I wonder if we should coin a new phrase for women with no actual symptoms of
yeast infection who are convinced they have infections?  There is actual
pain, and I'm certain the pain is real, and that there is a reason the mother
is feeling it.  I just hate for all cases where this pain is somewhat
mysterious in origen to be lumped together in the catch-all of "yeast".  I
certainly see women and babies with physical symptoms indicative of
candidiasis.  There are appropriate treatments for these nursing couples --
both traditional and non-traditional.  But pain in the absence of symptoms
demands  better detective work than just telling people to eat vegies and
boil their undies for months on end.  Probably 3/4 of the "yeast" visits I
see ultimately turn out to be other things.  Many are related to some kind of
dermatitis.  Most are trauma from poor attachment to the breast -- which is
such a basic thing, but must have gotten boring or something, because it is
too easily discounted by most people working with nursing moms. Rarer issues
include oral anatomy "fit" problems (tongue-tie, receeding chin, high
palate). Milk supply issues cause problems too. Low milk supply tends to
create a situation where baby generates excessive negative pressure on the
nipple causing star-burst splitson the tip. Too much milkcan cause baby to
crimp-off and crease the nipple trying to slow the flow.  Once again I refer
people to Lisa Amir's JHL article on eczema in the nursing mother, and to
Michael Woolridges articles "The aetiology of sore nipples," Midwifery
1986,2:172-6 and The 'anatomy' of infant sucking"
Midwifery 1986 2:164-7.  I'll say again:  if you treat conscientiously for
candida and you still have pain, its probably not candida -- even if it
started out being at least partly a yeast problem.
Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx