1. Once there are repeated vaginal infections there can be a number of physiologic barriers to healing.
2. The presence of a biofilm. Biofilm is matrix of substances produced by bacteria that caused the infection that irreversibly binds to the tissue, in this case the vagina, which then promotes further production of cells that keep the tissue destroyed and inflamed and prevent a healing. More simply put a vaginal biofilm is a layer on the walls of the vagina that is almost exclusively made by the very organisms that caused the infections in the first place. Biofilms allow organisms to resist treatments with antibiotics and antifungals. Vaginal Biofilms may thus contribute to both chronic relapsing infections as well as to resistance against bacterial or fungal organisms which cause Yeast or BV treatment, so it's something we need to gab about! There is a microscopic layer that acts as a enclosed and highly favorable nutrient environment for bacteria and yeast to exist within. If they exist within this layer then they are impenetrable to the antibiotics delivered though the blood stream in the case of oral medicines, or in the local environment as with creams and suppositories. It is why sometimes treatments seem to initially work, but then become resistant to the treatment as the organisms not in the biofilm will be eradicated, so some symptoms will resolve, and the organisms behind the biofilm will maintain their presence.
3. Non-ablative laser therapy with CO2 lasers are thought to be able to kill the biofilm and the new evidence for radiofrequency treatments is that they may be able to stop the cycle as well
4. Treating with antibiotics over a very long time may slowly penetrate the biofilm.
5. Stopping all therapy and providing immune support and changing the gut bacteria may enable the body to penetrate the biofilm from within to heal.