Medically Reviewed On: June 30, 2008

ANNOUNCER: Yeast infections are a problem most women will have to experience at least once in their lives. There are dozens of treatment options available, some of them over-the-counter but how do you know which option is right for you? It's not always an easy choice and most experts agree that a visit to the doctor is more valuable than many woman think.

JOHN HORN, PHARM.D: The first time a woman has symptoms, which she might think are a yeast infection, she probably should see a physician before she self-treats. The reason is that there are other causes for itching and discharge in the vaginal area and it really requires a physician to evaluate that. Another reason to see a physician would be if a patient self-treats and then finds that the infection does not go away when she uses the self-treatment according to the labeled instructions.

ANNOUNCER: There are several factors you and your doctor should consider when selecting among the many treatment options. One important issue is the difference between vaginal medications like Monistat, Gyne-Lotrimin, and Terazol and the oral medication Diflucan.

JOHN HORN, PHARM.D: The oral drug has to enter through the systemic circulation. Take it by mouth, it goes through the bloodstream and then gets to the infected tissues in the vaginal area. The locally applied drugs are a little different. Those are applied right to the site of infection and really treat the fungus sort of locally, as if it was a topical skin infection, which it essentially is. And so there's a fundamental difference between the oral and the topically applied drugs, just in the fact that with the oral you expose the whole body to the drug; with the topical you're really only exposing the area where the infection exists to the drug.

ANNOUNCER: Oral medications are only available by prescription, but that doesn't mean they are more effective than vaginal therapies.

DAVID ESCHENBACH, MD: Overall, they're equally effective; the intravaginal therapy often gets you relief of symptoms a little bit earlier than the oral therapy. But overall, they're quite equal in terms of getting rid of the organism, yeast itself, or providing relief of symptoms.

ANNOUNCER: For most women, the advantage of oral medications lies primarily in their convenience of use.

JOHN HORN, PHARM.D: The advantage of the oral product -- even though it's prescription -- is that the patient doesn't have to use something locally and some patients prefer a one-dose or two-dose oral product to one to three days or perhaps seven days of vaginally applied ointment or cream.

ANNOUNCER: Women who choose vaginal therapy have two options: creams and suppositories. They're equally effective, but differ in how they're applied.

DAVID ESCHENBACH, MD: So for cream applications, the patients fill up a little tube applicator that has a plunger on it and they put it in the vagina and just push the cream in the vagina. For the suppository, they take the wrapper off and then just push the suppository into the vagina with their finger.

ANNOUNCER: Both types of vaginal therapy have the advantage that they often take effect more quickly than oral treatments.

JOHN HORN, PHARM.D: Some patients find that symptom relief is actually a little quicker when they use a local application. The infection itself takes about the same amount of time to cure, but the local application of the cream does seem to relieve the symptoms more quickly.

ANNOUNCER: And while some vaginal therapies also require a prescription, others don't, making them easier to get a hold of when they're needed.

JOHN HORN, PHARM.D: This is really an advantage for a woman who knows that she has a yeast infection; she's probably had them before and knows the symptoms that she wishes to treat. That means that she can simply go to her pharmacy and buy the product herself; she doesn't have to spend the time trying to get in to see the physician and the, of course, added expense associated with that.

ANNOUNCER: Another issue to consider is side effects, which tend to be less of a risk with vaginal treatments.

JOHN HORN, PHARM.D: And so there's a fundamental difference between the oral and the topically applied drugs, just in the fact that with the oral you expose the whole body to the drug; with the topical you're really only exposing the area where the infection exists to the drug.

DAVID ESCHENBACH, MD: The intravaginal preparations usually have very few side effects, so they're quite well-tolerated. Occasionally, there will be an increased amount of irritation that goes on just from the preparation itself more related to the vehicle that it contains -- that contains it. The side effects of the oral therapy are, for the most part, nausea, some abdominal cramps and bloating are the most common.

ANNOUNCER: Whether women choose creams, suppositories, or oral treatment, they should also consider whether they want a short-acting treatment, or one that takes slightly longer. The right choice usually depends on the severity of the infection.

DAVID ESCHENBACH, MD: The topical therapy is anywhere from between one-time dose to a seven-day dose. The oral therapy is usually a one-time dose itself. The advantage of the one-day is it's obviously a one-time use and the efficacy is relatively high for people with mild symptoms. For the people with three- to seven-days, the advantage goes to people who have more moderate to severe symptoms or had recurrences before, where the one-time dose may not be enough to relieve symptoms.

ANNOUNCER: With all these choices, it's clear that treating a yeast infection isn't always as simple as it seems. So while women with past experience can treat themselves, anyone with doubts or with a first time infection should play it safe and talk to their doctor first.