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Condition
Thrush, vaginal
Class
Women's health
Description
Thrush is an infection caused by a yeast-like fungus called Candida albicans. It is a minor ailment, most commonly occurring as vaginal thrush in women in their thirties and forties.

During pregnancy almost one in five women will have vaginal thrush. It is estimated that 80% of women will experience vaginal thrush at least once during their lives.

Thrush can also affect babies, developing in the mouth as oral thrush or as a form of nappy rash.

Men can develop thrush of the penis.
Causes
Candida albicans is a common fungus found naturally in the vagina and mouth and throughout the body. It is normally quite harmless. A candidal infection happens when the pH, or acid balance, in the body becomes disturbed. So any change to the acidic environment of the body, especially the vagina, can cause the Candida fungus to multiply.

A common cause of all types of thrush can be taking a course of antibiotics. The antibiotics kill off other bacteria that are harmless, allowing the Candida fungus to thrive.

Vaginal thrush can be caused by the hormonal changes of pregnancy or menstruation, or by taking the contraceptive pill.

Diabetes which is poorly controlled may cause thrush as levels of sugar in the vagina may increase.

Anyone who is tired and run down will be more susceptible to thrush.

Perfumed bubble baths or soaps and tight or synthetic clothing are also thought to make it easier for vaginal thrush to develop.

Having sex can alter the acidity of the vagina because semen is alkaline.

Poor toilet hygiene can lead to vaginal thrush, as Candida is present in the bowels and can be easily passed to the vagina when using toilet paper.

Oral thrush in babies can be caught during birth or during breastfeeding. It can also be caused by inadequate sterilisation of baby feeding equipment.
Symptoms
Vaginal thrush often causes intense itching and soreness around the genital area and a white discharge, which is said to resemble cottage cheese but which does not usually smell. It may be painful to pass urine or have sexual intercourse. Some women also feel sudden pain but this is rare.

Oral thrush looks like small white patches on the gums or roof of the mouth, and will leave a raw red patch if rubbed off.
Treatment
The aim of treatment is to reduce the level of candidal infection by the use of an antifungal agent. The usual treatment for vaginal thrush is antifungal pessaries containing the antifungal agents clotrimazole, econazole, miconazole or nystatin which are inserted into the vagina with a special applicator. These agents are also available in the form of intravaginal creams that may be used instead of a pessary. Lower strength creams applied to the genital area will also help to soothe the itching outside the vagina.



Alternatively, oral tablets containing fluconazole, ketoconazole or itraconazole can be used to deal with Candida wherever it is present in the body. These antifungal agents are very effective, especially when the thrush is persistent. Many women prefer oral treatments to the use of intravaginal pessaries or intravaginal creams as they find them easier and less messy to use.

Some people find that eating live yoghurt and avoiding yeast-type foods and drinks during an attack can help. Complementary medicine can also be useful in dealing with underlying causes of thrush.

Tablets, pastilles or oral suspensions containing some of the same antifungal agents are available for the treatment of oral thrush.
When to see your pharmacist
If you think that you may have vaginal thrush, visit your local pharmacist. Before recommending any product, your pharmacist will need to ask you a number of questions. She or he may ask you your age, to describe your symptoms, whether you have had the symptoms before, how long you have had the symptoms, if you have any other illnesses and whether you have taken any medication in the past. Do not be embarrassed, vaginal thrush is a common condition, and the pharmacist just needs to ask these questions to make sure that you do have thrush and that you are treated appropriately.

If the pharmacist decides that you do have vaginal thrush and self-treatment is appropriate there are oral tablets containing fluconazole, intravaginal pessaries and intravaginal creams containing clotrimazole, and creams for external application containing clotrimazole or econazole all available through your pharmacy without the need for a prescription. Each of these preparations is used in a different way and for different lengths of time. Your pharmacist will explain how to use them properly.

If because of your age, if you are pregnant or because of your symptoms your pharmacist decides that self-treatment is not appropriate you will be advised to visit your doctor who can make a fuller diagnosis or prescribe antifungal agents that are not available for self-treatment.

Similarly, if you or your child has oral thrush, you will be advised to visit your doctor for a prescribed medicine.
When to see your doctor
You should visit your doctor if you have not had thrush before, if you have had more than two attacks in the past six months or if you have any pain on passing urine or during sexual intercourse. Pregnant women who have any type of discharge or abnormal bleeding should always seek medical advice. People with diabetes and people under 16 or over 60 years of age should also seek medical advice. If over-the-counter treatments do not clear your thrush within 7 days, you should seek advice from your doctor.

If a course of antibiotics has caused thrush previously, ask your doctor to prescribe a different type of antibiotic if you ever need treatment for a bacterial infection again.
Living with thrush
Although thrush can be a nuisance and an irritating problem, there is no need to be concerned. Thrush does not damage the vagina and it will not spread to damage your uterus or affect your fertility. If you are pregnant, it will not harm your unborn baby.



Similarly, there is no risk of passing the infection to male sexual partners and there is no need to treat male partners as a means of preventing your getting thrush. Thrush is not a sexually transmitted infection. Male partners only need to be treated if they themselves have thrush.



Refraining from sexual intercourse when symptoms are severe is usually desirable as minor damage to the lining of the vagina during sex may make symptoms worse and may allow the Candida fungus to multiply. If you do have sexual intercourse, a vaginal lubricant my help reduce irritation. If you are using antifungal creams or pessaries, there is a risk that these may weaken latex condoms and therefore extra care is advisable.



When treating thrush, follow the instructions provided with the medicine. There are a number of products available and each may be used in different ways and for different lengths of time, and it is easy to get confused, especially if you have switched from one treatment to another.



When symptoms have improved, there are a number of things that you can do to reduce the risk of thrush coming back again. For personal hygiene, avoid douching and the use of vaginal deodorants. Just wash the vaginal area with plain, unscented soap. When using toilet paper, wipe from front to back.



Wear light, loose fitting clothing made of natural rather than synthetic fibres to avoid the vaginal area becoming too warm and moist.



As a matter of personal preference you could try adding probiotic or natural yoghurt to your diet, but there is no conclusive evidence to prove that they work.
Useful Tips
  • Pay particular attention to toilet hygiene, and always wipe from front to back
  • Wash the area outside the vagina carefully with water but don't scrub the skin hard with sponges or flannels
  • Shower, wash or bathe immediately after exercising
  • Avoid hot baths and bubble baths
  • Avoid tight jeans and synthetic underwear
  • Eat well, exercise and relax
  • If you have persistent attacks of thrush, there might be a common cause, which can be identified and avoided. Go to see your doctor


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