or both! It’s hell. But it’s also helpful to know which infection is which so I can treat it properly.

In the meanwhile, as you get to know your body and your sex partner’s body and try to figure out what’s been going on with your vulva and vagina, I want you to still be able to enjoy oral sex. Everyone deserves to have the kind of sex they want to be having, even those of us who have very sensitive vulvas! That’s why I’d like to suggest some barriers you can use to avoid having any saliva near your vagina in the first place. First, you can use non-flavored dental dams or condoms cut in half. A glove also makes a great barrier, as do Lorals wearable dental dams. There is also the option of simply engaging in a different kind of sex, a kind that that would involve less saliva on your vulva. It’s really up to you.

Either way, I would definitely go see your doctor to discuss treatment options, but in the meanwhile, hopefully this gave you some helpful information. I’m wishing you well and hoping you have uneventful oral sex sooner than later!

You can chime in with your advice in the comments and submit your own questions any time.

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