Vaginal Thrush

Many women experience an occasional episode of vaginal thrush. Vaginal thrush is caused by an infection of fungal yeasts called Candida spp. The treatment choices include anti-thrush pessaries (you insert these in your vagina) or a tablet to take by mouth. If required, an anti-thrush cream, which you can rub onto the skin around your vulva (vagina), can be used. The treatment is usually effective. However, some women can experience repeated (recurring) bouts of thrush, and they may need longer treatment courses.

Your IPSA vaginal thrush consultation

When attending your IPSA clinic for your vaginal thrush consultation, you can be assured that a female IPSA practitioner will carry out your consultation. Your IPSA clinic is clean, totally confidential and quiet, and IPSA’s person-centred, holistic approach means that you will be fully involved in the consultation process. Your vaginal thrush symptoms will be taken seriously.

Your female IPSA practitioner will both explain and discuss with you the different available vaginal thrush treatment options, prior to reaching an agreement on the best method of vaginal thrush management for your particular symptoms.

What is vaginal thrush?

Thrush is a fungal yeast infection and is caused by a group of fungal yeasts called Candida spp. Small numbers of these yeasts live on your skin and around your vaginal area and are mostly harmless. Your immune system and the various harmless bacteria that also live on your skin and in your vagina usually stop the increase in Candida spp. When conditions are ripe, Candida spp. multiply. This is when they can invade your vagina, causing vaginal thrush symptoms.

Candida spp. thrive in moist, warm, and airless parts of your body; the vagina is therefore the most common site for these types of candidal infection. Other areas that are prone to these candidal infections include the mouth, groin and the nappy area (in babies).

Most thrush is due to Candida albicans, but other types of Candida spp. can also cause thrush, such as Candida glabrata and Candida tropicalis.

The symptoms of vaginal thrush

Thrush is the second most common cause for vaginal discharge. (The most common cause of a vaginal discharge is due to bacterial vaginosis. See IPSA’s bacterial vaginosis web page for more information on bacterial vaginosis.) Vaginal thrush symptoms are:

Discharge which is usually creamy white/quite thick, but sometimes watery.
Itching, discomfort, redness, or pain around your vulva (the outside of your vagina).
Pain/discomfort when having sex.
Pain/discomfort when passing urine.
Discharge that does not usually smell.

The symptoms can be minor and clear up without treatment, or they can be very irritating and will not clear up without treatment.

Thrush does not damage your vagina, and does not spread to the uterus (womb). If you are pregnant, then thrush does not harm your unborn baby.

Who gets vaginal thrush?

Over 50% of women will have thrush at least once, and often it develops with no apparent reason.

Thrush is more likely to develop if:

You are pregnant
You have diabetes
You take antibiotics
You have a weakened immune system (due to taking steroids or undergoing chemotherapy)
You are taking hormone replacement therapy or the contraceptive pill (this is currently under debate as the evidence is not yet clear)

Recurrent bouts of vaginal thrush (four or more episodes in one year) occur in about 5% of women who have had their first bout of vaginal thrush, but it is not known why some women experience recurrence whilst most do not. Some women unfortunately appear to be prone to this type of infection.

Will I require tests during my IPSA vaginal thrush consultation?

If you have never had vaginal thrush, then it is important for you to see your IPSA practitioner to confirm your diagnosis and for you to be provided with both treatment and advice. It is also important for other types of infection (which also cause vaginal discharge) to be ruled out.

During your consultation at your IPSA clinic, your IPSA physician will base her diagnosis on the typical signs and symptoms of vaginal thrush and she may not need to examine you, and you may not require any tests to be carried out.

If the reason for your discharge is unclear, then your female IPSA practitioner will take a swab (this is a thin stick with a small ball of cotton wool on one end) of your discharge, and this will go to the lab for testing. This is done to confirm what is causing your discharge.

If your vaginal thrush is recurring then your IPSA physician can treat you without further examinations being required; however, if the symptoms are different to those you usually experience, or they are recurring frequently, your IPSA doctor may then decide to examine you, take swabs, and also take a urine test (a diabetes test) to rule out diabetes.

