By and large, "Most women with recurrent yeast are normal, healthy women, but the vagina handles the yeast in a way that it's not able to control," says Dr. Paul Nyirjesy, an associate professor of obstetrics and gynecology at Jefferson Medical College in Philadelphia and director of the Jefferson Vaginitis Referral Center there.

Ledger, who has been researching the problem for 20 years, believes that the white blood cells that typically fight infection are unable to kill yeast in women with chronic or recurrent cases. This makes treatment difficult, he says, because the medications used to cure yeast infections are "static" that is, they slow down growth of the fungus, but rely on a woman's immune system to ultimately eliminate it. In such patients, the yeast never really disappears, and results in another infection if conditions in the vagina are right for it to multiply again.

Many patients with this problem now benefit from a strategy developed over the last six years by researchers at Wayne State University School of Medicine in Michigan. If a woman has a chronic or recurrent Candida albicans infection, doctors will treat her for two weeks with a member of the "azole" family of drugs, a line of medications that includes Diflucan and nearly all of the other anti-yeast drugs on the market.

After that comes treatment with the same or another azole drug once or twice a week for six months. The Wayne studies have found that at least 90% of patients will remain symptom-free while on the maintenance therapy. Still, some relapse after stopping the drug, and may have to resume treatment to feel better again.

It has made a tremendous difference,Fischer says. My quality of life is much better

Short or long-term treatment with azole drugs rarely works, however, for women suffering from non-albicans yeast infections, because these strains are resistant to that class of medications. It is unclear why some women develop these unusual strains of infection, but in Nyirjesy's clinic, they account for up to one-third of recurrent cases (the numbers are lower elsewhere in the country). Women without recurrent problems are susceptible to these strains as well, though they are highly unusual for first-time infections.

Older generations of drugs, such as oral and vaginal forms of Nystatin, and suppositories of boric acid work better in these cases. Inserting boric acid suppositories twice a day for two weeks is successful 65% to 70% of the time, Nyirjesy has found. If boric acid doesn't work, it's often hit or miss, he says.

Boric acid has proven useful to Kunis, who ultimately was diagnosed with vulvodynia, a chronic, incurable disease with symptoms that can include stabbing pains, rawness, burning and stinging in and around the vagina constantly or when touched.

Quality-of-life issue

Though her cultures for yeast were negative, Kunis continued to suspect that a "yeast connection" was triggering her pain. After a year and a half of consulting doctors who were unable to offer her a long-term solution, in October 2000 she turned to a nutritionist and acupuncturist, who agreed that her lab tests weren't telling the whole story. He put her on a yeast-cleansing regimen and a strict, low-carbohydrate, low-sugar diet. She began periodic boric acid suppositories, which she continues to use.

Three months later, Kunis stopped itching and her pain subsided. She now says she feels symptom-free 99% of the time and recently began dating again after a three-year hiatus. While she feels optimistic about her health, Kunis remains angry about the lack of research into vaginal problems like hers.

Ledger agrees that the handful of industry-funded drug studies cannot replace investigations into the cause of these confounding conditions.

That kind of research, typically supported by the National Institutes of Health, is practically nonexistent, Ledger says, because it's a problem for women and it's not life-threatening. What you're talking about is quality of life, and that's not weighed in while the NIH is funding things.

Recomended reading: 12 Hour Cure For Yeast Infection