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.

Attacks of thrush are very common. Most women have had at least one attack by their mid-20s. Thrush is not a dangerous infection, but it can cause a lot of distress if it keeps coming back. It is very uncomfortable and can wreck your sex life.

Myths about thrush – true or false?

The contraceptive pill causes thrush
Probably false. Doctors are still arguing about this, but there is very little evidence for it.

Thrush is a sexually transmitted disease
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.

Thrush always causes a discharge
False. Itching is the usual symptom of thrush and there is often no discharge at all, or just a slight discharge.

Thrush is very smelly
False. If there is an odour, it is minimal and not unpleasant.

Thrush can be prevented by douching the vagina
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.

Thrush is more common in people who have allergies
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?

There are three main symptoms of 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.

It is very difficult to know if thrush is the cause of your problem without having a test, because these symptoms can also occur in other types of infection. For example, an infection in the bladder (cystitis) will also cause stinging when you pass urine, various infections can cause vaginal discharge or vulval soreness, and some skin diseases (which are not infections) can cause vaginal itching.

Researchers in the USA tested women who felt sure they had thrush, and were buying thrush medication from a grocery store or pharmacy (Obstetrics and Gynecology 2002;99:419–25). They found that only 33% had thrush as their only problem. Another 20% had thrush as well as a different infection that needed a different treatment, such as bacterial vaginosis or trichomoniasis.

This means that if you think you have thrush you have two possible courses of action.

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.

Treatment

Creams and pessaries. If you have thrush, the Candida will be on the skin of the vulva, and also in the vagina. Therefore you need:

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.

Some of these treatments can be bought from pharmacies without a doctor's prescription, in packs containing both cream and pessaries. Read the directions carefully, because some types of pessary (such as nystatin) have to be inserted every night for 2 weeks, but others need to be used for fewer days.

In about 15% of people, these treatments may cause a burning feeling or irritation soon after applying the cream.

Many anti-thrush creams and pessaries can damage condoms and contraceptive diaphragms.

Treatments that you swallow (oral treatments). Some special anti-thrush tablets and pills are now available, such as fluconazole and itraconazole, which can be used instead of creams and pessaries. These are called oral treatments. Oral treatments have to be prescribed by a doctor; do not try swallowing a pessary that is meant to be inserted in the vagina. Although oral treatments are simpler than creams and pessaries, they can have side effects, so most doctors prescribe them only for very troublesome thrush that keeps coming back.

Why do some people keep getting thrush?

A common scenario is that you develop thrush, you treat it with an anti-thrush cream or vaginal pessary, the symptoms disappear, and then a few weeks later they come back again. This is called recurrent thrush. Doctors do not fully understand why some people suffer from recurrent thrush. There are three different theories.

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

Check that you really do have thrush. If it usually goes away with anti-thrush treatment, it probably is thrush, but it is worth making sure. According to research from the University of Leeds (published in the journal Sexually Transmitted Infections in 2001), a third of women who attended a clinic because of recurrent thrush did not actually have thrush. There were other reasons for their symptoms.

To check whether or not you have thrush, you should visit your family doctor or local genitourinary medicine clinic to have a swab taken. The swab will be sent to a laboratory, which will be able to tell if there is Candida or similar yeasts. Although Candida is the usual cause of thrush, in about 5% of cases symptoms are due to a slightly different type of yeast, for which another treatment might be more effective. With recurrent thrush there is an even greater chance that it is an unusual type.

Look after yourself. It is crucial to make life as difficult as possible for the Candida yeasts, so take a look at our list of dos and don'ts for anyone with a vaginal or vulval problem. Avoid anything that might irritate the vulva, such as bubble baths, perfumed soaps, vaginal deodorants and douches. For sex, use a lubricant to lessen the chance of damage to the vulva and vagina.

Keep the vulval area dry. Candida yeasts like warm, moist places so dry carefully after bathing or showering. Avoid tight fitting or synthetic-fiber knickers choose cotton.

