Thrush in women
Thrush is caused by the yeast Candida albicans. About 2 women in 5 have Candida in the vagina, without it causing any symptoms. Hormones in the vaginal secretions and the friendly vaginal bacteria keep it at bay. Problems arise when this natural balance is upset, and Candida multiplies. This can happen:
- during pregnancy (but thrush is less likely during breastfeeding)
- when you take antibiotics (because these get rid of the friendly bacteria)
- if you have diabetes, especially if your blood sugar levels are consistently too high
- if you wear tight, non-porous underwear, such as nylon knickers and tights (because Candida thrives in warm, moist conditions)
- if the vulva or vagina is sore for any other reason, particularly if you scratch (because damaged tissue is more susceptible to Candida)
- if you are ill for any reason
- if you are taking any drugs, such as steroids, which lower the body's resistance to infection.
Myths about thrush – true or false?
Probably false. Doctors are still arguing about this, but there is very little evidence for it.
False. Women who are not sexually active can suffer from thrush. The Candida yeasts are already in the vagina, and they cause thrush when the body's natural balance that keeps it under control is upset.
False. Itching is the usual symptom of thrush and there is often no discharge at all, or just a slight discharge.
False. If there is an odour, it is minimal and not unpleasant.
Very definitely false. Douching is squirting a soapy or antiseptic solution into the vagina to cleanse it. There is no need to do this, because the vagina cleans itself very efficiently. In fact, douching has the opposite effect; it destroys the friendly bacteria, gets rid of the healthy acidity and damages the lining, allowing thrush and other infections to take hold easily.
Possibly true: people who suffer from hay fever are more likely to suffer from repeated episodes of thrush (British Journal of Sexual Medicine 2007;30(2):46).
How do you know if you have thrush?
- The commonest symptom of thrush is itching and/or soreness around the entrance of the vagina (vulva). The soreness means that you have a stinging sensation when you pass urine and that sex is uncomfortable.
- There may also be a thick, whitish discharge (like cottage cheese), or a watery discharge. The discharge does not smell unpleasant.
- The vulval area looks red, there may be cracks in the skin and the vaginal lips (labia) are often swollen.
- You could see your doctor or to go to a genitourinary medicine clinic to check the diagnosis. If you have never had these symptoms before this is sensible.
- You could buy thrush medication from a pharmacy. According to the American research, there would be a less than 50:50 chance that this would be the right treatment. So if the symptoms persist after the course of treatment, see a doctor for a proper check-up and do not just buy more thrush medication.
- an anti-thrush cream to deal with the Candida on the skin
- an anti-thrush pessary to deal with the Candida in the vagina; a pessary is a specially shaped lump of anti-thrush medication for insertion into the vagina.
There are various types of anti-thrush creams and pessaries. Most contain -azole drugs, such as clotrimazole, econazole, fenticonazole or miconazole. These drugs are very similar and are all more or less equally effective. Nystatin is another type of anti-Candida pessary; it may stain your clothes yellow.
Why do some people keep getting thrush?
- The gut theory says that Candida yeasts lurk in the lower part of the gut (rectum). When you use an anti-thrush cream, you get rid of thrush from the vulva (the area around the opening of the vagina). According to this theory, you later get a reinfection from your own gut. This theory was very popular in the 1970s, but most doctors no longer believe it, because clearing Candida from the gut (with a long course of tablets) does not prevent recurrent thrush.
- The sexual theory says that your partner reinfects you, even though he does not have any symptoms himself. It is true that about 20% of the partners of women with recurrent thrush have the same type of yeast in their mouth or on their fingers or genital area, but most do not have any. And scientific studies mainly show that treating her partner has no effect on the likelihood of a woman having recurrences.
- The vaginal relapse theory is the one believed by most doctors. It seems that treatment does not eliminate the Candida totally. Tiny numbers of the yeast remain. If the situation is right for them for instance, the skin is moist and warm they slowly multiply until there are enough to cause symptoms again.
What to do if you keep getting thrush
- Gently smear a small amount of bio (live) yoghurt over the vulva, and also put it inside the vagina. The easiest way to do this is to use a tampon with its applicator. Push the tampon back inside the applicator so you have a space for about a teaspoonful of yoghurt. Then insert the tampon in the usual way, which will push the yoghurt into the top of the vagina. Remove the tampon an hour later. However, a scientific study showed that yoghurt did not decrease thrush (British Medical Journal 2004;329:548).
- Tea tree oil is another possibility. Dilute 20 drops or tea tree oil in half a cup of water, soak a tampon in this liquid and then insert it into the vagina. Change it as frequently as you would a normal tampon.
- Buy some 9% acetic acid gel (Aci-Jel) from a pharmacy. It comes with its own applicator.
Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Friday, February 26th 2010
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