More than 75% of women and people assigned female at birth will get a vaginal yeast infection at some point¹. Luckily, there are many ways to treat and ease these symptoms. This article will look at over-the-counter remedies, prescription drugs, and natural treatments. It will also cover how to prevent and manage these infections.

Key Takeaways

• Vaginal yeast infections are a common condition that affect millions of people each year.
• Diagnosis typically involves a pelvic exam, medical history, and testing of vaginal secretions².
• Treatment options range from short-course vaginal therapy to oral antifungal medications, depending on the severity of symptoms².
• Natural remedies like yogurt, honey, and essential oils may provide relief, but have not been scientifically proven to cure yeast infections³.
• Recurrent or severe yeast infections may require long-term antifungal medication treatment¹.

What is a Vaginal Yeast Infection?

A vaginal yeast infection, also known as vaginal candidiasis or vulvovaginal candidiasis, is a fungal infection. It happens when Candida yeast grows too much in the vagina⁴. This yeast is usually harmless but can cause problems if it gets out of balance⁴.

Causes of Vaginal Yeast Infections

Many things can make you more likely to get a vaginal yeast infection⁴. Antibiotics, hormonal changes, a weak immune system, diabetes, and tight or damp clothes are some of these factors⁴. Wearing wet swimsuits, not changing clothes quickly, and using scented products can also increase the risk⁴.

Symptoms of Vaginal Yeast Infections

Symptoms of a vaginal yeast infection can be mild or severe⁵. You might feel itching, irritation, redness, swelling, burning, and have a thick, white discharge⁵. In worse cases, you could see a lot of redness, swelling, and even sores⁵.

It’s important to know that⁴ up to 75% of women or individuals assigned female at birth (AFAB) will get a yeast infection at some point⁶. Over half of these people will have two or more infections⁵. Yeast infections are very common, second only to bacterial vaginosis⁴.

“Anyone with a vagina can get a yeast infection, most commonly after puberty and before menopause.”⁴

Diagnosing a Yeast Infection

Diagnosing a yeast infection usually means a healthcare provider will ask about your health history. They will also do a pelvic exam to check the vagina and cervix⁷. Sometimes, they might test a sample of vaginal fluid to find the fungus causing the infection⁸.

This step is key because some symptoms can mean other health issues, like infections from bacteria or other infections you can get from sex⁸. Knowing the exact cause is important for the right treatment.

There are different ways to test for yeast infections, based on where the symptoms are⁸. For infections in the vagina, doctors do a pelvic exam and look at a sample of discharge under a microscope or do a fungal culture test⁹. If the infection is in the mouth, throat, or esophagus, doctors will look at samples from there⁹.

For infections in the bloodstream or organs inside the body, doctors use the patient’s health history, symptoms, and lab tests to figure it out⁹.

It’s important to get an accurate diagnosis because yeast infections can be like other infections in how they show up⁸. Early tests and treatments are key, especially for infections in the mouth, throat, and esophagus, especially if your immune system is weak⁹.

About 5 to 9 percent of women get yeast infections often, which means three or more times a year⁷. These can be caused by different types of Candida fungus⁷. Women taking antibiotics or with diabetes may get these infections more easily⁷.

Probiotics don’t help prevent yeast infections and shouldn’t be used as a treatment⁷. These infections are more common in people with weak immune systems, like those on steroids or with HIV⁷. Women on birth control pills are also more likely to get them⁷. But, these infections aren’t spread through sex⁷.

If you think you have a yeast infection, see a doctor for the right diagnosis and treatment⁷. Knowing what’s causing it is key to treating it right and preventing more problems⁷.

Between 5 and 9 percent of women get yeast infections often, which means three or more times a year⁷. These can be caused by different types of Candida fungus⁷. Women taking antibiotics or with diabetes may get these infections more easily⁷.

Probiotics don’t help prevent yeast infections and shouldn’t be used as a treatment⁷. These infections are more common in people with weak immune systems, like those on steroids or with HIV⁷. Women on birth control pills are also more likely to get them⁷. But, these infections aren’t spread through sex⁸.

Over-the-Counter Yeast Infection Treatments

For mild to moderate vaginal yeast infections, over-the-counter (OTC) treatments can help. These include creams and suppositories with antifungal meds like miconazole (Monistat) or clotrimazole (Gyne-Lotrimin)¹⁰. These options usually work in 1 to 7 days to ease symptoms¹⁰.

