Vaginal thrush

What is vaginal thrush

Vaginal thrush is a common yeast infection caused by an overgrowth of the yeast candida albicans. This yeast lives naturally in the bowel and in small numbers in the vagina. It’s mostly harmless, but symptoms can develop if yeast numbers increase.

About 75% of women will have vaginal thrush in their lifetime. Other names for this infection are candidiasis or monilia.

Symptoms can include vaginal itching or burning, a white vaginal discharge and stinging or burning while urinating.

Vaginal creams or vaginal tablets (known as pessaries or suppositories) can help relieve thrush symptoms.

Thrush can also occur in other parts of the body, such as the mouth (known as oral thrush).

Thrush Is not regarded as a sexually transmitted infection (STI) but sexual partners with a penis may sometimes experience redness and irritation of the penis after sex without a condom. This is called balanitis of the penis.

Symptoms of vaginal thrush

Symptoms you may experience if you develop vaginal thrush include:

• vaginal and vulval discomfort – itching or burning
• a thick, white discharge with a ‘cottage cheese’ appearance with or without a yeasty smell
• redness or swelling of the vagina or vulva
• redness and swelling and sometimes splits or cracks in the genital skin
• stinging or burning while urinating or during sex.

These symptoms can usually be treated by using an over-the-counter product from the pharmacy.

See a doctor (GP) if you:

• are unsure if what you are experiencing is thrush
• have had several episodes of thrush over the past year
• have had recent sex without a condom or dam with a new partner
• have other symptoms like – pain, abnormal bleeding, sores or coloured discharge
• have tried an over-the-counter treatment but did not bet better.

Diagnosis of vaginal thrush

To make a diagnosis of vaginal thrush, your GP will need to:

• take a detailed history of your symptoms
• examine your genitals
• take a swab from the affected area.

Vaginal thrush causes

Vaginal thrush is not a sexually transmissible infection (STI).

It’s caused by an overgrowth of the yeast candida albicans, which is normally found on the genital skin. This overgrowth may occur due to:

• recent antibiotic use
• oral contraceptive use
• pregnancy
• menstrual cycle changes
• general health conditions (like diabetes, iron deficiency and immune system disorders)
• associated vulval skin conditions (such as eczema, psoriasis or jock itch)
• immunosuppressive medications.

Sometimes, the reason for candida overgrowth can’t be identified.

Frequent thrush can be a sign of chronic vulval dermatitis.

Vaginal thrush treatment

Treatment aims to reduce the number of yeasts, so they no longer cause symptoms. Options that are available from your local pharmacist without a prescription include:

• Antifungal creams or vaginal suppositories (pessaries) – these are put inside the vagina with a special applicator and used from one to 7 days, depending on the product. Occasionally a second course of treatment is required. Repeated topical treatments (applied to the skin) may occasionally cause skin irritation. Thrush creams can weaken condoms, so treatment should be applied after sex.
• A single 150 mg dose tablet (called Fluconazole) – this treatment has similar effectiveness to creams or suppositories (pessaries). It is more expensive than other options and is not recommended during pregnancy. If you are on other medications or pregnant, see your doctor or pharmacist before taking oral medication for thrush. Fluconazole is safe to use with the contraceptive pill.

Preventing vaginal thrush

To help prevent vaginal thrush:

• Wipe your bottom from front to back after going to the toilet. This will prevent the spread of candida albicans from the anus to the vagina.
• Avoid using soap to wash the genital area. Soap substitutes can be used.
• Avoid using antiseptics, douches or perfumed sprays (often sold as 'feminine hygiene products') in the genital area.
• Avoid using perfumed toilet papers and menstrual products.
• Avoid wearing tight-fitting pants and synthetic underwear.
• Consider changing your laundry detergent and don’t use fabric softeners.
• If you frequently experience thrush after taking antibiotics, seek advice from your GP. Think about planning ahead by taking thrush treatment when symptoms first occur.

Vaginal thrush and sex

You can still have sex when you have vaginal thrush. However, it can be uncomfortable, and you may experience a burning sensation during or after sex. Use plenty of lubricant to protect your skin.

Repeated painful sex during thrush episodes can lead to ongoing vaginal and vulval pain that persists even after thrush is treated. You may wish to avoid sex during this time.

Thrush is not an STI, but male partners can sometimes get redness and irritation after sex.

The treatment for thrush can weaken internal and external condoms. Apply treatments after you have had sex if you are using condoms.

Ruling out other vaginal and vulvar conditions

A few other vaginal and vulvar conditions result in symptoms that are like those of thrush (such as bacterial vaginosis and vulvitis). See your doctor if you:

• have had several episodes of thrush in a short period
• have had recent sex without a condom with a new partner
• have associated pain in your pelvic area or abnormal bleeding
• treated yourself with a thrush treatment and your symptoms haven’t gone away.

Managing recurrent vaginal thrush

If you experience repeated episodes of vaginal thrush (4 or more episodes in a year), see your GP.

Approximately 5% of people with a vagina experience recurrent thrush. This condition is different to standard thrush because discharge is not always present. Instead vaginal dryness and lack of lubrication during sexual activity is experienced.

People experiencing recurrent thrush are hypersensitive to candida albicans. The condition is treatable and needs to be confirmed and treated by a GP. The usual minimum length of treatment for recurrent thrush is about 6 months.

Your GP can also check for the presence of STIs and other skin conditions that may have similar symptoms and exclude other conditions that can cause thrush (such as diabetes).

Any factor contributing to the overgrowth of candida albicans should be identified and managed. If no contributing factors are found, a course of preventative treatment may be recommended.

There is no evidence to support the treatment of male partners of women who experience thrush.

Thrush outbreaks, while uncomfortable, do not cause any long-term health issues.

There is also no clear evidence that dietary changes prevent thrush, but the research is limited.

Where to get help

• Your GP (doctor)
• Sexual Health Victoria (SHV). To book an appointment call SHV Melbourne CBD Clinic: (03) 9660 4700 or call SHV Box Hill Clinic: (03) 9257 0100 or (free call): 1800 013 952. These services are youth friendly.
• Melbourne Sexual Health Centre Tel. (03) 9341 6200 or 1800 032 017.
• Victorian Sexual Health Network – where to get tested – visit Melbourne Sexual Health Centre's GP partner clinics for STI check-ups and treatment
• Women's sexual and reproductive health hubs (throughout Victoria)
• Jean Hailes Clinics. Tel. (03) 9562 7555
• Thorne Harbour Health (formerly Victorian AIDS Council) Tel. (03) 9865 6700 or 1800 134 840
• Ballarat Community Health Sexual Health Clinic Tel. (03) 5338 4500
• Bendigo Community Health Sexual Health Clinic Tel. (03) 5434 4300 or (03) 5448 1600
• Gateway Health Clinic, Wodonga Tel. (02) 6022 8888 or 1800 657 573
• Sunraysia Community Health Services Tel. (03) 5022 5444
• Barwon Health Sexual Health Clinic Tel. (03) 5226 7489
• 1800 My Options Tel. 1800 696 784 (in Victoria) for information about sexual health, contraception and pregnancy options