Use aqueous cream for washing the genital area, instead of soap. You can buy this from pharmacies. Apply it to the area, and then wash it off. (British Journal of Sexual Medicine 2007;30(2):46)

Avoid long courses of antibiotics. The longer a course of antibiotics, the more likely it will lead to thrush. So if you need antibiotics, ask your doctor if a short course would be appropriate

Natural remedies. If your recurrences are predictable, try a natural remedy to ward it off. For example, if your thrush usually comes before a period, on days 21–24 of your cycle, you could try a natural remedy starting on day 18. But remember that you can get a reaction to a natural remedy as easily as to a cream from the chemist, so stop straight away if that happens. Here are some popular natural remedies.

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.

Do not bother trying a yeast-free or sugar-free diet. There is no evidence at all that these diets have any effect.

Ask your doctor about oral treatment. A 7-day or 14-day course of an anti-thrush drug taken by mouth (oral treatment) may deal with the Candida yeasts more thoroughly. After that, you could use the pessaries in the vagina once or twice a month to prevent the problem returning.

Oral treatments may have side effects, and are unsuitable if you are pregnant or trying to get pregnant.

Consider long-term medication if you are having many troublesome recurrences. Your doctor can prescribe oral treatment, which is usually taken once a week. After 6 months, you stop the treatment and wait and see if the thrush returns (New England Journal of Medicine 2004;351:876–83). However, taking a prescription drug regularly for a condition that is not seriously hazardous to your health is a big decision. It is not suitable if you are pregnant or trying to get pregnant. Discuss all the pros and cons very carefully with your doctor, and go for it only if your symptoms are really distressing. Some doctors favor an anti-allergy medication in addition to the anti-thrush treatment (British Journal of Sexual Medicine 2007;30(2):46).

Consider asking your partner to get treatment. Clinics do not usually advise that your partner is treated (because they do not believe in the sexual theory of thrush). But if you have lots of recurrences, it might be worth asking your partner to be treated as well.

Written by: Dr Margaret Stearn
Edited by: Dr Margaret Stearn
Last updated: Friday, February 26th 2010

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Comments on this article

Posted by Optional on 23/07/2010 at 04:52:06 pm

I got really nervous when it started itching because i'd had unprotected sex with my boyfriend for the first time. I even started crying thinking it was Herpies... then i got a mirror and just saw all this gross white stuff... then i googled it and it was sooo much of relief.

Posted by ms la on 21/07/2010 at 10:44:16 pm

I was so scared thought it could be an STD or something but I read this site. I been taking antibiotics for 10 days. ( for non related infection) and I started itching and having thick white cottage cheese discharge with out any smell and I realize ill be fine with over the counter meds

Posted by Optional on 13/07/2010 at 08:11:13 am

i have had thrush and i have taken all the medication for it and then a week later i have had sex with my parnter and it burns and hurts when i have sex with him it has never happend before then i put the cream on but the cream doeant work its so itchy and i dont no what to do does anyone have the same problam and can u help to stop it what can i do i am in pain and i dont wont to have this anymore

Posted by Optional on 12/07/2010 at 10:30:57 pm

I have used the cream for my thrush and completed the course of 6 days.. but now i still have white stuff and its a cream like substance. is that just the cream that was used to get rid of thrush in the first place?

Posted by Optional on 02/07/2010 at 02:24:30 am

Hi. I've suffered miserab;y with recurrent thrush and have had it at least every few wks for the last 2yrs. I tried everything but it kept clearing up then coming back. Even my partner was treated, though he had no symptoms. I've just had to fight my case with the doctors to have my IUD removed as this was all I could put it down to (had it in for 2yrs 4 months). That was 2wks ago and so far the thrush hasn't come back. Do you think that this could've been causing the problem?