Vaginal Creams and Suppositories

Vaginal creams and suppositories are top choices for OTC yeast infection treatments¹⁰. They are put into the vagina to help balance yeast and bacteria¹⁰. You can find these treatments at stores like Walgreens, Walmart, and Rite Aid, offering various options for different symptoms¹¹.

Safety Tips for OTC Treatments

When using OTC yeast infection treatments, follow the instructions closely and finish the treatment¹⁰. Stay away from scented feminine hygiene products, as they can make things worse¹⁰. It’s smart to talk to a healthcare provider before starting treatment at home for a professional check-up and advice¹⁰.

Be careful with latex condoms and yeast infection treatments. The oils in some creams can harm the latex, so you might need to use something else for safe sex or birth control¹⁰.

Even though OTC treatments work well, remember that probiotics have mixed results in preventing yeast infections¹⁰. Some studies say eating yogurt with live cultures or taking probiotic supplements can slow yeast growth and lower the risk of getting a yeast infection¹⁰.

“It’s important to be cautious with the use of latex condoms alongside yeast infection treatments, as the oils in some creams may damage the latex, necessitating a different method for safe sex or birth control during treatment.”

In summary, OTC yeast infection treatments, like creams and suppositories, can help with mild to moderate cases. But, always follow safety tips, finish the treatment, and see a healthcare provider if things don’t get better or get worse¹⁰¹¹.

Prescription Yeast Infection Medications

For some yeast infections, over-the-counter treatments aren’t enough¹². In these cases, doctors might prescribe stronger medicines. These can be creams or suppositories for the vagina, or pills like fluconazole or ibrexafungerp¹³.

Oral Antifungal Pills

Oral antifungal pills, such as fluconazole (Diflucan), are often prescribed for yeast infections¹³. You might take one pill or a short course to slow the fungus’s growth¹³. This medicine treats many fungal infections, like those in the vagina, mouth, and lungs¹³. It’s also used to prevent infections in some medical treatments¹³.

These pills can clear yeast infections with just one dose¹⁴. Fluconazole stays in the body for at least 72 hours, helping to fight the infection¹⁴. But, it can cause side effects like headaches and stomach pain¹³. Serious side effects like nausea and seizures are rare but need immediate medical help¹³.

Resistance to fluconazole (Diflucan) is rare, but it can happen¹⁴. If so, doctors might use other medicines like ibrexafungerp (Brexafemme)¹⁴.

Prescription antifungal pills can help if over-the-counter treatments don’t work¹². Always talk to a healthcare provider to find the right treatment for you¹².

Yeast Infection Treatment

Treating yeast infections depends on how bad they are¹⁵. For mild to moderate infections, a short treatment is usually enough. But, if they’re severe or keep coming back, you might need a longer treatment¹⁶.

Short-Course Vaginal Therapy

For yeast infections, a short treatment of 3 to 7 days is common¹⁵. This can be creams, tablets, or suppositories put into the vagina. These quick treatments work well and are often the first choice for doctors¹⁷.

Long-Course Vaginal Therapy

Severe or recurring yeast infections might need a longer treatment¹⁵. This could be up to two weeks of antifungal medicine, then a weekly dose for months¹⁵. This plan helps fix the root cause and stop future infections¹⁶.

Treatment Type	Duration	Medication Form
Short-Course Vaginal Therapy	3-7 days	Creams, Tablets, Suppositories
Long-Course Vaginal Therapy	Up to 2 weeks, followed by weekly maintenance	Antifungal Medications

It’s key to follow your doctor’s advice and finish all your treatment¹⁷. With the right treatment, yeast infections can clear up in a few days to a week¹⁵.

“Antifungal medications are the most effective treatment for yeast infections and are available in various forms such as oral medications, topical creams, ointments, and suppositories for vaginal yeast infections.”¹⁵

Natural Remedies for Yeast Infections

Some people look into natural remedies for yeast infections instead of over-the-counter or prescription options. These include boric acid suppositories and supplements like garlic and probiotic-rich foods like yogurt¹⁸. But, it’s important to talk to a healthcare provider before trying these home remedies.

