each year , an estimated 10 million health care office visits to gynecologists are due to vulvovaginitis . vulvovaginitis refers to a variety of inflammatory lower genital tract disorders that may be secondary to infection , irritation , allergy , or systemic disease . infectious causes of vulvovaginitis include bacterial vaginosis , candidiasis , and trichimoniasis ; while noninfectious causes include exposure to chemicals , allergens , genital atrophy , and trauma . of the infectious vaginitides , only vulvovaginitis due to candida offers over the counter medications for women to self diagnose and treat their condition . these nonprescription antifungals , introduced to the market in 1990 , are among the top ten best selling over - the - counter drugs in the us with annual sales of approximately $ 250 million . one survey reports that 73% of women with recurrent vulvovaginitis have resorted to over - the - counter medications to reduce health care cost and avoid an expensive office visit . further , homeopathic drug sales were estimated at $ 201 million in 1995 and have steadily risen to an estimated 300450 million in 2003 [ 3 , 4 ] . this article attempts to clarify the efficacy of the available over - the - counter options for women seeking self treatment for vaginitis symptoms and further discern which products are appropriate for treating self - diagnosed yeast   vaginitis . we   visited four common venues frequented by women in their search for vaginitis treatment ; one grocery store , one drug store , one health food store , and the ubiquitous wal - mart . we went to the feminine hygiene section of each store and purchased one of each available product that could be considered a treatment option by the average consumer . cures most vaginal yeast infections  were purchased as well as any products claiming to  relieve vaginal itching . we next conducted a review of the literature , searching for rcts evaluating the efficacy of each product . our search for published literature included conventional search engines ( pub med , ovid , cochcrane , cinahl , apc journal club , google ) , and alternative medicine databases ( longwood herbal taskforce , nccam , natural medicines com - prehensive   database ) . the products purchased could be grouped into three categories : intravaginal imidazoles , vaginal anti - itch creams , and homeopathic treatments . the intravaginal imidazoles were as a whole the more expensive products ranging from $ 6$19 , with an average cost of $ 12 . the homeopathic remedies ranged in price from $ 4$13 , with an average cost of $ 8.50 . finally , the vaginal anti - itch creams range in price from $ 2$6 , with an average price of $ 4 . further , a review of five rcts found no significant difference in treatment durations of one to fourteen days of imidazole therapy for uncomplicated vulvovaginitis . the cdc recommends that pregnant women use the seven - day treatment course due to the lower average concentration of medication . finally , the one , three , and seven - day regimens all deliver the same total dosage of active ingredient ; they differ solely in the number of doses and therefore strength of each   dose . our review of the literature failed to reveal studies confirming the efficacy of vaginal anti - itch creams for treatment of infectious vaginitis . these products may confuse women seeking self treatment for vaginitis due to their proximity on the shelves , as well as their claims to  relieve vaginal itching ,  the primary symptom of yeast vaginitis . we could not locate any rcts proving the effectiveness of any of the homeopathic treatments . systemic reviews have not found homeopathy to be a definitively proven treatment for any medical condition  . despite   the introduction of otc drugs for treatment of vulvovaginitis , the costs of health care office visits to treat this disorder   are still rising , to an estimated of 3.1 billion dollars by 2014 . this may be due to the fact that women have proven to be inadequate in self diagnosis . in fact , in one study only one third of the women correctly diagnosed themselves with a yeast vaginitis . further , women with a previous clinical diagnosis of candida infection were not more accurate at identifying their current condition . the   most common cause of infectious vulvovaginitis is bacterial vaginosis which has been found to be twice as prevalent as yeast vaginitis . while vaginitis was once thought not to be clinically perilous , there is a mounting body of evidence linking infectious vaginitis with more serious adverse reproductive outcomes . infection with bacterial vaginosis and trichomoniasis have been shown to increase one 's risk of acquiring hiv and other sti 's including pid , which can lead to infertility 
 [ 2 , 9 ] . further , there has been a positive link between bacterial vaginosis and increased risk of preterm labor . bv also increases a women 's risk of postabortion uterine infection and posthysterectomy cuff infection . empowering women to correctly identify and treat their symptoms with the proper medications will alleviate their discomfort and prevent adverse outcomes from lack of recognition of symptoms necessitating a physi-   cian visit . since our findings did not prove any significant differences 
 between brand or formulation of any of the intravaginal 
 imidazoles , women should chose their treatment based on personal 
 preference . knowing that these products are equally effective 
 allows the consumer to base her decision on price , route of 
 administration , and ease of use . it should be noted that women 
 with chronic or persistent yeast infections are less likely to 
 respond to short courses of therapy and should consult with their 
 doctor about a specific treatment regimen . vaginal anti - itch creams are grouped on the shelves next to the vaginal yeast infection treatments . these products such as vagisil , vagi - gard , summers eve , and equate vaginal cream are marketed to the consumer as anti - itch creams , making them a seemingly enticing treatment option for symptomatic relief of pruritis associated with candida . these creams utilize ingredients including anesthetics ( benzocaine ) , external analgesics ( resorcinol ) , and 
 anti - pruitics ( hydrocortisone ) . women should be aware that if they purchase these creams they may experience only temporary alleviation of symptoms and this may delay appropriate medical treatment . further , these creams may act as an irritant in some women and in fact exacerbate their symptoms . a wide variety of nontraditional therapies have been touted for their potential to combat yeast infections . the most commonly cited alternative therapies in a literature review were yogurt containing live acidophilus , boric acid tablets , garlic , and tea tree oil . however , our search did not uncover any otc products utilizing these ingredients that bore a label claiming to  cure most vaginal yeast infections . of the alternative therapies widely available over - the - counter claiming to treat yeast infections , homeopathic remedies predominate . a variety of homeopathic treatments were not only available at the health food stores , but at least one homeopathic product was on the shelves at each venue we visited , including eckerd drug and wal - mart . homeopathic remedies as a genre were significantly less expensive with a mean price of $ 3.50 less than the intravaginal imidazoles . simplistically ,   the theory of homeopathy is to administer small doses of toxic substances to stimulate the body 's own immune response . homeopathic products are often so diluted that they no longer contain even a single molecule of the  active  substance . this accounts for the fact that homeopathic substances have little proven beneficial or harmful effects . studies have found that women with recurrent vaginal yeast infections are more likely to experiment with alternative therapies due to the lower relative cost and the difficulty of obtaining a last minute doctors appointment . an estimated 42% of patients with recurrent vaginal yeast infections have resorted to alternative therapies . the use of products not proven efficacious or approved by the cdc may delay treatment of more serious medical conditions or promote more adverse outcomes . self - treating allows women to minimize out - of - pocket costs , and avoid a costly and time consuming visit to their health care provider . however , choosing a treatment for vaginitis can be cumbersome due to the number of available products , causing the consumer to feel overwhelmed and confused . most topical agents for treating vulvovaginal candidiasis are available otc , packaged in the one , three , or seven - day treatments . these products are of equal efficacy , allowing the consumer to purchase a treatment based on the ease of use and price . consumers should be aware that vaginal anti - itch creams and homeopathic remedies have not - proven efficacy in any rtcs and homeopathic treatments likely do not contain enough  active  substance to merit an effect . the price discrepancy among treatments may lure the consumer towards treatments that have little or no proven efficacy . it should be noted that these products cost an average of two to three times more than the vaginal anti - itch creams and homeopathic remedies . the authors recommend that physicians be directive in their counseling of patients about which otc products women should purchase once diagnosed with a yeast infection .