Posted by Chaz on 29/06/2010 at 04:40:14 am

i dont no if i have thrush its dead itchy and burning am getting some white discharge it doesnt smell i have used some clotrimazole thrush cream but its not stopping the iching could you help plz what is it

Posted by Optional on 24/05/2010 at 02:46:30 pm

i recently had thrush or what i think it is and have been treating it with a cream, i am still sore after around a week and have also been left without feeling or pleasure. is this normal please help

Posted by Optional on 20/05/2010 at 03:42:31 am

January this year lost my virginity,and during me losing my virginity me and my boyfriend used protection but while we were having sex or making love rather i noticed that he had no condom on and i stopped him but he said he putted it, a day passed and i felt like i had a bubble on my virgina but ignored it the following day had the same feeling and went to the toilet to investigate i took a toilet paper and checked if evaerything was cool and i found a condom, after that i had a very bad thrush my virgina was and so painful i could not even sleep, i told my ma and she recommended antibiotics which made me get a lot of discharge but the pain got better, so it worries me because im thinking what if after having sex again im going to go through that again

Posted by Amy on 19/05/2010 at 05:09:57 pm

hello this infomation has helped alot i think i found what i was looking for

Posted by Optional on 07/05/2010 at 09:26:15 am

Thank you so much. You have all put my mind at rest. 1st time with thrush i think...and Ive taken the tablet today and am treating with the cream.Feeling better already

Posted by Optional on 06/05/2010 at 03:28:54 am

Did not really tell me anything I did not already know!!!!!!!!!!!

Posted by Optional on 03/05/2010 at 11:38:28 pm

just to let people know you can buy oral treatments over the counter more cheaply if you ask for a pharmacy pack of fluconazole. Branded tablets cost about £20, the pharmacy pack varies in price - I once got it for 89p (!!!!), but next time the same pharmacy charged me about £5. Ask around. I can usually get it for about £4 - cheaper than prescriptions.

Posted by Optional on 24/04/2010 at 10:14:31 am

After having sex with my boyfriend a few times my vulvar was sore. I discovered it was thrush cause I also had other symptoms. Again, we had sex and I had a slight pain when we finished. This pain was not as bad as before and it went away quickly this time. What is this?

Posted by Optional on 22/04/2010 at 04:09:01 am

Ive been self treating my self for thrush for 5 days now, i used canesten combi , i dont seem to have a discharge as such now but im still sore and itchy and need to wee about every half hour ! Is this normal

Posted by ............. on 07/04/2010 at 02:06:14 am

What would happen if you leave thrush untreated?

Posted by Optional on 06/04/2010 at 01:36:53 pm

When i get thrush the vulva area seems to swell and become quite sore.. is this normal? any feedback would be muchly appreciated.

Posted by Optional on 04/04/2010 at 03:42:02 am

I took the pessary for a three day course and used the cream at the same time and i dont seem to fell the symptoms of Thrush anymore. Can you have sex five days after taking the pessary or not??

Posted by Optional on 20/03/2010 at 02:54:40 pm

I found after a few years that my thrush was re occuring because i was wearing a thong

Posted by Mmoni on 15/03/2010 at 04:56:33 am

I have a problem of getting recurrent thrush, but it comes once a year, its painful , itching and makes me feel uncomfortable, it started me at an early age, i waz abt 15yearz old by then nd never had any sexual activities

Posted by Optional on 13/03/2010 at 12:04:07 pm

I have had vaginal "thrush" for around 2 months now. Symptoms include itching, red bumps around, and inside my vagina, and a white creamy dischargein which very mildly smells of yeast. I have used endless amounts of cream, oral tablets, and pessary's. None of which have an affect. Which leads me to believe its not thrush. I am on the contraceptive pill, but have been for over a year. I've been to my doctors several times, had swabs taken, but can't get a clear answer. I'm going back to my doctors monday to talk, but would appreciate any feedback.

Posted by Sian on 11/03/2010 at 11:00:20 am

Found out recently that I had thrush. Have had treatment and it's gone! The only symptom I had was severe pain during sex. Now I'm having major problems relaxing. I dread the thought of having sex. HELP!!