Studies show that some natural ingredients can fight the fungus causing yeast infections. For example, a 2022 study found that a 5% boric acid gel helped reduce symptoms in mice¹⁸. A 2012 study showed that nearly 87% of women with chronic yeast infections got better with a probiotic pill¹⁸. Also, a 2006 review mentioned that certain probiotics in yogurt can fight vaginal infection-causing yeasts¹⁸.

Other natural options like garlic, coconut oil, and oil of oregano also have antifungal effects against Candida albicans¹⁸. But, we need more research to know if these work well for humans. It’s best to talk to a healthcare provider, especially if you’re pregnant or have other health issues¹⁸¹⁹.

Some people use natural remedies along with over-the-counter or prescription meds for yeast infections. A study found that 89% of people using vaginal Lactobacillus capsules and medication stayed clear of yeast infections for a year²⁰. This shows that combining natural and conventional treatments might help some people.

Remember, natural remedies can help some people, but they’re not a full replacement for medical care. If your symptoms don’t get better or get worse, you should see a healthcare provider for the right care¹⁹.

In conclusion, while natural remedies for yeast infections might seem promising, we need more proof of their effectiveness. They should be used carefully and with a healthcare professional’s advice. The best treatments for yeast infections are still over-the-counter and prescription options, backed by strong scientific evidence¹⁸²⁰¹⁹.

Preventing Recurrent Yeast Infections

For those who often get yeast infections, making some lifestyle changes can help stop them from happening again²¹. Things that can cause yeast infections include antibiotics, certain birth control methods, pregnancy, diabetes, and some medicines that weaken the immune system²². If you get four or more yeast infections a year without antibiotics, and they have symptoms, it’s considered recurring.

Lifestyle Changes to Prevent Yeast Infections

• Avoid tight or damp clothing that can create a moist environment and promote yeast growth²².
• Use unscented feminine hygiene products, as fragrances can irritate the delicate vaginal area²².
• Maintain good vaginal hygiene by keeping the area clean and dry²².
• Manage any underlying health conditions, such as diabetes, that can increase the risk of yeast infections²¹.
• Incorporate probiotic-rich foods or supplements into your diet to help maintain a healthy vaginal microbiome and reduce the likelihood of yeast overgrowth²¹.

For those with recurring yeast infections, there are ways to prevent them²¹. Options include longer treatment courses or using certain creams²¹. Taking fluconazole weekly or using cream twice a week for six months can help²¹. If infections come back, treatments like weekly or biweekly doses can work well²¹. Boric acid tablets can also be used, but they’re dangerous if swallowed and should be kept away from kids and pets²¹.

Not all home remedies work for yeast infections²¹. Probiotics and yogurt aren’t proven to prevent them²¹. If you think your birth control is causing infections, you might want to switch it or ask for fluconazole before taking antibiotics²².

By making these lifestyle changes and trying effective treatments, you can lower the risk of getting yeast infections again²². If you keep getting infections, you might need more tests to check for diabetes or HIV²².

When to See a Doctor

If you have a mild yeast infection, it might go away on its own or with over-the-counter treatments. But, if symptoms don’t get better or get worse, you should see a healthcare provider²³²⁴. A doctor can give you the right diagnosis, check for other possible causes, and suggest better treatment if needed²³²⁴.

If you have a weak immune system, have health issues, or are pregnant, talk to a doctor before treating a yeast infection²³. This is because chronic or frequent yeast infections might mean you have an underlying condition, like uncontrolled diabetes, that needs more attention²⁴²⁵.

• See a doctor if it’s your first yeast infection to get the right diagnosis and treatment²⁴.
• Get medical advice if over-the-counter treatments don’t work to clear up a yeast infection²⁴.
• Consult a doctor if symptoms look like a yeast infection after having sex with a new partner, as it might need different treatment²⁴.

It’s best to see a doctor for any yeast infections that keep coming back, as they can give you the best treatment and check for other health issues²³²⁴²⁵.

“Frequent yeast infections can be a sign of an underlying medical condition, so it’s important to see a doctor for proper diagnosis and treatment.”

If you keep getting yeast infections, don’t wait to get medical help. Your doctor can give you the help you need to manage your condition and avoid any problems²³²⁴²⁵.

Yeast Infection Treatment During Pregnancy

Vaginal yeast infections are common in pregnant women due to hormonal changes²⁶. These hormonal shifts can upset the balance in the vagina, letting the Candida fungus grow too much²⁶.

