Archives of Gynecology and Obstetrics

, Volume 300, Issue 3, pp 647–650 | Cite as

Influence of recurrent vulvovaginal candidiasis on quality of life issues

  • Eiko I. Fukazawa
  • Steven S. WitkinEmail author
  • Renata Robial
  • João G. Vinagre
  • Edmund C. Baracat
  • Iara M. Linhares
General Gynecology



More than 370 million women will experience recurrent vulvovaginal candidiasis (RVVC) during their lifetime. However, RVVC is often trivialized as clinically insignificant and not worthy of research funding. We evaluated the influence of RVVC on the quality of life in affected women.


The validated World Health Organization Quality of Life Abbreviated Assessment (WHOQOL-Bref) questionnaire was administered to 100 women with RVVC and to 101 epidemiologically matched women with no history of vulvovaginal candidiasis. RVVC was defined as at least four episodes of clinical and culture-positive vaginal candidiasis within a 1 year period. Data were analyzed by Chi square, Student t test and analysis of variance. Internal consistency of responses to questions was evaluated by Cronbach alpha.


The Cronbach alpha coefficient was > 0.80 for responses to generalized questions and > 0.65 for answers to more specific questions, indicating substantial internal consistency. Perception of quality of life and satisfaction with their health was greatly reduced in the RVVC group (p < 0.001). Diminished responses to physical and psychological well-being were also reported by women with RVVC (p < 0.001). Various aspects of social relations including sexual activity were similarly reduced (p < 0.001) as were satisfaction with issues such as home environment, financial resources and employment (p < 0.001).


RVVC affects multiple aspects of a woman’s well-being. Women with this condition deserve serious attention from clinicians and research into susceptibility, prevention and treatment of this infection deserves much greater emphasis.


Health questionnaire Quality of life Recurrent vulvovaginal candidiasis 


Author contributions

EI Fukazawa and IM Linhares: trial conception and design and wrote original draft. EI Fukazawa, R Robial, and JG Vinagre: patient interviews and initial data analysis. IM Linhares and SS Witkin: final data analysis and interpretation, and wrote final version of manuscript. IM Linhares and EC Baracat: study supervision.

Compliance with ethical standards

Conflict of interest

None of the authors have any conflict of interest.


  1. 1.
    Giraldo P, von Nowaskonski A, Gomes FA, Linhares I, Neves NA, Witkin SS (2000) Vaginal colonization with Candida in asymptomatic women with and without a history of recurrent vulvovaginal candidiasis. Obstet Gynecol 95:413–416Google Scholar
  2. 2.
    Goncalves B, Ferreira C, Alves CT, Henriques M, Azeredo J, Silva S (2016) Vulvovaginal candidiasis: epidemiology, microbiology and risk factors. Crit Rev Microbiol 42:905–927CrossRefGoogle Scholar
  3. 3.
    Linhares LM, Witkin SS, Miranda SD, Fonseca AM, Pinotti JA, Ledger WJ (2001) Differentiation between women with vulvovaginal symptoms who are positive or negative for Candida species by culture. Infect Dis Obstet Gynecol 9:221–225CrossRefGoogle Scholar
  4. 4.
    Ilkit M, Guzel AB (2011) The epidemiology, pathogenesis, and diagnosis of vulvovaginal candidiasis: a mycological perspective. Crit Rev Microbiol 37:250–261CrossRefGoogle Scholar
  5. 5.
    Sobel JD (2016) Recurrent vulvovaginal candidiasis. Am J Obstet Gynecol 214:15–21CrossRefGoogle Scholar
  6. 6.
    Babula O, Lazdane G, Kroica J, Ledger WJ, Witkin SS (2003) Relation between recurrent vulvovaginal candidiasis, vaginal concentrations of mannose-binding lectin, and a mannose-binding lectin gene polymorphism in Latvian women. Clin Infect Dis 37:733–737CrossRefGoogle Scholar
  7. 7.
    Witkin SS, Jeremias J, Ledger WJ (1988) A localized vaginal allergic response in women with recurrent vaginitis. J Allergy Clin Immunol 81:412–416CrossRefGoogle Scholar
  8. 8.
    Cassone A (2015) Vulvovaginal Candida albicans infections: pathogenesis, immunity and vaccine prospects. BJOG 122:785–794CrossRefGoogle Scholar
  9. 9.
    Sobel JD, Weisenfeld HC, Martens M, Danna P, Hooton TM, Rompalo A et al (2004) Maintenance fluconazole therapy for recurrent vulvovaginal candidiasis. N Eng J Med 351:876–883CrossRefGoogle Scholar
  10. 10.
    Denning DW, Kneale M, Sobel JD, Rautemaa-Richardson R (2018) Global burden of recurrent vulvovaginal candidiasis: a systematic review. Lancet Infect Dis 18(11):e339–e347CrossRefGoogle Scholar
  11. 11.
    Chapple A (2001) Vaginal thrush: perceptions and experiences of women of south Asian descent. Health Educ Res 16:9–19CrossRefGoogle Scholar
  12. 12.
    Aballea S, Guelfucci F, Wagner J, Khemiri A, Dietz JP, Sobel J et al (2013) Subjective health status and health-related quality of life among women with recurrent vulvovaginal candidiasis (RVVC) in Europe and the USA. Health Qual Life Outcomes 11:169CrossRefGoogle Scholar
  13. 13.
    Zhu YX, Li T, Fan SR, Liu XP, Liang YH, Liu P (2016) Health-related quality of life as measured with the Short-Form 36 (SF-36) questionnaire in patients with recurrent vulvovaginal candidiasis. Health Qual Life Outcomes 14:65CrossRefGoogle Scholar
  14. 14.
    Nguyen Y, Lee A, Fischer G (2017) Quality of life in patients with chronic vulvovaginal candidiasis: a before and after study on the impact of oral fluconazole therapy. Aust J Dermatol 58:e176–e181CrossRefGoogle Scholar
  15. 15.
    World Health Organization. Division of Mental Health (1996) WHOQOL-bref: introduction, administration, scoring and generic version of assessment: field trial version. Dec Geneva. Accessed Nov 2018
  16. 16.
    Tavakol M, Dennick R (2011) Making sense of Cronbach’s alpha. Int J Med Educ 2:53–55CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Gynecology and ObstetricsUniversity of Sao Paulo Medical SchoolSao PauloBrazil
  2. 2.Department of Obstetrics and GynecologyWeill Cornell MedicineNew YorkUSA
  3. 3.Institute of Tropical MedicineUniversity of Sao Paulo Medical SchoolSao PauloBrazil

Personalised recommendations