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Vaginal thrush

Vaginal thrush is a yeast infection that can make you feel sore and itchy around your vagina. It’s also known as vulvovaginal candidiasis. Vaginal thrush is common – about three-quarters of women will have it at some point in their lives. You can get thrush at any age, but it’s most common in women who are in their 30s and 40s.

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Symptoms of vaginal thrush

You might not have any symptoms of thrush, and not realise you have it, but if you do get symptoms, they may include:

  • feeling itchy and sore outside your vagina, which is an area called your vulva
  • a thick, white vaginal discharge (it may look like cottage cheese)
  • slight pain when you have sex
  • pain when you go to the toilet (to pee)

If your thrush is severe, you might get red, cracked or damaged skin

If you think you might have thrush, go and see your pharmacist to get some advice – you can get treatments over-the-counter.

If your symptoms get worse or an over-the-counter treatment doesn’t help, contact your GP surgery, or go to your local sexual health clinic. Thrush isn’t a sexually transmitted infection, but does share some similar symptoms with other infections so it’s a good idea to rule these out.

Some people find that vaginal thrush comes back. If you have thrush with symptoms more than four times in a year, it’s known as a recurrent infection. For more information about this, see our FAQ: Recurring thrush.

Diagnosis of vaginal thrush

If you don’t have any symptoms of thrush, it might be picked up by your GP or at a sexual health clinic in a test for something else. If you do have symptoms, your doctor, nurse or pharmacist will usually be able to diagnose thrush just by asking about them. They may also ask you about your medical history and whether you've had thrush before.

If over-the-counter treatments haven’t helped, your doctor or nurse might examine you, or do a swab test. A swab looks similar to a small round cotton bud and is used to collect a sample of cells or discharge from your vagina. This will check if you have thrush, and not another type of infection. The test isn't usually painful, although it might feel a little uncomfortable.

A swab test is only usually necessary if:

  • you’re at risk of having a different infection
  • your treatment hasn’t worked
  • your symptoms keep coming back

If you’re sexually active, your doctor or nurse may take more swabs to test for other infections at the same time. And they might also check the acidity (pH) of your vagina with a swab as it might help to tell what’s causing your symptoms.

You might get the result immediately, but if the samples need to be sent to a laboratory to be tested – you’ll usually get them back within a week.

Self-help for vaginal thrush

If you have thrush, you might find it helps to stop using soap around your genital area. Use water or non-perfumed moisturising cream instead – if you’re unsure what type to use ask a pharmacist for advice. You could try using an emollient cream or ointment such as E45 on your skin outside your vagina too. Although there’s no proof it will work, you could wear loose clothing and cotton underwear while you have it, to help with any irritation.

Treatment of vaginal thrush

Medicines

If you get treatment for thrush with medicines, it will usually get better within a week or two at most. You can buy most thrush medicines from a pharmacy, without a prescription. These come in the form of tablets you swallow, or vaginal creams or pessaries. A pessary is a tablet that you put into your vagina, usually at night. Examples of treatments include:

  • clotrimazole (Canesten) cream or pessary
  • econazole (Gyno-Pevaryl) cream or pessary
  • fenticonazole nitrate (Gynoxin) cream or pessary
  • fluconazole (Diflucan) tablets
  • itraconazole (Sporanox) tablets

Tablets work just as well as pessaries and creams but there are some differences in side-effects. Oral treatments might make you feel sick, and give you diarrhoea or a headache, while pessaries can cause some irritation to the area and a discharge.

Whatever treatment you choose, it’s really important to finish the full course of your treatment. There’s a chance your thrush may come back if you don’t.

Thrush that doesn’t get better

If your symptoms don't start to get better within a week or two (or your symptoms come back), contact your GP surgery or sexual health clinic. They might take a swab to check what’s causing your symptoms. If you do have thrush, your doctor may prescribe a longer course of treatment or a combination of medicines that isn’t normally available over-the-counter. For more information, see our FAQ: Recurring thrush.

Special considerations

If you're pregnant

If you’re pregnant, ask your GP, midwife or a pharmacist before you take any medicines to treat thrush. For more information about having thrush while you’re pregnant, see our FAQ: Thrush and pregnancy.

If you have diabetes or a weakened immune system

You may need a longer course of treatment for thrush, so check with your GP.

If you're sexually active

Some creams and pessaries for vaginal thrush may damage condoms and diaphragms. If you use these for contraception or to protect you from sexually transmitted infections, ask your GP, nurse, or pharmacist for advice on what to use.

Causes of vaginal thrush

Vaginal thrush is caused by yeast (usually a type called Candida albicans). This usually lives harmlessly in, or around, your vagina, alongside healthy bacteria. But if it grows more than usual, this causes thrush.

There are several things that can make it grow more, which include:


Doctors aren’t completely sure whether some types of contraception, such as the combined contraceptive pill, may increase your risk of getting thrush. But it’s thought that taking hormone replacement therapy (HRT) may increase your risk.

Complications of vaginal thrush

Vaginal thrush doesn’t usually cause any long-term problems. But some women get continuous bouts of thrush. Less than five in every 100 women are thought to be affected by this. If your thrush keeps coming back, it can make you feel down or depressed, and it can affect your sex life too. See your GP to get some support if this happens to you. You can also read more about thrush coming back in our FAQ: Recurring thrush.

FAQ: Are there any natural treatments for thrush?

At the moment, there isn't enough proof to show that yoghurt or other natural therapies (such as garlic or tea tree oil) help treat thrush.

More information

Vaginal thrush is caused when the amount of yeast (usually Candida albicans) in your vagina increases. It’s been suggested that using yoghurt that contains healthy bacteria (known as ‘live’ yoghurt) may help lower the amount of Candida albicans that can grow. But scientists have found that yoghurt or other ‘live’ products don’t really help to prevent or treat the symptoms of thrush.

