Vaginal thrush

What is vaginal thrush?

Vaginal thrush is a common yeast infection caused by the candida species of fungus. It is easily treated and can be prevented. It is also called vaginal candidiasis.

Thrush occurs in many areas of the body, but especially in the vagina, anus and mouth.

Vaginal thrush can affect women of any age, although it is more common in women between the ages of 15 and 50 years old. It is unusual in girls who have not yet begun their periods and in older women after menopause.

What are the symptoms of vaginal thrush?

The most common symptoms are itchiness, irritation, swelling and redness in and around the vagina. You might also notice:

• a thick, white or creamy vaginal discharge, which may look like cottage cheese
• pain and/or discomfort during sexual intercourse
• a burning or stinging sensation when urinating

Up to 1 in 5 women with vaginal thrush do not experience noticeable symptoms.

What causes vaginal thrush?

Most thrush is caused by the fungus candida albicans. This fungus exists naturally in the vagina, mouth, bowel and elsewhere. Normally, it causes no problems. But in some circumstances, the balance of normal bacteria and fungi in the body changes and the fungus starts to multiply and cause symptoms.

This can happen:

• when taking antibiotics; these upset the normal balance of bacteria on the skin and in the body
• during a period, or in pregnancy, when hormonal changes make the vagina more prone to thrush
• in people with certain other illnesses, such as diabetes or a poorly functioning immune system

Thrush is not a sexually transmitted infection (STI) and many people already have a small amount of candida in their bodies before they have sexual contact with a partner. In fact, the organism is more common in people who are not sexually active.

However, sexual activity can worsen thrush and the infection can make sex uncomfortable.

When should I see a doctor?

You should see a doctor if:

• you have a smelly discharge, sores on the skin around the vagina, abnormal vaginal bleeding or pain in the tummy
• this is the first time you’ve had symptoms of thrush
• the symptoms don’t clear up with over the counter treatments after 7 to 14 days
• you have 4 or more yeast infections a year
• you are aged under 16 or over 60
• you have diabetes
• you are pregnant or breastfeeding
• you are worried you or your partner could have a sexually transmitted infection (STI)

If you have had thrush before and treated it successfully, but it was more than 6 months previously, then it is fine to treat it yourself without seeing a doctor.

However, if you are pregnant and have thrush (or think you might have thrush), you should see your doctor before starting any treatment.

How is vaginal thrush diagnosed?

Thrush can be confused with other conditions that cause itching and redness with or without discharge. These other conditions include herpes infections and bacterial infections.

Your doctor will examine you and take a swab or do further tests to confirm the diagnosis. If you get thrush a lot, they may also want to rule out other medical conditions like diabetes or HIV.

How is vaginal thrush treated?

The treatment of thrush is usually very simple. The most effective treatment is pessaries (dissolving tablets) or cream inserted into the vagina. You can buy this over the counter from a pharmacy. Other options are tablets that also do not require a prescription. These medications kill the fungus that causes thrush.

You can also buy over the counter creams to relieve the soreness and itchiness around the vagina. Ask your pharmacist for advice.

During treatment, avoid irritants such as soaps, bath oils, bubble baths, spermicides, vaginal lubricants and vaginal hygiene products.

Avoid taking oral thrush treatments if you’re pregnant or breastfeeding, and use one of the other methods instead. Babies can also develop thrush once they are born. Thrush in babies can be easily treated too. Parents are advised to visit their doctor or ask their health visitor for advice.

Treatment is not usually needed for a sexual partner of someone who has thrush, unless they have symptoms. If you have a sexual partner, be aware that vaginal creams can damage latex condoms, diaphragms and cervical caps.

In most cases, treatment will relieve the symptoms. However, some women may have thrush that keeps coming back, and others seem to get it almost continually. In these instances, doctors may prescribe longer courses of treatment.

You should seek medical advice if:

• the treatment you are using for vaginal thrush is not working
• you keep getting thrush despite treatment
• you start to feel unwell, particularly if you think you have a high temperature
• you have a weakened immune system

Can vaginal thrush be prevented?

Some women find taking preventative measures to stop vaginal thrush doesn’t seem to help much, but others find they do make a difference. So it makes sense to try the following:

• Change underwear daily and wash underwear in hot water (this destroys fungi).
• Candida likes moist, warm places. Avoid wearing tight-fitting clothing like jeans and pantyhose, and underwear made from synthetic fibres and panty liners.
• Avoid douching, or taking baths with bubble-bath, soap and bath salts, as these can upset the natural balance of the vagina.
• Avoid staying in wet clothes like swimming costumes for a long time.
• Don’t take antibiotics unless you really need them.
• Don’t clean the skin around your vagina more than once a day. You can use water and a moisturiser as an alternative to soap.
• If you have diabetes, keep your blood sugar levels under control.
• Always wipe from front to back after going to the toilet.

There isn’t any good evidence that changing your diet will help prevent thrush, although some women find that eating yoghurt or other products containing lactobacilli (so-called ‘good’ bacteria), will help. But applying plain yoghurt directly to the vagina won’t help in treating or preventing thrush.