Many women will experience an episode or two of vaginal thrush, which is caused by fungal yeasts (Candida species) infecting your vagina. The available treatment choices for vaginal thrush include either anti-thrush pessaries (which you insert into your vagina) or an anti-thrush tablet to be taken by mouth. Also, an anti-thrush cream is available for you to apply to the skin around your vagina. These anti-thrush treatments are usually effective. Unfortunately, for some women, who have repeated/recurrent bouts of thrush, longer treatment courses are often needed.
Your IPSA Medical vaginal thrush consultation
When attending IPSA Medical’s clinic, a female IPSA Medical clinician will carry out your vaginal thrush consultation. Your IPSA Medical clinic is a professional, totally confidential and conducive facility, and IPSA Medical staff always work with a person-centred, holistic approach to your care. Your IPSA Medical specialist will assess your vaginal thrush symptoms, and will both explain and discuss the current vaginal thrush treatment options with you, prior to reaching an understanding with you on the best possible vaginal thrush management regime for your specific symptoms.
What is vaginal thrush?
Vaginal thrush is a type of fungal yeast infection which develops when a group of fungal yeasts (Candida spp.) multiply. Small numbers of these organisms naturally live both on your skin and also around your vagina, and mostly, they cause no issues. Your own immune system combined with the various other harmless bacteria that live both on your skin and also in your vagina usually prevent these thrush-causing organisms from multiplying. However, sometimes the conditions in your vagina change and allow the Candida spp. to multiply, invading your vagina and causing your vaginal thrush symptoms.
Candida species thrive in the parts of your body that are airless, moist and warm, and this is why your vagina is a common site for these types of fungal infection. Other areas which are prone to candidal infections include your mouth, your groin and for toddlers and babies, the nappy area.
Most vaginal thrush episodes are caused by Candida albicans. Other types of Candida can also lead to a bout of vaginal thrush (e.g. Candida glabrata or Candida tropicalis).
What are the symptoms of vaginal thrush?
Vaginal thrush is the second most common reason for having a vaginal discharge, with the most common being due to bacterial vaginosis. (Visit IPSA Medical’s web page on bacterial vaginosis for more information regarding bacterial vaginosis.) The common symptoms for vaginal thrush include a creamy white and thick (or sometimes watery) discharge (which usually doesn’t smell), with redness, discomfort, itching or pain around the outside (the vulva) of your vagina, and with pain or discomfort being experienced when having sex or when passing urine.
These vaginal thrush symptoms can be fairly minor and can clear without any anti-thrush treatment, or they can be irritating and only clear with anti-thrush treatment.
Vaginal thrush doesn’t spread to your womb (your uterus) and doesn’t damage your vagina. If you are currently pregnant, vaginal thrush does no harm to your unborn baby.
Who usually gets vaginal thrush?
More than 50% of all women will have an episode of vaginal thrush in their lifetime, with thrush often developing with no specific cause, but it is more likely to occur when you have diabetes, are pregnant, taking antibiotics, have a weakened immunity (e.g. from chemotherapy treatment or from taking steroids), are on the contraceptive pill (although this is not fully proven scientifically) or are on HRT (hormone replacement therapy).
Recurrent vaginal thrush (four bouts or more in a year) occurs in around 5% of all women who have already experienced an initial bout of thrush; it is unclear why some women do experience recurrence and seem to be prone to recurrent thrush when the majority do not.
Will I need to have tests done at my IPSA Medical vaginal thrush consultation?
If you have never had a vaginal thrush bout before, then it is important to see your IPSA Medical specialist to confirm your thrush diagnosis, to rule out other types of vaginal discharge-causing infections, and for you to access both advice and treatment.
During your vaginal thrush consultation, your IPSA Medical specialist will base any diagnosis on the typical vaginal thrush symptoms/signs: she might not need to actually examine you and you might not need any tests.
If the cause behind your discharge is not clear, then your IPSA Medical clinician will use a swab (a type of thin stick with a small cotton wool ball on the end) to sample your discharge, and this sample goes to our lab for testing to confirm what is actually responsible for your discharge.
If you have recurrent bouts of vaginal thrush, your IPSA Medical clinician can treat your thrush without you undergoing any further examinations. But if your symptoms are different from the ones you usually experience, or occur frequently, then your IPSA Medical specialist might then examine you, taking a swab, and giving you a urine test so as to rule out diabetes.
IPSA Medical’s vaginal thrush treatments
Topical vaginal thrush treatments
When you are prescribed a topical vaginal thrush treatment, it can be either a pessary or cream containing various anti-yeast medications (e.g. miconazole, econazole, or clotrimazole). You usually insert the treatment into your vagina via an applicator. Mostly a single dose (when inserted into your vagina) clears a vaginal thrush bout. You might also use an anti-thrush cream for a few days for the skin around your vagina, particularly if the area is itchy. With more severe thrush infections, your IPSA Medical clinician might advise you to use a second pessary three days after your first thrush treatment.
All of these anti-thrush treatments are available at IPSA Medical’s extensive on-site pharmacy.
Side effects from anti-thrush medication are not common but your IPSA Medical physician will discuss the possible issues with you when you are at your consultation.
You can have anti-thrush treatments when pregnant and again, your IPSA Medical clinician will also advise you on that, although the anti-thrush treatments are usually longer when pregnant.
Some topical vaginal thrush treatments can damage diaphragms/condoms, so alternative contraception is advised both during your anti-thrush treatment and for a few days afterwards.
Vaginal thrush tablets
Two kinds of anti-thrush tablets are used for vaginal thrush treatment: flucozanole, which is a single dose, and itraconazole, which is taken as two doses in one day. They are contraindicated however, if you are currently pregnant/breastfeeding.
Your IPSA Medical on-site pharmacy stocks these tablets, and during your consultation, your IPSA Medical physician will clearly explain any side effects to you. Your IPSA Medical physician might also recommend the anti-thrush cream to alleviate any itching, in which case you will be provided with the so-called combination pack (the tablet/s and the cream).
If your vaginal thrush is severe, your IPSA Medical clinician will suggest taking a second anti-thrush tablet three days after the initial treatment.
Both the tablets and topical treatments are equally effective.
How to relieve your vaginal thrush symptoms
Your IPSA Medical physician will explain simply how to relieve any vaginal thrush symptoms. For example, by:
- Avoiding any tight-fitting clothing and instead wearing loose underwear made from natural fibres
- Avoiding wearing synthetic clothing
- Avoiding biological liquids/washing powders when washing your underwear
- Avoiding all fabric conditioners
- Avoiding all perfumed products (e.g. soap, shower gel) for washing with, especially around your vagina, because these can irritate your thrush
- Moisturising and protecting your skin each day in the area around you vagina with a simple emollient
- Using natural remedies (e.g. inserting live yoghurt/adding vinegar or bicarbonate of soda to your bath) which alter the acidity levels of your vagina, and although not scientifically proven, many women find them beneficial
What if my vaginal thrush treatment doesn’t work?
If your symptoms are still present one week after you began your anti-thrush treatment, then re-visit your IPSA Medical physician. Around 25% of anti-thrush treatments do fail. Why?
- Your symptoms might be related to another disorder and not to vaginal thrush.
- You may have another infection alongside your vaginal thrush, and this is when your IPSA Medical specialist will usually take vaginal swabs (to sample your discharge) to determine the reason behind your symptoms.
- Most bouts of vaginal thrush are from a Candida albicans infection, but in 10% of thrush cases, a different strain (for example, Candida glabrata) causes the infection and it might not respond to the usual anti-thrush treatments.
- You might be experiencing a rapidly recurring new bout of thrush, especially if you are an undiagnosed diabetic or have poorly controlled diabetes, or are taking antibiotics.
- You might have not taken your anti-thrush medication correctly.
Do I need to visit my IPSA Medical specialist when I have a bout of vaginal thrush?