There also isn’t enough proof to show that douching (washing out your vagina with water or special douching fluid) helps either. Douching can irritate your vagina, so experts don’t recommend you do it.

It's also important to remember that natural doesn’t always mean harmless. Natural therapies may interact with medicines or cause side-effects, so be sure to speak to your pharmacist or GP before you use any.

fAQ: Can men get thrush?

Yes, men can get thrush too, and if they have symptoms they’ll need treatment.

More information

The symptoms of thrush in men include:

  • a red rash with white patches on their penis, which may be itchy
  • a discharge – this might smell
  • a tighter foreskin than normal

These symptoms can also be caused by problems other than thrush, so it’s a good idea to visit a GP or sexual health clinic for advice.

Treatment for thrush in men includes the same creams as used in women, such as clotrimazole and econazole cream, or a fluconazole tablet.

Thrush isn’t usually passed on by having sex (with men or women). So your partner won’t need any treatment if they don’t have symptoms. But sometimes, although it isn’t common, it’s possible to get infected with thrush through sex, particularly if your immune system is weak for some reason. You could use a condom but some pessaries and creams for thrush may damage them. Speak to your GP or pharmacist for advice about thrush and contraception.

FAQ: I’m pregnant – will thrush harm my baby?

No, it’s common to have thrush while you’re pregnant and it doesn’t harm your baby.

It’s important that you see your GP or midwife for treatment, rather than buy it over the counter. And if you see a pharmacist, be sure to let them know you are pregnant. This is because treatment for vaginal thrush can be different in pregnant women.

If you’re pregnant or breastfeeding, your doctor will probably recommend that you use a pessary or cream instead of antifungal tablets. You put these directly into your vagina. Take care when you put the pessary into your vagina, so you don’t damage your cervix (the neck of your womb). You might prefer to put it in by hand, instead of with the applicator.

If your symptoms haven't started to get better within a week or two, go back to see your GP, or ask your midwife for advice.

FAQ: Why do I keep getting thrush?

Some women get thrush that keeps coming back. This is called recurrent thrush and it’s thought that it affects less than five women in every 100.

Doctors don’t know why thrush keeps coming back in some women but they have some theories, which we list below.

  • It’s possible that thrush might keep coming back if you don’t take your treatment for thrush properly – it’s really important to complete the full course.
  • You might have a strain of Candida that’s resistant to treatment. This can happen if you’re infected with a type of yeast called Candida glabrata. Up to two in 10 women who get recurring thrush are infected with this type.
  • It might happen if you continue to be affected by things that can increase your risk of getting thrush. If you have diabetes and don’t get it under control, you might keep getting thrush, for example.

Yet despite these possible reasons, for half of women who get recurrent thrush, there’s no apparent reason why. If you continue to have problems, go and visit your GP or sexual health clinic to get support and advice. They may prescribe a treatment that you take for longer, or look for other things that might be causing your symptoms.

FAQ: Can you get thrush anywhere else?

Yes, you can get thrush anywhere in your body – you can get it in your vagina, or in your mouth, on your skin and nails, for example. You can even get an infection in your lungs.

More information

Most people carry yeast on their body and it doesn’t cause any problems. But sometimes it can flourish and cause an infection, and this can happen in both adults and children; even in babies.

Babies can get a yeast infection in their mouth, which is called oral thrush, and five in 100 babies are born with an infection. If your baby has oral thrush, you’ll see curd-like white patches in their mouth. You can rub this away, leaving a red base. It isn’t usually painful for your baby.

Adults can also get thrush in their mouth, which may look just red, or you can get white patches as babies do. You can get it if you wear dentures for example, or use an inhaler for asthma, or if you smoke. If your baby has thrush and you’re breastfeeding, they can pass it to you and you can get nipple thrush. If you don’t get treatment, you could keep passing it between you.

There are a range of treatments for oral thrush, including gels and suspensions. If you get oral thrush from using an inhaler, it helps to rinse your mouth with water afterwards, or use a spacer. A spacer is a chamber that you attach to the end of your inhaler to help you breathe your medicine in properly. If you have it from wearing dentures, make sure you clean them and have breaks from wearing them – leave them out at night. If you have thrush on your nipples, you can use a cream to clear up the infection. You and your baby will both need treatment.

Details

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    Further information

    Sources

    • Candida – female genital. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised May 2017
    • Vaginal and vulval candidiasis. PatientPlus. patient.info/patientplus, last checked July 2014
    • United Kingdom national guideline on the management of vulvovaginal candidiasis (2007). British Association of Sexual Health and HIV. www.bashhguidelines.org, published 2007
    • 2014 UK national guideline on the management of vulval conditions. British Association of Sexual Health and HIV. www.bashh.org/documents, published February 2014
    • Thrush and bacterial vaginosis. fpa. www.fpa.org.uk, last updated January 2014
    • Emollient bath and shower products, paraffin-containing. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed August 2017
    • Econazole nitrate. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed June 2017
    • Fenticonazole nitrate. NICE British National Formulary. www.evidence.nhs.uk/formulary/bnf/current, reviewed June 2017
    • Candidiasis (vulvovaginal). BMJ Best Practice. bestpractice.bmj.com, last updated March 2015
    • Candidiasis. Medscape. emedicine.medscape.com, updateed November 2016
    • Balanitis. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised July 2015
    • Candidiasis. PatientPlus. patient.info/patientplus, last checked January 2017
    • Breastfeeding problems. NICE Clinical Knowledge Summaries. cks.nice.org.uk, last revised January 2017
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    Reviewed by Rachael Mayfield-Blake, Freelance Health Editor, August 2017
    Expert reviewer Mr Robin Crawford, Consultant Gynaecologist
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