By Miss Louise Hayes MBBS (Lond.) FRCOG
Consultant in Gynaecology & Women’s Health
Published July 7th 2023
The chances are, you know thrush all too well. Around three-quarters of women will get it at one time or another – and many will get rid of it only to find it coming back again, and again. Fortunately, for most women it’s temporary, and easy to cure. But can you prevent it? And can you stop it coming back?
Do I have thrush?
If you’re asking, and you’ve had it before, the answer’s probably yes.
It is possible to have thrush and not even be aware of it. Some women suffer no symptoms, and only discover they have it in the course of a checkup for something else.
But for most women thrush is very irritating and unpleasant, and causes:
- Soreness/itching – affecting the vagina and in particular the vulva, often making it painful to pee or have sex. (Soreness without itching is probably not thrush – see below.)
- Vaginal discharge – thrush is one of the most common causes of vaginal discharge. Discharges due to thrush are generally creamy white and are typically quite thick – ‘like cottage cheese’ – though not always: they can be watery.
In more serious cases, symptoms can include:
- Redness (erythema) – usually in the vagina and vulva, though it can also spread to the perineum – the skin between vagina and anus
- Splitting and/or swelling of the vaginal skin
- Scratch marks to the vulva
- Rashes to nearby vaginal skin
If you’re having:
- Vaginal discharges that are unusually coloured (not white/off-white/clear)
- Bleeding between periods, or after sex
- Soreness, but no itching
- A need to wee all the time
- Blisters or a rash on the skin of the vulva
…it’s probably not thrush, and you definitely need to see your doctor to find out what it is and get it dealt with.
What causes thrush?
Thrush is not an STI, though it can be passed on during sex. Thrush isn’t caused by an infection but by excess candida – a yeast fungus which is entirely natural, and, at ‘normal’ levels, harmless.
Candida hangs around wherever it finds the warm, moist conditions it likes – in the mouth, the gut and the vagina – where your body’s natural ‘friendly’ bacteria keep it in check. It’s when your body’s defences are down for one reason or another that candida grows out of control, and you get thrush.
Things that make you more likely to get thrush include:
- Damaged or already irritated skin
- Products that cause irritation, like perfumed toilet paper, bubble baths or vaginal washing products
- Antibiotics – which actually kill your body’s natural defences against thrush
- Diabetes that’s not being controlled properly
- A weakened immune system, due to chemotherapy, perhaps, or HIV
- Just being generally run down, tired
Thrush is not a sign of bad hygiene. Ironically enough, it can actually be caused or made worse by ‘excessive’ efforts at cleanliness. Using douches, scented products and soaps can actively kill or remove the ‘friendly’ bacteria your body uses to keep a check on candida. If you suspect this may be an issue for you, try washing only with water, or at most, unscented soap, and avoiding ‘product’.
What can I do about thrush?
For starters, there are a number of things you can do that might help relieve the symptoms, such as:
- Avoiding tight-fitting clothing, particularly any made from synthetic materials. Try wearing loose-fitting cotton instead and see if it helps
- Avoiding wearing underpants at night
- Keeping perfumed soaps, shower gels and similar ‘feminine’ products away from the vaginal area
- Moisturising the skin around the vulva on a daily basis, using E45 or some similar simple emollient
Some women swear by probiotic yoghurt, eaten and/or applied directly to the affected area. Hard medical evidence is hard to come by, but maybe it would work for you. Can’t hurt to try!
Many women, particularly those who suffer recurrent bouts of thrush (defined medically as four or more bouts a year, though it basically means thrush that keeps coming back), get to recognise its symptoms, try different treatments, and learn what works for them.
For most, the solution is simple, easily available over-the-counter treatments. For ‘regular’ cases of thrush, your pharmacist will probably recommend a pessary or cream, applied directly to the affected area. These should start relieving your symptoms pretty much straightaway, with all traces gone within a week or so.
If your symptoms haven’t gone after about a week, it’s probably time to think about seeing your doctor, which you should definitely do in any case, if:
- You’re aged under 16 or over 60
- You’re pregnant
- You’ve recently had sex without a condom with a new partner
- You have abnormal vaginal bleeding
- You have pain in your lower abdomen (tummy), or in your pelvic area
- You feel generally out of sorts, in addition to your genital symptoms
- You have symptoms that aren’t like the ones you’re used to from previous bouts – fishy/nasty-smelling discharges, blisters or broken skin, for example
- You’ve had two episodes of thrush within six months and haven’t seen anyone about it for a year or more
- You (or your partner) have had a previous sexually transmitted infection
- You’ve reacted badly to anti-thrush medication or treatments in the past
- You have a weakened immune system – due to chemotherapy or HIV, for example – or you’re being treated for cancer or are taking long-term steroid medication
How can my doctor help with my thrush?
The single most important thing your doctor can do is make sure that what you’re suffering from really is thrush – and if it’s not, what it is.
They’ll generally start out by asking you about your symptoms, and related issues like whether you’ve ever had them before, whether they’re the same this time, whether there are any ‘obvious’ possibilities that need to be ruled out, such as STIs, from having unprotected sex with a new partner.
