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Girls, we get it at least once in our lifetime.

Guys, your girls (daughters, girlfriends, wives, mothers, grandmothers) get it at least once in their lifetime.

So. Read on.

What is thrush?

Vaginal thrush, also called yeast infection or candidiasis, is an overgrowth of yeast that leads to a range of unpleasant symptoms, such as itching and soreness around the vagina. Most women will have thrush at least once during their lives, and many will have more than one episode. But for some women, thrush keeps coming back. Recurrent thrush can affect a woman’s sex life and self-image, and may be a sign of a more serious health problem. Even if you only have thrush once, it can be extremely uncomfortable. And, if you don’t know what is happening or why, it can also be very stressful. This online leaflet explains what thrush is, what causes it, how to treat it and what you can do to help prevent it in the future.

Thrush is caused by yeast, already present in the body, which grows out of control. This yeast is almost always Candida albicans, but another, more resistant yeast, Candida glabrata, can also lead to thrush.

Many women, (as well as men and children) carry yeast in and on their bodies without any problems. Yeast usually lives in the intestines, vagina, mouth and skin, where ‘friendly’ bacteria help keep yeast levels low. When this balance is disrupted, however, and the yeast is allowed to grow unchecked, it causes havoc in the body.

The vagina is one of the areas most likely to be affected by thrush. Although the vagina is generally too acidic for yeast to grow out of control, it is sensitive to small changes and can easily become an ideal environment for yeast to flourish. Too much yeast irritates the vaginal tissues and this leads to the typical symptoms of thrush.

Symptoms

The telltale signs of thrush include itching, burning, soreness, swelling of the vagina and vulva (outer area of the vagina), and a yeasty-smelling discharge. You may have one symptom or several, and symptoms can range from mild to severe.

- Itching and burning

These are the most common symptoms of thrush and often the most distressing. Burning and itching can be so intense it is difficult to resist scratching, but scratching will only make the problem worse.

- Soreness, swelling and pain

Thrush irritates the delicate tissue of the vagina and genital area, making it sore, swollen and red. As a result, it may be painful to urinate (urine will sting the inflamed tissue). It may also be painful to have sex. In some cases, anything that touches or rubs the area, including sitting and walking, can be painful.

- Discharge

Discharge caused by thrush is usually (but not always) white and thicker than a woman’s regular discharge. The ‘typical’ discharge linked to thrush is yoghurt-like in appearance and smells strongly of yeast. Some women, however, have a watery or mild-smelling discharge. The amount can also vary from a little to a lot.

Yeast thrives in a warm, moist environment with low acidity and a good supply of sugar. It doesn’t take much to change the pH (acid/alkaline balance) of a healthy vagina to create the ideal breeding ground for candida.

Antibiotics

Many women develop thrush soon after they start a course of antibiotics. There are two possible reasons for this:

- Antibiotics kill friendly bacteria

Antibiotic drugs are used to fight a range of common infections. Unfortunately, they can also kill ‘friendly’ bacteria, such as lactobacilli, which help to keep yeast in the vagina under control. Without lactobacilli, the balance in the vagina is disrupted and candida can take over. Although antibiotics have no effect on yeast itself, they can change the environment in the vagina just enough to cause thrush.


- Your body may be run down

If you are taking antibiotics, your body is likely to be run down or weak from an illness. While your body is busy fighting another infection, yeast may seize the opportunity to multiply.

- The contraceptive Pill

The Pill affects hormones that, amongst other things, can affect a woman’s ability to metabolise (process) sugar. Yeast feeds on sugar, and if there is extra sugar in the body, yeast will use it to grow. The contraceptive pills available now are less disruptive to the body than they used to be. Because of this, it is widely believed that taking the Pill no longer increases a woman’s risk of thrush. Some studies, however, suggest that women who use the Pill may still be more likely to develop thrush, and have recurrent thrush, than woman who do not use the Pill.


- Intra-uterine device (IUD)
Some of the side effects associated with the IUD, such as heavy bleeding and bleeding between periods, also play a role in the development of thrush. (See periods below). Women who use an IUD may also have an increased risk of developing vaginal and uterine infections, which can lead to thrush.