IPSA’s treatment options for vaginal thrush

Topical vaginal thrush treatments

Topical vaginal thrush treatments are pessaries and creams containing anti-yeast medications (such as econazole, miconazole or clotrimazole). You insert these into your vagina with an applicator. Usually one single dose inserted into your vagina is enough to clear your bout of vaginal thrush. You may also want to rub some anti-thrush cream onto the skin around your vulva (vagina) for a couple of days, especially if you are itching and in discomfort. With a more severe infection, your IPSA doctor may advise a second pessary (after a three-day gap from the first treatment).

All of the treatments are available at IPSA’s on-site pharmacy.

Side effects are not common (your IPSA doctor will discuss these with you during your consultation)
You can use these treatments if you are currently pregnant (again, your IPSA physician will advise you), although treatments are usually longer for pregnant women
Some topical treatments for vaginal thrush can damage condoms and diaphragms, so use alternative contraception both during treatment and for a few days after treatment

Tablets for vaginal thrush

There are two types of tablet used to treat vaginal thrush: flucozanole (a single dose) and itraconazole (two doses over one day). These should not be taken if you are pregnant/breastfeeding.

Your IPSA on-site pharmacy stocks the tablets and during your vaginal thrush consultation, your IPSA physician will explain any of the side effects to you. Your IPSA doctor may also recommend the cream to alleviate itching around your vulva, in which case you will be given a ‘combination pack’ (tablet/s plus a cream).

If your thrush infection is severe, then your IPSA doctor will suggest a second treatment with the tablet three days after your initial treatment.

The tablets are as effective as the topical treatments.

Relieving your thrush symptoms

Your IPSA doctor will explain how to relieve your vaginal thrush symptoms during your consultation. For example:

Avoid wearing tight-fitting clothes (especially synthetic clothing). Instead wear natural-fibre, loose-fitting underwear
Avoid washing your underwear in biological washing powders/liquids
Avoid using fabric conditioners
Avoid any perfumed products (soaps/shower gels) around your vaginal region (as they may further irritate the condition)
Use a simple emollient each day to moisturise/protect the skin around your vulva
‘Natural’ remedies for vaginal thrush include inserting live yoghurt into your vagina or adding bicarbonate of soda or vinegar to your bath. This alters the acidity of your vagina. Although there is little scientific evidence proving that these remedies work, some women find that these approaches soothe their symptoms

What if the vaginal thrush treatment does not work?

If your symptoms have not gone one week after you started treatment, then see your IPSA physician. One in five treatments fail for various reasons:

Your symptoms might not be because of thrush as there are other causes for vaginal discharges.
Vaginal thrush can sometimes occur alongside another infection. In this case, your IPSA doctor may carry out tests such as vaginal swabs (to take a sample of your discharge with a small ball of cotton wool that is on the end of a thin stick) to clarify what is causing your symptoms.
Most vaginal thrush bouts are caused by Candida albicans. However, 10% are caused by other Candida spp. strains, e.g. Candida glabrata. These infections might not be as easily treated with the more usual anti-thrush treatments.
You might not have used your thrush treatment correctly.
You might have had a rapid recurrence of another new thrush infection. (This is likely if you are on antibiotics or have undiagnosed/poorly controlled diabetes.)

Do I need to see my IPSA physician if I get vaginal thrush?

If you have had thrush previously and you get the same symptoms again (a recurrence), then mostly this is treated without an examination/tests. Many women do know when they have got vaginal thrush and thus treat it themselves. However, a vaginal discharge/vulval itch can be due to other causes. It is best not assume that all discharges/itching are due to vaginal thrush. The following list is a guide for when you should see your IPSA physician if you have what you believe to be vaginal thrush symptoms.