Some over-the-counter treatments might be safe for pregnant women, but it’s key to talk to a healthcare provider first²⁶. Medicines like fluconazole (Diflucan) are usually avoided during pregnancy because they could harm the baby²⁷.

Doctors might give pregnant women special antifungal creams or suppositories like clotrimazole (Lotrimin) or miconazole (Monistat)²⁶. These are safe because they’re applied directly to the affected area and don’t get absorbed by the body much²⁶.

To ease the discomfort of a yeast infection during pregnancy, you can try cold compresses, warm baths with baking soda or Epsom salt, and unscented baby wipes²⁸. Wearing cotton underwear and using hydrocortisone cream for itching can also help²⁸. Keeping clean and changing wet clothes quickly can also stop yeast infections from coming back²⁸.

Only a doctor can truly diagnose a yeast infection, so self-diagnosis can lead to wrong treatment²⁶. Pregnant women with symptoms should see a doctor for the right treatment²⁸.

Some think probiotics like yogurt with live cultures can help prevent yeast infections, but there’s not enough proof for pregnant women²⁶. Expectant mothers should talk to their doctors for advice on managing yeast infections and keeping their vagina healthy²⁸.

“Proper diagnosis and treatment by a doctor are crucial for managing yeast infections during pregnancy.”

Complications of Untreated Yeast Infections

Yeast infections are very common, with 75% of women getting them at least once in their lives²⁹. If not treated, these infections can cause serious health problems.

Untreated yeast infections can spread to other body parts. They can irritate the skin, cause bleeding, and open sores²⁹. Men can get balanitis, an inflammation near the penis head, from these infections²⁹. If ignored, it can turn into balanoposthitis, affecting the foreskin.

Oral thrush, a yeast infection in the mouth, often affects babies and young kids²⁹. It’s more likely in people with diabetes, those eating a lot of sugar, or with poor mouth care²⁹. It can move to the esophagus or bloodstream, causing serious health issues²⁹.

Yeast infections aren’t contagious like viruses and aren’t STIs²⁹. But, they can spread through sex, especially in people with weak immune systems³⁰. They can also lead to early delivery, miscarriage, and spreading to partners if not treated³⁰.

Untreated yeast infections can cause a lot of problems, from skin issues to serious infections like bloodstream infections²⁹. Getting treatment quickly and keeping clean is key to handling these infections.

Tips for Managing Yeast Infection Symptoms

Hygiene and Lifestyle Adjustments

If you’re facing the discomfort of a vaginal yeast infection, there are steps to help you feel better³¹. Keeping the genital area clean and dry is key to reducing irritation³². Wearing loose, breathable clothes and avoiding tight pants can also help a lot. Plus, skip scented feminine products to avoid making things worse³².

Using a cold compress on the vulva can ease inflammation and discomfort³². It’s wise to avoid sex until the infection clears up to prevent spreading it or new symptoms³². These simple actions can help manage yeast infection symptoms and aid in healing.

“Yeast infections can be a frustrating and uncomfortable experience, but with the right approach, you can take steps to manage the symptoms and get back to feeling your best.”

If symptoms don’t go away or get worse, or if you’re unsure, see a healthcare provider³². They can offer tailored advice and may prescribe stronger treatments for the infection³³³¹³².

Yeast Infections and Oral Contraceptives

Using birth control pills can make getting a vaginal yeast infection more likely³⁴. This happens because the hormones in these pills can mess with the balance of bacteria and yeast in the vagina. This leads to too much Candida³⁴³⁵³⁶.

Some types of birth control make getting yeast infections more common³⁴. Hormonal pills can upset the natural balance of hormones, letting yeast grow too much³⁴. Also, things like spermicidal jellies and creams can change the bacteria in the vagina, causing yeast to grow too much³⁴.

If you keep getting yeast infections while on oral contraceptives, you might want to talk to your doctor about other options³⁵³⁶. Things like hormonal changes near your period, stress, antibiotics, a weak immune system, and high blood sugar can also make yeast infections more likely³⁶.

Some hormonal birth control methods can make getting a yeast infection more likely because they change the body’s natural hormone balance³⁶. This can lead to too much yeast, like Candida, growing. This is more common with methods that have estrogen and progestin³⁶.

