title: Signs of chronic stress in women with recurrent candida vulvovaginitis.
abstract: OBJECTIVE
  The purpose of this study was to determine whether there is an association between recurrent vulvovaginal candida and chronic stress. Chronic stress affects the hypothalamus-pituitary-adrenal axis, which influences the immune function. Recurrent candida vulvovaginitis is increasing.
  
  
  METHODS
  Women with recurrent vulvovaginal candida (n = 35) and age-matched healthy control subjects (n = 35) collected saliva for the analysis of cortisol. Hormone analyses of blood samples and vulvovaginal examinations were performed. A questionnaire was completed.
  
  
  RESULTS
  Morning rise cortisol level was significantly blunted among patients compared with control subjects (P < .002). Mean levels of salivary cortisol were lower the first 45 minutes after awakening in women with recurrent vulvovaginal candida, compared with control subjects. More patients than control subjects reported a history of condyloma, bacterial vaginosis, and herpes genitalis. No differences were seen between patients and control subjects regarding sexual hormone binding globulin, dihydroepiandrosterone, testosterone or Hemoglobin A1c.
  
  
  CONCLUSIONS
  Morning rise salivary cortisol level is blunted in women with recurrent vulvovaginal candida, which indicates signs of chronic stress. The higher incidence of vulvovaginal infections in these women compared with control subjects may reflect impaired immunity, which may be due to chronic stress.
authors.affiliation: Department of Obstetrics and Gynecology, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden. sophia.ehrstrom@ds.se
authors.forename: Sophia M
authors.initials: SM
authors.lastname: Ehrström
authors.forename: Dan
authors.initials: D
authors.lastname: Kornfeld
authors.forename: Jessica
authors.initials: J
authors.lastname: Thuresson
authors.forename: Eva
authors.initials: E
authors.lastname: Rylander
mesh_terms: D000328:Adult; D002177:Candidiasis / Q000150:complications*; D002908:Chronic Disease; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000032:analysis; D010865:Pilot Projects; D012008:Recurrence; D012463:Saliva / Q000737:chemistry; D013315:Stress, Psychological / Q000150:complications*; D014848:Vulvovaginitis / Q000150:complications* / Q000382:microbiology*
chemical_list: D006854:Hydrocortisone