If you are under 16/over 60 years old.
If you are pregnant.
If you feel unwell alongside having the vaginal/vulval symptoms.
If you are experiencing any abnormal bleeding from the vagina.
If you have abdominal pain (pain in your lower tummy area).
If you (or your partner) have had a sexually transmitted infection (STI).
If you have had a bad reaction to treatments/medications for thrush in the past.
If your immune system is weak (e.g. if you are undergoing chemotherapy or are on long-term steroids).
If you have had vaginal thrush twice in six months and have not seen your IPSA physician about your thrush for over a year.
If you have vaginal thrush symptoms that are not usual for you (such as a bad-smelling discharge or blisters/ulcers forming next to your vagina).
If you have attempted self-treatment but the symptoms have not cleared up.

What can I do to prevent a recurrence of vaginal thrush?

During your IPSA vaginal thrush consultation, your IPSA doctor will advise you on ways to minimise any recurrence of your thrush. These tips are based on common practice and not on evidence from research studies:

Sex. Thrush is not an STI. However, when you have sex, the friction might cause minor damage to your vagina and this can mean that Candida are more likely to multiply. If your natural secretions are not adequate during sex, then use a suitable lubricant for sex.
Hygiene. Vaginal thrush is not caused by poor personal hygiene. Normal vaginal conditions can be altered through excess washing/rinsing out (douching) of your vagina, by using scented soaps, bubble baths, spermicides and so on. The normal mucus and bacteria that are present in your vagina might become imbalanced by these hygiene routines and thus allow Candida to multiply and produce an infection. Washing only with water and with unscented soaps, and not douching your vagina may help to reduce recurrence.
Antibiotics. If you are taking antibiotics for another issue, then vaginal thrush is more likely to occur. Antibiotics can kill your normal vaginal bacteria that help to defend against Candida The Candida spp. are yeasts, and yeasts are not killed by antibiotics. Not every antibiotic course leads to thrush, but if you are prone to vaginal thrush and are prescribed antibiotics, then always have your anti-thrush treatment to hand so that you can use it if you get the first signs of vaginal thrush.
Clothes. Do not wear synthetic/nylon underwear or tight-fitting clothes too often. Loose cotton pants are best. Stockings should be worn rather than tights. This is to prevent your vaginal area from being kept constantly moist, warm and airless.

What is the IPSA treatment for recurrent (repeated) vaginal thrush?

If you do suffer from recurrent bouts of vaginal thrush, one option is to treat each episode when it occurs. The other option that your IPSA physician may suggest is:

Using one of the treatments (tablets or a topical treatment) for longer than usual. Your IPSA clinician will advise you about the timing for your particular vaginal thrush treatment, which can be seven or fourteen days in the case of topical treatments.
Using the topical treatment or taking a fluconazole tablet once each week. (Sometimes your IPSA clinician will prescribe other tablets for you and will give you full instructions on when and how to take them.) This is called ‘maintenance treatment’ and can often prevent vaginal thrush from recurring.
Continuing the maintenance treatment for a six-month period and then stopping treatment.

The majority of women do remain clear of vaginal thrush when on the maintenance treatment. After stopping the treatment, many do then remain free of vaginal thrush, or perhaps only have an occasional bout. Unfortunately, some women do develop recurrent thrush. For these women, the treatment plan might be repeated, with the maintenance treatment continued for a longer period.

Return to your IPSA physician if you do develop thrush when on the maintenance treatment as it may indicate a resistant strain of Candida spp. and this could require alternative treatment.

If you suffer from recurrent vaginal thrush, your IPSA doctor might also discuss your current contraception method with you and might suggest a change. The combined oral-contraceptive pill (the pill with both oestrogen and progesterone hormones) has been shown to possibly make recurrent vaginal thrush more likely. The evidence is, however, contradictory, with one study showing that woman using the progestogen-only contraceptive injection being less likely to develop vaginal thrush.

Some other points about vaginal thrush

Male sexual partners do not require thrush treatment unless they do have thrush symptoms (itching, soreness and redness on the foreskin and on the head (or glans) of the penis).
Women do not catch vaginal thrush from men with no symptoms.
Vaginal thrush is more common when pregnant and it can be a little more difficult to clear up. If you are pregnant, your IPSA physician may advise you to take a seven-day topical treatment.

If you suspect that you have vaginal thrush, then book online or phone IPSA for your same-day vaginal thrush consultation.