The vaginal ring is less likely to cause yeast infections than other hormonal birth control because it has lower hormone levels³⁶. Using low-dose oral contraceptives or progestin-only pills might also lower the chance of getting yeast infections³⁶.

If over-the-counter treatments don’t work, a doctor might give you a stronger medicine like fluconazole³⁴. If you keep getting yeast infections, you might need to take antifungal medicine regularly³⁴. Keeping track of what might cause your infections can help you avoid them³⁴.

Changing your lifestyle can also help prevent yeast infections. This includes wearing cotton underwear, avoiding tight clothes, and keeping your vagina clean³⁴³⁶.

“Hormonal birth control can increase the risk of yeast infections, with the risk being highest within the first month of starting the birth control method and decreasing over time.”³⁵

Yeast Infections and Diabetes

People with diabetes, especially those with high blood sugar, are more likely to get vaginal yeast infections³⁷. High blood sugar makes a perfect place for Candida yeast to grow³⁷. Managing diabetes with medicine, diet, and lifestyle changes can lower the chance of getting these infections³⁷.

Research shows a strong link between diabetes and yeast infections³⁸. A 2018 study with over 300,000 people found that those with diabetes were more likely to get infections, including yeast infections³⁷. Keeping blood sugar levels in check can help lower the risk for people with diabetes³⁸.

Diabetes can cause yeast to grow too much by giving extra sugar to skin cells and mucous glands³⁷. A 2009 study in the American Journal of Obstetrics and Gynecology found that diabetes can make the vaginal area more acidic, helping yeast grow³⁷. People with diabetes who have trouble managing their diabetes are more likely to get recurring yeast infections³⁷.

If left untreated, a yeast infection in someone with diabetes can spread and become serious, even life-threatening³⁷. If yeast infections keep coming back, a doctor might suggest oral antifungal medicine like fluconazole (Diflucan)³⁷.

To avoid fungal infections, wear loose, breathable clothes, skip scented hygiene products, and keep clean³⁷. People with diabetes should get checked for vaginal yeast infections now and then³⁸.

Uncontrolled type 2 diabetes makes yeast infections more likely because yeast loves high blood sugar³⁹. Some diabetes drugs, like SGLT-2 inhibitors, might make yeast infections worse³⁹.

For yeast infections, treatments range from prescription meds like Diflucan to over-the-counter creams like Lotrimin AF³⁹. To prevent infections, keep blood sugar in check, eat low-carb, drink plenty of water, exercise, take your diabetes medicine, and wear cotton underwear³⁹.

“Maintaining good blood sugar control is key to reducing the risk of yeast infections for individuals with diabetes.”

Recurring Yeast Infections

Vaginal yeast infections can be a real challenge for many women. They happen when you get three or more infections each year. This issue affects about 5 to 9 percent of women⁴⁰. These infections are tough to treat because the Candida yeast might not respond to standard treatments like azoles.

Azole-Resistant Therapy

When yeast infections don’t respond to azole treatments, doctors look for other options. They might suggest boric acid suppositories or longer courses of oral antifungal meds⁴⁰. It’s also key to find out why these infections keep coming back, like diabetes or a weak immune system.

About 25 to 33 percent of women get yeast infections from antibiotics⁴⁰. Women with diabetes, especially those who don’t control their blood sugar, are more likely to get these infections⁴⁰. Using birth control pills with estrogen can also increase the risk⁴⁰.

Keeping blood sugar under control can prevent yeast infections in women with diabetes⁴⁰. But, wearing clean clothes or loose clothes doesn’t help prevent them⁴⁰.

Severe cases of recurring yeast infections take longer to get better⁴¹. Sometimes, a different type of Candida is causing the problem⁴¹. Doctors usually treat simple infections with 1-6 days of medication. But for complicated cases, treatment can last up to 14 days⁴¹.

Up to 20% of recurring yeast infections are caused by nonalbicans fungi, which fluconazole might not cure⁴². In these cases, other antifungal drugs or treatments like clotrimazole or boric acid might work better⁴².

Understanding why yeast infections keep coming back and the treatment options can help women work with their doctors for lasting relief⁴⁰⁴¹⁴².

Conclusion

Vaginal yeast infections are common and can be treated with over-the-counter and prescription meds, plus some natural remedies⁴³. Most infections go away within a week with the right treatment⁴³. In fact, about 75% of women get a yeast infection at least once in their lives⁴⁴.