Posted by Optional on 04/03/2010 at 04:47:47 pm

Okay... so i have never in my life had sex before and i just started getting my period about a month ago. My vulva is very red, itchy and it looks swollen to me. I have gone exploring down there only once. This area hurts most when i am walking and barely at all when my legs are apart. I really would like to know what is up!? THANKS

Posted by Anonymous on 10/02/2010 at 10:12:00 pm

I am suffering with thrush during my second pregnancy as I did with my first. The problem did clear up with an oral and pessary treatment after having given birth - however it is unpleasant and it does cause loss of confidence. I shall be going back to my doctor for another treatment. I have found the info above very informative and reassuring to know that this appears to be quite a common complaint.

Posted by Thrush on 27/01/2010 at 01:24:00 pm

i am also suffering from thrush and itchy discharge and its very thick but sometimes it become wet and be like milk. i went to the doctor several time but it doesnt come right please help.

Posted by nicola on 26/01/2010 at 03:59:00 pm

i have been getting thrush now for 3 months and its starting to really bother me so i visited the doctor after buying creams and pills which are expensive i thought enough is enough. just to say to all women out there thats in the same boat as me get it checked as it could be a sign of diabetes it seems to come on me just before my period as well. just for you all to be aware iv had blood tests done but havent had results yet il let you all know in due course.

Posted by Anonymous on 17/01/2010 at 11:57:00 pm

hi ave had thrush for almost a year i jus leave it but as soon as i take a canesten it jus gets even worse n it gets worse wen am on my period does anyone no any cure i reli need 2 change my diet and thursh pills are too expensive

Posted by Anonymous on 05/11/2009 at 08:34:00 am

Im 13 not yet started period but i think i may have thrush. Im really embarresed to tell.. as its just hard as i cant just go to the doctors on my own so my parents have to know aswell. :(

Posted by Amanda on 09/09/2009 at 09:40:00 pm

Hi, I suffer from recurrent thrush and having just finished a months worth of pills (for the second time in two years) hoping it was cured have that horrible feeling that I am in for another bout again. That must be my punishment for having sex last night with my husband on our third wedding anniversary and wearing Jeans today!! There has to be a cure out there somewhere - I jsut hope I find one before my huband strays!!!

Posted by Nina on 07/09/2009 at 01:11:00 pm

Hi - I am a longterm sufferer of thrush (probably related to weak immune system from CFS, also long-term stress and clinical depression) and I truly KNOW the suffering and would like to pass on the fruits of my knowledge. After a while I stopped bothering with Canesten as I would clear up and then a day after get another bout. Once during a bout, after 5 miserable days of itching and having eaten NO sugar or bread during this time I (by chance) ate a large portion of oily fish and the itching disappeared. I have since found that eating oily fish can clear up thrush. Now I am not so simple-minded to suggest this as a straight cure, However it is certainly true that eating Omega 3 as well as loads of B-vits gives your body those building blocks it needs to repair itself, and many of us in this modern age may be deficient in omega 3s and B-vits. Furthermore stress and depression simply swallow up omega3 and B-vits. I now MANAGE my condition through diet and exercise: I exercise regularly if moderately (exercise really kickstarts the body to function better); I don't eat much bread (yeast), try very hard to eat little sugar; I eat 4 portions of oily fish a week (you probably need less); and eat loads of B-vitamin rich food eg. pulses, amaranth grain, spelt, rye, buckwheat. If I get a bout which is rare now, I immediately eat a portion of salmon and oatcakes spread with marmite. It works for me, I imagine it wont hurt to try it. I sincerely hope this may help someone.

Posted by kassandra on 31/08/2009 at 04:46:00 am

Why is it that when my partner and I use condoms during sex, I do not get thrush but always get it the few times we've had sex without using a condom?