Allergies

Some women have an allergic reaction to latex condoms, spermicides, or the rubber in diaphragms and cervical caps. Allergy symptoms may be similar to thrush, but the underlying problem is different, as is the treatment. It is essential to get an accurate diagnosis to make sure you are taking the right steps to get better (See diagnosis).
Diabetes

Women with diabetes are more likely to get thrush than are women who do not have diabetes. This is because diabetes increases blood sugar levels, which may, in turn, increase the sugar in vaginal secretions. Diabetic women also tend to have high sugar levels in their urine, and this may contribute to thrush by feeding yeast in the genital area just outside of the vagina.

Diet

Certain foods may have an impact on thrush. Some practitioners believe sugar, dairy products, coffee, tea and wine contribute to thrush by increasing urinary sugar.

Perfumes, deodorants and washing

Anything that changes the natural acidity (pH) of the vagina, or damages the tissues in and around the vagina, may lead to thrush. Perfumed soaps, vaginal deodorants, douches, disinfectants and scented bubble baths can all irritate or damage the delicate tissues of the vagina and vulva. Whether you use perfumed soaps or not, scrubbing, excessive washing or rubbing hard with a towel may do enough damage to lead to thrush.

Periods

Vaginal secretions change throughout the menstrual cycle, and while the vagina can usually deal with these slight changes, some women tend to get thrush just before or after their periods.

Menstrual blood can change the acidity of the vagina, and, as a result, some women get thrush during their periods. Tampons and towels may also play a part in creating the right environment for thrush. If a tampon is left in too long (more than about 12 hours), it can dry out the vagina, change the pH balance and trigger thrush. Unchanged towels can create a moist, warm environment around the vulva, and yeast thrives under these conditions.

Pregnancy

Many women have their first episode of thrush while they are pregnant. Hormone levels change dramatically during pregnancy and this creates high levels of sugars in vaginal secretions. If the extra sugars aren’t broken down quickly, candida will use them to grow.

Note: Thrush should not affect the foetus as it develops in the womb, but it may be passed on to the baby during vaginal birth. Most babies are exposed to yeast at birth anyway and it generally doesn’t cause a problem. If babies develop thrush, it is usually in their mouths and is easily treated. Ask your GP or midwife for more information. (For treatment of vaginal thrush during pregnancy see treatments.)

Sex

Vaginal thrush is not a sexually transmitted infection (STI) – if you’ve never had sex, you can still get thrush – but sex may play a role in the development of thrush. Penetrative sex can irritate the vagina, particularly when there is little lubrication. Semen may change the acidity of the vagina which can then lead to thrush. And some studies suggest that oral sex increases a woman’s risk of developing thrush. Masturbation has not been linked to thrush.

Thrush can be, but is not always, passed on to a partner during sex. Most women get thrush as a result of their own internal changes or circumstances, not from the person they are having sex with. Men are more likely than women to get thrush through sex.

Your sexual partner does not necessarily need to be treated at the same time as you, but if you continue to get thrush, it may be worth asking your partner to have a check-up.

Tight clothing

Tight trousers, leggings, synthetic knickers or tights prevent air from circulating and can create a warm, moist place for thrush to develop.

Weak immune system

If your body’s immune system is run down due to stress, illness, poor nutrition, HIV, fatigue or serious injury, you may be more vulnerable to thrush. This is because your body is less able to keep the infection at bay.

Now that treatments for thrush are available over the counter, it may seem easier to self-diagnose than to make an appointment and go to a clinic, particularly if you’ve had thrush before. However, many women may be misdiagnosing themselves. Research shows that only 28 to 35% of women who have had thrush before can accurately diagnose thrush at a later date.

Some symptoms of thrush are common to other vaginal infections so it is important to be sure that you have thrush, and not something else, before you start treatment. (See chart below) The wrong treatment can make an infection worse and using thrush treatments when you don’t need them can help the yeast build up a resistance to treatment.
You should see a doctor or nurse if you have symptoms and:

-you have never had thrush before
-you are pregnant
-you want to check you don't have another infection
-the treatment you are using isn't working

Antifungal drugs

Thrush is caused by a fungus (candida), and is therefore treated with antifungal drugs. Treatments are available as:

-Pessaries to be inserted into the vagina
-Creams to be put on the vulva and/or into the vagina
-Capsules to be swallowed

Treatments can be bought over the counter at a chemist, but they may be cheaper (or free) if you get them by prescription.