Knowing what causes yeast infections, like antibiotics, diabetes, and hormonal changes⁴⁴⁴⁵, helps in preventing and treating them. This can lead to better vaginal health and well-being⁴³⁴⁴⁴⁵. Treatments include over-the-counter antifungal drugs for mild infections⁴³. For severe cases, prescription meds and natural remedies are used⁴³⁴⁴⁴⁵.

If symptoms don’t get better or get worse, seeing a healthcare provider is key for the right diagnosis and treatment⁴⁵. Regular check-ups and good hygiene can lower the chance of getting yeast infections again⁴⁴. Taking care of yeast infections quickly and effectively helps women stay healthy and happy.

FAQ

What is a vaginal yeast infection?

A vaginal yeast infection, also known as vaginal candidiasis or vulvovaginal candidiasis, is a type of fungal infection. It happens when Candida yeast grows too much in the vagina.

What are the common causes of vaginal yeast infections?

Common causes include antibiotic use, hormonal changes, and weakened immune systems. Diabetes and wearing damp or tight clothes also play a part.

What are the typical symptoms of a vaginal yeast infection?

Symptoms include itching, irritation, redness, swelling, a burning sensation, and a thick, white, odorless discharge.

How are vaginal yeast infections diagnosed?

A healthcare provider will ask about your medical history, do a pelvic exam, and test vaginal fluid. This helps identify the fungus causing the infection.

What are the over-the-counter treatment options for vaginal yeast infections?

Over-the-counter options include creams and suppositories with antifungal meds like miconazole, clotrimazole, and tioconazole.

What safety tips should be followed when using over-the-counter yeast infection treatments?

Always read the instructions, finish the treatment, and avoid scented feminine hygiene products. They can make things worse.

What prescription medications are used to treat vaginal yeast infections?

Prescription treatments include creams or suppositories with terconazole. Oral pills like fluconazole (Diflucan) or ibrexafungerp (Brexafemme) are also used.

What are the different types of yeast infection treatment durations?

Mild to moderate infections usually need a short treatment, like 3-7 days of antifungal creams or suppositories. Severe or recurring infections might need up to two weeks of treatment, followed by weekly maintenance doses for months.

What are some natural remedies for vaginal yeast infections?

Natural remedies include boric acid suppositories and supplements like garlic and probiotic-rich foods like yogurt. But, it’s best to talk to a healthcare provider before trying these remedies.

What lifestyle changes can help prevent recurrent yeast infections?

To prevent recurring infections, avoid tight or damp clothes, use unscented feminine hygiene products, and keep the genital area clean. Managing diabetes can also help.

When should someone see a doctor for a yeast infection?

See a doctor if symptoms don’t go away or get worse, or if you keep getting yeast infections. They can give you the right treatment and check for other problems.

How are yeast infections treated during pregnancy?

Pregnant women should talk to a healthcare provider before using any treatments. Some over-the-counter options might be safe, but others could harm the baby. Pregnant women might get special antifungal creams or suppositories.

What are the potential complications of untreated yeast infections?

Untreated infections can spread, increase the risk of other infections, and cause chronic or recurring infections. They can also make sex painful, lead to urinary tract infections, and affect pregnant women’s health.

What tips can help manage yeast infection symptoms?

Manage symptoms by keeping the genital area clean and dry, wearing loose clothes, avoiding scented products, using cold compresses, and not having sex until the infection clears up.

How can oral contraceptives affect the risk of yeast infections?

Oral contraceptives can make yeast infections more likely. The hormonal changes they cause can upset the balance of bacteria and yeast in the vagina.

How do yeast infections and diabetes relate?

Diabetes, especially if not well-controlled, raises the risk of yeast infections. High blood sugar levels create a perfect environment for Candida yeast to grow.

What are the treatment options for recurring yeast infections?

For recurring infections, a healthcare provider might suggest different treatments. This could include boric acid suppositories or longer courses of oral antifungal medication. This is because the yeast might have become resistant to standard treatments.

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42. Twice weekly maintenance therapy ideal for recurrent yeast infections – https://www.contemporaryobgyn.net/view/twice-weekly-maintenance-therapy-ideal-for-recurrent-yeast-infections
43. How long does a yeast infection last? – https://www.medicalnewstoday.com/articles/321342
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