Vulvovaginal candidiasis (VVC) is the second most common cause of vaginal infection globally, associated with adverse reproductive and obstetric outcomes. Traditional antifungal treatments, while effective, face challenges such as drug resistance, recurrence, and side effects. Alternative therapies, including probiotics, postbiotics, synbiotics, and vaginal microbiota transplantation (VMT), are being explored to address these issues. Probiotics, such as Lactobacillus strains, help restore vaginal microbiota balance by competing with pathogens, producing antimicrobial compounds, and modulating immune responses. Postbiotics, derived from microbial metabolites, offer a safer alternative with longer shelf life and predictable mechanisms. Synbiotics combine prebiotics and probiotics to enhance microbial growth and immune function. VMT, a promising live biotherapeutic approach, involves transferring healthy vaginal microbiota to restore balance. Despite their potential, challenges such as safety, standardization, and long-term effects remain. Further research is needed to optimize these therapies for VVC management.Vulvovaginal candidiasis (VVC) is the second most common cause of vaginal infection globally, associated with adverse reproductive and obstetric outcomes. Traditional antifungal treatments, while effective, face challenges such as drug resistance, recurrence, and side effects. Alternative therapies, including probiotics, postbiotics, synbiotics, and vaginal microbiota transplantation (VMT), are being explored to address these issues. Probiotics, such as Lactobacillus strains, help restore vaginal microbiota balance by competing with pathogens, producing antimicrobial compounds, and modulating immune responses. Postbiotics, derived from microbial metabolites, offer a safer alternative with longer shelf life and predictable mechanisms. Synbiotics combine prebiotics and probiotics to enhance microbial growth and immune function. VMT, a promising live biotherapeutic approach, involves transferring healthy vaginal microbiota to restore balance. Despite their potential, challenges such as safety, standardization, and long-term effects remain. Further research is needed to optimize these therapies for VVC management.