Vaginal thrush 101

About 75% of women will experience vaginal thrush in their lifetime, and 5% of those will get recurrent thrush.¹ Thrush, also known as vaginal candidiasis, is, in most cases, easy to treat. Learn all about the causes, symptoms and treatment for this common infection, as well as how to prevent it.

Thrush is a common fungal infection caused by an overgrowth of the yeast that lives on the skin, in the mouth, in the digestive system and in the vagina.

You can get thrush in your mouth, or folds of skin, but for women, it’s most common in the genital area and is known as vaginal thrush.

Thrush is a reality most women face at some point. It’s easily treated and doesn’t cause any long-term issues.

It’s caused by a yeast called Candida albicans, which is a normal organism in the GI tract, mouth and vagina, and is also considered to be part of the beneficial flora.

When an imbalance of the normal flora occurs, it causes an overgrowth of the yeast, which in turn causes an infection.

Thrush is more likely to affect women who have periods (from puberty to menopause) because they have higher levels of oestrogen. Oestrogen increases the amount of glycogen (a form of sugar) in the vagina, which can create a favourable environment for candida to grow.²

Thrush is not caused by poor hygiene, nor is it a sexually transmitted infection, although sex can make symptoms worse and male partners can sometimes end up with redness or irritation on their penis.

While it isn’t always clear what the cause is, here are some of the main reasons you might experience a bout of vaginal thrush:

• Antibiotics. Along with the harmful bacteria they are designed to kill off, some antibiotics kill the healthy bacteria that normally keep the yeast in check. Other medications, such as steroids and chemotherapy, can do likewise.
• Pregnancy. Thrush is more common in pregnant women due to hormonal changes. (It won’t harm the baby.) Other factors that impact hormones, such as contraceptives, menopausal hormone therapy, or different stages of the menstrual cycle, can also make you more susceptible.
• Diabetes. Diabetes can weaken your immune system making you more susceptible to infections, including thrush. Other underlying health conditions that affect the immune system, such as iron deficiency, and HIV, pose a similar risk.
• Sweaty or moist skin. Thrush thrives in an environment where the air doesn’t flow freely, for example, in tight clothes or damp swimsuits. It is also common where there’s added friction, such as during cycling or sex.

A mild case of vaginal thrush might not have any symptoms and won’t require treatment. Those who do have symptoms may notice:

Itchiness, redness or soreness in the vulva (around the labia and the entrance to the vagina and urethra).

A thick white discharge with a yeasty smell. Dryness and soreness during sex. A burning or stinging feeling when you pee. Small splits in the genital skin.

Some basic hygiene practices may lessen your chances of developing thrush. Wiping front to back and washing your hands after using the bathroom will prevent the spread of candida albicans from the anus to the vagina.

The incidence of thrush can be reduced by keeping the vulval area cool and dry. Wearing cotton underwear and careful drying after washing can also help to reduce the risk of thrush.

Avoid using antiseptics, perfumed sprays, douches or soap on the genital area, instead opting for soap substitutes. Perfumed toilet paper and sanitary items are also best avoided.

And watch what you wear! Tight-fitting, synthetic clothing can increase the risk of thrush. It’s also important to avoid overusing antibiotics, and if you have diabetes, to manage your blood glucose levels.

While we need a healthy diet to strengthen the immune system, there’s little scientific evidence to support the Candida diet. This overly restrictive diet advises cutting out foods high in carbs, sugar, yeast and gluten, starchy vegetables, some dairy foods, caffeine and alcohol.

If you suspect you have thrush, especially for the first time, it’s a good idea to see your GP to rule out any other causes of your symptoms.

Vaginal infections that aren't thrush but may look or feel like it includes herpes, trichomoniasis, bacterial vaginosis (BV) and gonorrhoea. It’s also important to rule out a sensitivity or allergic reaction.

Once you know what you’re dealing with, there are several types of treatment for vaginal thrush that include anti-fungal creams, tablet pessaries, and oral tablets. All are available from pharmacies without a prescription.

If you’re pregnant, see your GP or speak to the pharmacist for guidance, as not all treatments are suitable during pregnancy.

You should also see a doctor if:

• Thrush treatment doesn’t work
• You start feeling unwell or experience a high temperature
• You have a weakened immune system
• You are on other medications
• You’ve had recent unprotected sex with a new partner
• You have pain in your pelvic area or abnormal bleeding
• You get thrush 4 or more times a year.

Health Direct has solid information on thrush, including symptoms, treatment options and a helpline.

Jean Hailes for Women's Health has information on thrush and sex, and recurring thrush.