One hundred and two women with a history of a median of six episodes of vulvovaginal candidiasis (VVC) and 204 age-matched controls participated in a structured in-depth interview on sexual behavior. Mean and median ages of the two groups were 26.7 and 26 years, respectively. Sexual characteristics, associated with VVC in crude analyses, were adjusted in multifactorial analyses for coital frequency, experience of casual sex, vaginal irritation, smoking, alcohol habits, and having a steady partner. In addition, education, as a measure of socioeconomic status, was added in the multifactorial analyses. VVC was not associated with multiple sexual partners or ever-experience of causal sex. Sexual variables that remained significant or were of borderline significance after adjustment were: age at first intercourse (p = 0.001), causal sex partners the previous month (odds ratio (OR) = 3.1), sex during menstruation (OR = 1.7), regular oral sex (OR = 2.4), experience of anal intercourse ever (OR = 2.4), oral intercourse the last month (OR = 3.1), and frequency of oral intercourse (p = 0.02). Thus, the study indicates that certain sexual activities are associated with repeated episodes of VVC.

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A history of recurrent vulvovaginal candidiasis (RVVC) was reported by 102 women, while current vulvovaginal candidiasis (VVC) was diagnosed in 83 of the same 996 women. They had all attended two family planning and one youth clinic, respectively. Two women, without RVVC or VVC, matched for age for each case of RVVC, were selected as a comparison group (COMP). Recurrent, but not current VVC, was associated with a history of sexually transmitted disease. Those with current, but not with recurrent, VVC had significantly more often genital warts and bacteriuria (> 10(5) bacteria/ml), but significantly less often bacterial vaginosis than the COMP women. Both VVC and RVVC were inversely correlated to a vaginal flora change with a mixed anaerobic vaginal flora. Those with VVC had a greater number of lactobacilli on vaginal cultures, than those with RVVC and the women in the COMP group. VVC and a history of RVVC both occurred more frequently in women with a lactobacilli-predominated vaginal flora, as compared with those with a flora change with a mixture of anaerobic and facultative anaerobic bacteria.