If you have already experienced a bout of vaginal thrush and have a recurrence (you now have the same symptoms as before), then this can be treated without any examinations/tests. Many women with recurring vaginal thrush are familiar with the signs/symptoms and treat their thrush at home. However, both vaginal discharge and vulval itching might not be due to thrush so you are best not to assume that your discharge/itching is because of vaginal thrush. The following guide highlights when you should visit your IPSA Medical clinic when you believe you have signs/symptoms of vaginal thrush. Visit your IPSA Medical physician if:
- You are pregnant
- You have abnormal bleeding (from your vagina)
- You are over 60 or under 16
- You feel unwell alongside also having the ‘usual’ symptoms of vaginal thrush
- You have reacted badly to previous anti-thrush medications/treatments
- You have a weakened immunity (e.g. if you are on long-term steroid medication or undergoing chemotherapy)
- You are experiencing pain in the abdomen/lower tummy
- You/your partner have an STI – a sexually transmitted infection
- You have symptoms that you don’t usually experience with thrush, like blisters or ulcers around your vagina or a nasty smelling discharge
- You have self-treated but your thrush hasn’t cleared
- You have had two bouts of thrush within a 6-month period and haven’t seen your IPSA Medical specialist in more than a year
What steps can I take to prevent the recurrence of vaginal thrush?
During your IPSA Medical thrush consultation, your IPSA Medical physician will advise you on how to minimise thrush recurrence, as based on what is common practice (not specifically on evidence from scientific research):
Sex: vaginal thrush is not sexually transmitted but when you have sex, friction can lead to minor vaginal damage so that Candida organisms become more able to multiply. If your natural vaginal secretions are not lubricating you enough during sexual intercourse, then use a vaginal lubricant.
Hygiene: vaginal thrush is not related to you having poor personal hygiene. Your vaginal conditions can change when you wash/rinse out (or douche) excessively, use scented soaps, use bubble baths, or spermicides, for example. Your normal bacterial and mucus balance in your vagina can be upset with such hygiene routines, encouraging the Candida to multiply and cause infection. Wash only with water and non-scented soaps, and do not douche your vagina to help reduce any recurrence.
Antibiotics: if you are on antibiotics for another medical reason, vaginal thrush is then more likely. Antibiotics can kill the bacteria that defend your vagina against a Candida overgrowth. Candida, being yeasts, are not affected by antibiotics. Not every antibiotic treatment will lead to vaginal thrush, but if you are especially prone to the condition and are taking antibiotics, then have an anti-thrush treatment ready beforehand in case you get the first symptoms/signs of vaginal thrush.
Clothes: do not wear any synthetic underwear or any tight-fitting clothes. Loose cotton trousers are the best. You should wear stockings and not tights to prevent the area from constantly being kept airless, moist and warm.
What is IPSA Medical’s treatment for recurrent thrush?
If you suffer from repeated bouts of thrush, one option you have is to treat each bout when it develops. There are other options that your IPSA Medical clinician might suggest to you:
- Use the tablet/s or topical treatment for longer than normal, for example, from 7–14 days for your topical treatment. Your IPSA Medical clinician will advise you.
- Use the topical treatment once a week or take fluconazole (a tablet) once a week as a maintenance regimen to prevent recurrence. (Your IPSA Medical specialist might prescribe different tablets for you, and will explain clearly how these should be used.)
- Carry on with the maintenance regimen for 6 months and then stop any treatment.
The vast majority of women will be clear of thrush when on these maintenance regimens. After stopping all treatment, many then have no more bouts, or only the occasional bout. Unfortunately, however, some women will experience recurrent thrush where their treatment plan might have to be repeated with their maintenance regimens continued for longer.
You should return to your IPSA Medical clinician if you re-develop thrush when on your maintenance regimen because this can be indicative of the presence of a resistant Candida strain requiring an alternative form of treatment.
If you do suffer from recurrent bouts of thrush, then your IPSA Medical physician might also discuss contraception with you and suggest a change to your current method. The combined oral-contraceptive pill (with both of the hormones oestrogen and progesterone) possibly makes recurrent thrush more likely. The evidence is still contradictory, with one research study even showing that the progestogen-only contraceptive injection makes developing vaginal thrush less likely.
Some other key points on vaginal thrush
Any male sexual partners you have will require treatment if they develop thrush symptoms (itching, redness and soreness on their foreskin and the head (or the glans) of their penis).
Women cannot catch thrush from men who have not got any thrush symptoms.
Thrush is more prevalent when you are pregnant and it can also be slightly more difficult to clear. If you are currently pregnant, then your IPSA Medical clinician might advise you to take the 7-day topical anti-thrush treatment.
If you do suspect you have thrush, then book your appointment online or phone IPSA Medical for your same-day IPSA Medical vaginal thrush consultation.
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