Vulvovaginal Candida (Thrush)

Thrush (or vulvovaginal candida) is an infection of the vagina and/or vulva that causes your genitals to be itchy and sore. It is very common and up to 20% of women of reproductive age have Candida (though for many, there are no symptoms). It is not a sexually transmitted infection, although it can occasionally be passed on during sex. Men and women can get thrush, but this article is talking about vulva and vaginal thrush symptoms.

What causes thrush?

We all have germs living on or inside us. Some are beneficial, like the ‘healthy’ gut bacteria that help to process food. Many of these organisms do not cause harm unless they grow in number too much. One of these germs is a type of yeast called Candida spp. It is normal for Candida spp to be present in the vagina and on the skin that makes up the vulva. There are some groups of harmless bacteria that, along with our immune system, keep the amount of Candida in check. As a result, Candida does not usually cause any issues. However, when circumstances are good for Candida spp, their number increases, and it can cause symptoms. This may be related to hormonal changes, problems with your immune system, or due to changes in the vaginal bacteria after taking antibiotics.

How do I know if I have thrush?

Signs and symptoms of thrush can include:

• An itchy and sore vulva (the outer part of a woman’s genitals)

• A sore vulva and/or vagina during sex

• Burning when you pass urine

• A thick, white vaginal discharge that does not smell

Symptoms can get worse just before your period, and sometimes tight clothing can make symptoms worse too. Thrush does not always need a test to confirm it; diagnosis is often based on your symptoms. However, if your symptoms are not typical for thrush, or you are having recurrent thrush infections, a test is often needed. This is done by a doctor, who will take a small sample of the vaginal discharge using a swab (a long cotton bud). The sample is sent to the laboratory to be looked at. Swabs for other infections may also be taken at the same time.

There are a number of home tests you can buy online. We recommend if you decide to go down this route then to use a reputable pharmacy and if possible speak to a pharmacist to check that this is the right test for you. It is worth noting however that this will cost you money (unlike any tests that your GP can arrange), is not a laboratory test and there is always a chance for human error. If you take this test, we also suggest you still speak with your doctor or a pharmacist about treatment options. The vulva and vagina are sensitive areas and you always want to seek advice before using treatments in this space. If you are pregnant you should speak with your midwife if you suspect you have thrush as although symptoms of thrush are common they could also be signs of other issues such as high sugar levels (especially if persistent or recurrent).

How is thrush treated?

If you think you might have thrush, book in appointment to see your GP or a sexual health clinic. You can also speak with a pharmacist who may be able to help.

There are several treatment options for thrush. The most common treatment is Clotrimazole (which you might know as CanestenTM). This can be in the form of a cream or a pessary tablet for your vagina – usually inserted by using an applicator. You may also want to rub anti-thrush cream around the skin of the vulva if this is sore and itchy. Side effects from this treatment are uncommon, but it is always wise to read the instruction leaflet for guidance. Generally, these treatments can be used if you are pregnant, although it is best to check with your doctor or pharmacist first.

A tablet called Fluconazole is also available. Like the anti-thrush cream, this can be bought in the pharmacy. This is taken as a single dose on one day. Sometimes, a longer course of Fluconazole is needed. In this instance, a doctor will need to prescribe it. Fluconazole is not recommended in pregnancy.

The symptoms of thrush can also be helped by avoiding tight-fitting clothing, avoiding use of soap or washing products and if necessary only using simple non perfumed emollients (moisturisers, creams, ointments) to soothe the skin of the vulva. Make sure that any moisturiser, cream,or ointment is OK for use in intimate spaces. Using the wrong products could cause discomfort.

What is chronic candida?

If you have thrush four times in one year, you may have chronic candida. This is less common than regular thrush and needs a different treatment. Your doctor may recommend taking an anti-thrush tablet for up to six months. They may also advise other tests to look for other vaginal infections. Sometimes, people who experience recurrent bouts of thrush may have an underlying reason for a weakened immune system, like, for example, diabetes. This is also something your doctor may want to investigate.

Can I have sex if I have thrush?

Thrush is not sexually transmitted, so you do not need to avoid sex. That said, sex may be uncomfortable while you are infected. The anti-thrush creams used for treatment can also affect the quality of latex condoms, and so other forms of contraception should be used. There is no need to routinely screen or treat sexual partners.

Jenny’s story

Jenny is 22 years old.

“For over a week I had been worrying about having a sore and itchy vulva. This made me feel embarrassed, and I was not keen to ask for help. I was worried that it could be a sexually transmitted infection. After I noticed some odd lumpy white vaginal discharge, I finally decided to make an appointment with my GP. They reassured me that my symptoms were typical of thrush and that it is very common. I was given a tablet to take and an anti-thrush cream to put onto the sore areas. Within a few days, things felt back to normal.”