Your discussion may be all your doctor or nurse needs to confirm thrush, and move on to prescription. But if anything’s still in doubt, they may use a swab (like an oversized cotton bud) to take samples for testing. The experience is likely to be a bit uncomfortable, but not painful. When the test results come back (generally within a week or so) the doctor will have a definitive diagnosis, and can hopefully move on to treatment of whatever it is you have.
In some cases, though they are rare, further tests may be called for, such as urine tests, if diabetes or an STI (whose symptoms can closely resemble those of thrush) are suspected, or blood tests to check for any underlying issue that may be making you vulnerable.
What’s the treatment for thrush?
Most ‘regular’ bouts of thrush can be easily, quickly and effectively treated, using either topical treatments, applied directly to the affected area, tablets, or both.
So-called ‘topical’ treatments are anti-yeast pessaries and creams which you rub into the affected area and/or insert into the vagina.
For pessaries, one large dose generally does the trick, though sometimes lower doses over a number of days is preferred, with creams used in the meantime if necessary to help soothe itching while the cure gets to work. In mild cases, or for girls under 16, a cream gently massaged into the affected skin may be all that is needed.
Many topical treatments can be bought easily over the counter – your pharmacist will be happy to advise you on your options. Or you can get them on prescription.
As a rule, such topical treatments are fine if you are pregnant, but do check with your doctor or pharmacist. And be aware that recovery usually takes longer if you’re pregnant.
It’s important to note that some pessaries and creams can damage condoms and diaphragms, making them less effective both as infection barriers and as birth control. You should use alternative contraception during treatment, and for several days afterwards.
With all topical treatments, it’s important that you follow the instructions – and any from your doctor or nurse – and in particular don’t stop treating just because ‘it seems to be cleared up’. Make sure you complete the full course, even if it seems unnecessary.
Two thrush treatment tablets are available: fluconazole, which is taken as a single dose, or itraconazole which comes as two doses in a day. You can get either on prescription; you can also buy fluconazole without a prescription. You shouldn’t take these if you are pregnant or breastfeeding.
Tablets sometimes come together with creams in a combination pack: use the creams to suppress the itching while the tablet gets to work. If your thrush is severe, you may find it takes more than one dose to get completely clear.
How long does thrush last?
Mild infections can go away of their own accord, without any treatment, and often without ever displaying any symptoms, within a few days. More serious cases can take weeks to cure. As a rule of thumb, if you’re treating yourself and it hasn’t cleared up in a week or so – and certainly within a fortnight – you need to speak to your doctor.
Can thrush affect my unborn child if I’m pregnant?
No. Thrush doesn’t affect your baby at all. But it does have important implications for you.
You should use only creams or pessaries to combat your thrush, not tablets. You should be careful when using an applicator to insert pessaries in your vagina, to avoid any possible injury to your cervix (the neck of your womb). You may find it easier to dispense with the applicator and use your hand instead.
What can I do if thrush keeps coming back?
If your thrush keeps coming back, resist the temptation to just apply more of whatever ‘cured’ it last time. You really need to go and discuss it with your doctor.
There is a connection between thrush and oestrogen. Thrush is much more common in the years you’re fertile – ie, between your first period and your last. Some women are particularly prone to thrush at particular points in their cycle – just before a period, for example. The hormone changes that come with pregnancy also increase your chances of getting thrush. And there have been suggestions of links with HRT, and with the pill, though hard evidence on this remains scarce.
Whatever the reason, repeated bouts of thrush demand proper medical attention from your doctor.
For one thing, it may turn out that what you thought was thrush is actually something else. An STI, for example, or another skin condition that produces similar symptoms. For another, your doctor may want to run tests to rule out related issues that could be at the root of your problem – diabetes, for example.
The solution could be as simple as staying on the treatment for longer, or combining two or more different treatments at the same time. Once again, don’t stop treatment because ‘it’s ok now’: always complete the course, even if all seems well.
Is there anything I can do to avoid thrush in future?
No matter how effective your cure, there’s never any guarantee that thrush won’t come back. But there are a few basic things that can improve your chances, such as:
- Always wiping from front to back, to avoid spreading anal bacteria to your vagina
- Wearing loose, cotton underwear rather than anything clinging, particularly tight pants made from synthetic fibres
- Not spending too long in tight pants, swimming suits, biking shorts or leotards
- Trying a different laundry detergent or fabric softener if you suspect a problem
- Checking out alternatives to condoms if you think they might be causing a reaction
- Avoiding douching, and ‘feminine hygiene products’ like sprays, coloured or perfumed toilet paper, deodorant pads or tampons, and bubble bath
Can I still have sex if I have thrush?
You can, but it’s important to avoid any possibility of damage, which encourages candida. So make sure your vagina is well lubricated, using lubricants if necessary to reinforce your body’s natural secretions. When you’re done, wipe yourself clean and dry. Also, though thrush is not an STI, it can be passed on during sex, so you might want to use a condom.