Pessaries and creams

Pessaries and creams work directly at the site of infection – in the vagina and on the outer lips of the vagina.

Pessaries are bullet-shaped tablets that can be either hard or waxy. They need to be pushed high into your vagina with your finger or an applicator.

There are two types of creams used to treat thrush: vaginal and vulval. Vaginal creams work internally and, like pessaries, are inserted into the vagina using an applicator. Vulval creams are usually used with an internal treatment, to help soothe and treat itching outside the vagina.

Pessaries and creams can be messy – they melt and leak out into your pants – so it’s best to insert them at night just before you go to bed. You may also want to use a panty liner, as some treatments are coloured and can stain.

Length of treatment

The length of treatment varies with different brands of pessaries and creams. It may last one day, three days, six days or 14 days. You don’t need to stop treatment if you get your period. In fact, it’s important to complete the full course of treatment, even if your symptoms seem to have cleared.

The active ingredient in pessaries and creams may be clotrimazole, econazole, fenticonazole, miconazole or nystatin. Nystatin is a little bit different than the other drugs. It is a more general antifungal that works against a range of fungi and yeast. It can take longer and may be less effective at curing thrush than the other antifungal preparations.

Side effects

The potential side effects are the same for all of the drugs listed above: skin irritation and burning. Side effects from pessaries and creams are thought to be rare, but as they mimic the symptoms of thrush it may be difficult to tell the difference.

Recurrent thrush

Women who get thrush again and again (four or more times a year is considered recurrent) may be given pessaries as prevention. These are long-acting pessaries taken either twice a week, once a week or once a month over a three to six month period.

Allergies, irritation and drug interaction

If you have a peanut allergy, avoid vaginal creams that contain arachis oil.

Betadine pessaries, used to treat recurrent thrush, are iodine-based and may cause irritation. To reduce irritation, moisten the pessary with water before inserting it.

Pessaries and creams containing miconazole may cause bleeding and bruising if taken at the same time as warfarin – a prescription blood thinning drug.

Pregnancy and breastfeeding

Pessaries and creams are not well absorbed into the body’s circulation and are therefore unlikely to affect a developing foetus, but there has been little research into their use during pregnancy. Treatments with clotrimazole have been used by pregnant women for years and are considered safe. But iodine-based pessaries, such as betadine for recurrent thrush, should not be used during pregnancy. Some experts advise against using econazole during the first three months of pregnancy. If you are pregnant and have thrush, talk to your doctor or midwife about treatment.

Damage to barrier contraception

Some pessaries and creams can damage the rubber of diaphragms and condoms, making them useless as contraception.

Thrush can also be treated with capsules that you swallow. These are available either as a single dose (fluconazole) or as two capsules to be taken in the same day (itraconazole). Many women prefer pills to creams or pessaries, but they are more likely to cause side effects and should not be used if you are pregnant, breastfeeding or taking certain medication.

Side effects and drug interactions

Oral medication for thrush may cause nausea, diarrhoea, abdominal pain, dizziness or skin rash. It may also cause more serious problems if you are using it at the same time as other drugs such as loratadine (an antihistamine used in some allergy medication). If you are taking medication for another condition, check with the pharmacist or your doctor before taking antifungal tablets.

Recurrent thrush

When thrush keeps coming back, it may be a signal that yeast has taken over another part of the body, such as the intestines. If this is the case, vaginal pessaries and creams will not be able to treat the whole problem. Oral tablets fight yeast throughout the body and therefore are often prescribed for women who have recurrent thrush.

Pregnancy and breastfeeding

If you are pregnant or breastfeeding you should not use oral treatments for thrush. Some pessaries and creams may be safe to use, or you may want to consider alternative treatments (next section, below). It is always a good idea to check with your doctor or midwife before using any treatment while you are pregnant.

Complementary and other threatments

There is also a range of alternative or complementary treatments for thrush. Not all of these treatments are supported by research, but many women find them useful. Complementary treatments tend to be most effective when used as soon as you begin to notice the symptoms of thrush.

Calendula

Calendula (from marigold flowers) is both anti-fungal and soothing. Calendula pessaries for thrush are available at some health food stores. Calendula cream or gel may be helpful if applied directly on the irritated area outside of your vagina. Do not put a cream or gel into your vagina unless it says on the package that it is safe to use internally.

