Vaginal thrush, medically referred to as candida albicans, is a common condition caused by a yeast infection in the vagina and surrounding area. It is also called vaginal yeast infection or candidal vulvovaginitis, also known as vulvovaginal candidiasis. The yeast infection is normally kept under control by harmless bacteria, but sometimes conditions change and the yeast increases rapidly.
Vaginal thrush is often unpleasant and uncomfortable, but the good news is it can usually be treated with over-the-counter medication or a prescription from your doctor. However, for some women, it can be difficult to treat and keeps recurring.
Vaginal thrush is a common condition and it is estimated that three out four women, i.e. 75%, will develop the infection in their lifetime and half of these will have repeat infections of one or two episodes.
What Causes Vaginal Thrush?
If you think you have thrush, you are not alone. For many women it is a taboo subject, but it is common and nothing to be ashamed of.
Vaginal thrush is caused by yeasts from a group of fungi called Candida. Both fungus and bacteria naturally live in your vagina, but when the fungus candida albicans increases, it can cause thrush. This fungus may increase when your immune system is weak or when good bacteria - called lactobacilli - can’t keep the fungus under control.
It is not clear why some women are more prone to thrush than others, but it is most common in women who:
are in their twenties and thirties – thrush is less common in girls who haven't started their periods and women who have been through the menopause
have sex when they are not fully aroused or they are worried it may hurt – this can lead to vaginal dryness and tightness during sex, which can trigger thrush
take antibiotics - about 30 per cent of women will have thrush because of this
have poorly controlled diabetes
have a weakened immune system as stated earlier – for example, because of a condition such as HIV or a treatment such as chemotherapy
take birth control pills
are experiencing menstrual cycle changes
have associated vulval skin conditions, such as eczema
Other potential thrush triggers include:
wearing tight clothing – which prevents natural ventilation
using products that irritate the vagina, such as vaginal douches or bubble bath
Vaginal thrush isn't classed as a sexually transmitted infection (STI), but it can be triggered by sex (particularly if you have trouble relaxing and your vagina is dry). However, there's a very small risk of passing the condition on during sex, so you may want to avoid having sex until it's cleared up.
Some vaginal thrush treatments can also weaken latex condoms and diaphragms, so you may want to avoid having sex or use another form of contraception during treatment and for a few days afterwards.
Symptoms of Vaginal Thrush
Symptoms you may experience if you develop vaginal thrush include:
itching, irritation and soreness around the entrance of the vagina (vulva) or the vaginal lips (labia)
redness or swelling of the vagina or vulva
vaginal discharge – this is usually odourless and may be thick and white (like cottage cheese), or thin and watery
a stinging or burning sensation when peeing or during sex
splits in the genital skin
When to see the doctor
If you've had thrush before and think you have it again, you can normally treat it with medicines bought from a local pharmacy.
If you've never had thrush before and you think you may have it, visit your doctor. Once you recognise your own symptoms and you know they’re not serious, with your doctor’s help, you will be able to deal with thrush independently at home. Thrush doesn’t take long to clear up once you’ve started treatment.
It's a good idea to get medical advice from your doctor or a sexual health clinic if:
you have thrush for the first time
you're under the age of 16 or over 60
you're pregnant or breastfeeding
you have unusual symptoms, such as coloured or smelly discharge, or sores on the vulva
you have abnormal vaginal/menstrual bleeding or pain in your lower tummy
you have vaginal ulcers or blisters
you've had two episodes of thrush within the last six months
you've reacted badly to antifungal treatment in the past, or it didn't work
you or your partner have previously had a sexually transmitted infection (STI) and you think it might have returned
your symptoms don't improve after 7-14 days of treatment
Thrush isn't usually anything to worry about in these cases, but your doctor may want to run some tests.
They can also advise you about the most suitable treatment and give you a prescription, if necessary.
How is Vaginal Thrush Diagnosed?
Most doctors will treat thrush without a test because the symptoms are usually obvious. If unsure, your doctor will take a swab from your vagina to confirm the diagnosis and/or carry out tests to check for any underlying cause.
The test will also show if the symptoms are being caused by other common conditions, such as bacterial vaginosis or trichomonas.
Since thrush is not viewed as an STI, so your partner will not need to be tested or treated unless he or she also has symptoms.
How to Treat Vaginal Thrush
If symptoms are mild, your doctor will usually recommend a short course of antifungal medicine, usually for one to three days. If the symptoms are more severe, the treatment course will be longer.
A variety of treatment options are available including taking tablets orally, inserting them into your vagina (pessaries) or using a cream. Tablets and pessaries work equally well.
For one in five women short courses of antifungal medication may not work. If your symptoms don't clear up within 7 to 14 days, your doctor may recommend you take a regular 'maintenance dose' of antifungal treatment.
Recent studies have shown this strategy can significantly help reduce the recurrence of thrush. Using a tablet of fluconazole once a week appears to be effective in preventing thrush from coming back. Ask your doctor for advice.
Prognosis of Vaginal Thrush
The prognosis is good and most women with thrush will respond to antifungal treatment. In some instances, such as in immunocompromised women and those with poorly controlled diabetes, thrush may result in a more severe disease with widespread systemic fungal infection.
How to Prevent Vaginal Thrush
As well as using antifungal medicines, there are a number of things you can do to help ease thrush symptoms:
Wash your vaginal area with non-perfumed soap and water, or use water alone. You can use water and an emollient (moisturiser) soap substitute to clean the vulva (the vaginal area) if you prefer using soap, but avoid cleaning this area more than once a day.
Avoid using antiseptics, highly-scented soaps, shower gels, vaginal deodorants or douches.
Avoid wearing tight-fitting clothes made of artificial fibres such as nylon. Tight or synthetic clothes stop air flow providing a moist area, which is ideal for bacteria and fungi to grow.
Sleep naked and spend time naked at home to air your genitals.
Whenever possible, wear cotton underwear and loose-fitting clothing.
Avoid using latex condoms, spermicidal creams and lubricants if they cause irritation. Instead, try using non-allergenic condoms.
Don’t have vaginal sex straight after anal sex. Wash thoroughly after anal sex and use a new condom and water based lubricant before vaginal sex.
Change your tampons or pads frequently.
Ensure you wipe from front to back after going to the toilet.
Always wash your hands after you have been to the toilet and before touching the vaginal area.
Change your underwear after swimming and working out.
Wash underwear in hot water (to destroy fungi).
Avoid very hot baths.
Avoid stress and maintain a healthy lifestyle, doing so will keep your immune system strong.
Ensure your blood sugar level is kept under control, if you have diabetes.
Some women eat probiotic yoghurt or supplements to prevent vaginal thrush, but there's little evidence to suggest this works.