Posted by Anonymous on 22/08/2009 at 03:14:00 am

I have it right now and I am pregnant and due. I hope it doesn't hurt too much when the baby comes out. I am thinking a bath with some lavender or chamomile.. Chamomile tea in it will help to relieve the pain. :)

Posted by Anonymous on 13/08/2009 at 08:24:00 pm

I have thrush at the moment It hurts like hell. my first time The cream doesnt help, i have to take it everytime after i use the loo otherwise it hurts too much to handle. Is there anything I can do to help the pain? Will paracetamal help? Thank you

Posted by shelby on 13/08/2009 at 04:19:00 pm

this information has been very useful

Posted by Anonymous on 21/07/2009 at 05:04:00 pm

I dont have any itching or burning but i find a lot of thick white/yellowy discharge regularly throughout the day and i am not sure whether it is thrush or something else.

Posted by karen on 21/07/2009 at 07:44:00 am

I have been suffering from recuring thrush for 18 months now. It recurrs on average every 2-3 weeks. I apear to have the more resistant strain. Is there a different treatment for this.

Posted by Anonymous on 07/07/2009 at 02:53:00 am

I always feel itchy around my genital area. I haven been apply clotrimazole cream for almost half a year. However, on and off I still feel itchy around my genital area, especially before my peiod. Can i know what happen to my genital area? Any home remedy or natural way to diagnose it? Thank you

Posted by Anonymous on 21/05/2009 at 09:18:00 pm

Thankyou so much this has been so helpful

Posted by Lost on 19/05/2009 at 09:46:00 pm

i think i might have thrush but i have the merina coil, i dont want to take it out as i have about another 4 years can it be treated without taking the coil out?

Posted by Anonymous on 18/05/2009 at 10:53:00 pm

i have looked up a lot about yeast infections and thrush but i dont think i have it. whenever my boyfriend fingers me or touches the area around my vagina it is kind of itchy and burns but then it goes away. then it happens again. i dont know what it is. i did leave a tampon in for like maybe 10 hours on accident because i feel asleep and ever since then it always hurts after i have contact to my vagina. i dont know whats wrong. do u have any idea?

Posted by Kirst on 20/04/2009 at 10:37:00 pm

I'm not sure if it I'd thrush but I sting only when I touch and I have alot of White gunge in my pants, how can I make the White (none smelly gunge) go away?

Posted by joolz on 15/04/2009 at 09:51:00 pm

i have just finished an 8 month course of tablets for reaccurring thrush and with 2 days of stopping the tablets i have had another flare up. i have suffered with thrush for the last 2 years and get it about twice every month. the doctor will no longer give me tablets and i am just left trying to buy the tablets over the counter

Posted by S. on 15/04/2009 at 12:13:00 am

I don't really know if this is Thrush, but my mom and I are going to find out, I'm very uncomfortable all the time, and it always burns when i pass urine, it feels dry and i sometimes find clumpy white stuff too. Sometimes when i change position in sitting then I feel somewhat better, as if discharge helps. Its both itchy and burny at the same time mostly, and the doctor said it was not a UTI. To anyone whom can answer this, i thank you.

Posted by B. on 11/03/2009 at 12:35:00 pm

Informative and in layman's language. Confirmed everything I have been experiencing. Very debilitating problem. Hopefully after 1 pessary it has gone!

Posted by Anon on 25/02/2009 at 10:16:00 am

I only get Thrush when i take Anti biotics.To avoid Thrush i eat yoghurt and take Inner Health Plus tablets, as soon as i start with Antibiotics. The quicker you get onto these, theess chance you will get Thrush and have to treat it with Medication.

Posted by awidze on 08/02/2009 at 02:11:00 am

very informative & thank u!!

Posted by Anonymous on 29/01/2009 at 02:28:00 pm

Thank you for this very informative site. I have learned a lot in just a few minutes. The information is comprehensive and easy to understand. Thanks again.

Posted by Anonymous on 19/01/2009 at 11:02:00 am

this advice helped me a lot Thanks :)