Garlic

Garlic has strong antibacterial and anti-fungal properties, and may help stop thrush in some women. Peel a clove of garlic (be careful not to nick it), wrap it in muslin, to make sure you can remove it, and insert it into your vagina. Leave the garlic in overnight. Be prepared to smell quite strongly of garlic while you are using this treatment.

Tea tree oil

Some women find tea tree oil helpful in stopping thrush. Its effectiveness in fighting candida albicans is also supported by scientific studies. To use tea tree oil for thrush:

- put tea tree oil on the tip of a tampon and insert it into your vagina
-put tea tree on a panty liner or towel
- dampen cotton wool with tea tree (mixed with water) and gently wipe around the vaginal area

Some health food stores carry ready-made tea tree oil pessaries and manuka oil salve (manuka is another type of tea tree). Look in the women’s health section or ask the sales assistant. Be aware that tea tree may sting at first, but it should stop after a short while.

Lactic acid wash

This is a relatively new product now available at larger chemists. The wash, to be used externally, contains lactic acid that helps maintain the natural pH balance in the vaginal area. This prevents yeast from taking hold. It can be used as a daily wash instead of soap, or as a treatment when you feel thrush may be developing.

Vinegar

Some women find vinegar can help stop thrush but, as with garlic, the smell is quite strong. Vinegar is acidic and may help restore the pH balance of the vaginal area to give the friendly bacteria a better chance of successfully fighting off yeast. Never use vinegar on its own – it must be diluted with water (1 tablespoon vinegar with 1 pint of water). You can also add acidophilus to the mixture (see yoghurt below). Use the mixture to gently wash the outside of your vagina or dip a tampon in it and insert it over night.

Yoghurt

Natural live yoghurt can be used in two ways to deal with thrush: eating it and/or inserting it into your vagina. The key is not the yoghurt itself but the bacteria, lactobacillus acidophilus, in the yoghurt. This helps the body maintain, or regain, its natural pH level and keeps yeast under control.

Eating yoghurt may help keep yeast levels low throughout the body, but particularly in the stomach and intestines. Because candida in the bowel can easily make its way to the vulva and vagina, keeping your digestive system clear of thrush may help prevent vaginal thrush.

Inserting yoghurt into your vagina may also help restore your vaginal pH balance, but there is less scientific support for this method. If you want to give it a try, put one teaspoon of yoghurt in an applicator, a plastic syringe or on a tampon, and insert it high into your vagina. Repeat this every night for a week. It is important that you use only unsweetened, plain, live yoghurt.

The active ingredient in this treatment, lactobacillus acidophilus, is also available at health food stores as a supplement on its own.

Soothing the itching

Itching can be so bad that you may want something to soothe it quickly before or during treatment. Some of the treatments above will help soothe at the same time, but there also other options you could try:

Aloe vera – Aloe vera gel or juice may help relieve itching and cool burning around the vagina. Aloe vera is available at health food stores.

Cold – The burning that often accompanies itching may be temporarily relieved with cold water or ice cubes wrapped in a cloth.

Nappy rash cream – This may be soothing on the outer lips of the vagina. (Nappy rash cream is known in the USA as diaper rash cream or ointment.)

Preventing thrush

There are a number of simple things you can do to help prevent thrush:

- Eat yoghurt with lactobacillus acidophilus, or take lactobacillus acidophilus supplements regularly.

- Do not douche – the vagina cleans itself and using a douche, particularly with perfumes or other chemicals, causes more harm than good.

- Wear cotton underpants and clothes that aren’t too tight. This will prevent the area from becoming too moist and warm.

- Do not leave tampons, contraceptive sponges, cervical caps or diaphragms in place too long.
- Wipe from front to back after going to the toilet. Candida in the bowel can infect the vagina and cause thrush, but wiping from the front will help reduce the chance of this happening.

- If you are taking antibiotics, and are prone to thrush, consider using a thrush treatment at the same time. Remember that using a treatment too often when it is not necessary may make yeast resistant.

- Avoid using perfumed soaps, bubble baths or vaginal deodorants. The chemicals in these products are too harsh for the delicate tissue and pH balance of the vaginal area.

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