A women's guide to thrush

What is "thrush"?

Thrush is an infection caused by a yeast-like fungus called Candida albicans. It thrives in warm, dark, moist conditions and causes a white vaginal discharge which oozes from the vagina and causes intense itching that is worse at night.

Thrush affects most women at some time in their lives. Most have no more than one or two episodes in a lifetime, or one or two episodes a year. However, some are unfortunate enough to have attacks of thrush so often that they never seem to be free from it.

Women are more prone to thrush when:

Pregnant
On antibiotics
Using certain oral contraceptive pills
Diabetic
Anaemic
Emotionally upset
Resistance is low due to disease or lack of sleep
On a diet or eating a poor diet.

Although the commonest name for the condition is "thrush", it can also be referred to as "candidosis", "candidiasis" or "moniliasis". Yeast infections are rarely sexually transmitted.

What are the symptoms?

Thrush usually affects the vulva and vagina, causing itching, and is often associated with a thick, white vaginal discharge. There may be swelling of the vulva, soreness during or after intercourse and pain on passing urine.

The discharge is highly irritating, making scratching and rubbing unavoidable. Many women find this highly embarrassing. The entire area between the legs, inner thighs and buttocks may be affected in severe or neglected cases.

Thrush in men

Men can also carry thrush on the penis without any signs or symptoms. Soreness or redness of the penis during or after intercourse may be early signs of the condition. In severe cases, the end of the penis can be covered by thrush, causing the skin to peel.

Normal vaginal conditions

It is normal to have a wetness or secretion from the vagina. This secretion keeps the vagina clean, and the amount and consistency of the secretion vary at different times in the monthly menstrual cycle. The secretion is greatest at the mid-point between two periods, which coincides with the time of peak fertility, and is at its least just before the onset and just after the stopping of the menstrual flow.

Apart from keeping the vagina clean and healthy, the secretion also acts as a lubricant during sexual intercourse, preventing the build-up of friction and stopping soreness afterwards.

The secretion is usually clear or slightly cloudy and feels slippery to the touch. When it dries it may be faintly yellow and cause slight staining of the underclothes. This is particularly noticeable mid-cycle, during pregnancy and in some women on the oral contraceptive pill.

Vaginal changes

The normal vaginal secretions can change when the body undergoes either physical or hormonal changes which affect the vagina, such as pregnancy or taking the oral contraceptive pill.

However, some changes are not normal and may be a warning of a possible infection:

Soreness or dryness, particularly after intercourse
A strong-smelling or frothy vaginal discharge
Itching or burning
Swelling of the genital area
An urge to pass urine more often than usual
Pain on passing urine
Rashes or sores on the genital area.

What causes thrush?

As we have seen, thrush is caused by a yeast-like fungal growth. The foreign organisms usually enters the vagina in one or two ways:

They can migrate into the vagina from the surrounding skin or be pushed into the vagina from the skin during intercourse or when inserting a tampon. So, even if a women has never had intercourse, she can develop a vaginal infection.
Much more rarely, organisms can be transferred into the vagina from the male during intercourse.

Once the organisms have found their way into the vagina, there are a number of factors that can cause them to multiply and produce symptoms:

Warmth and moisture
Yeasts flourish in a warm, moist environment. Wearing tights, nylon (non-porous) underwear or tight jeans can create such an environment by trapping body heat and perspiration and preventing air from circulating around the genital area.
Yeast build-up can also be promoted by not drying properly after washing and by excessive perspiration.
So, if you suffer from repeated attacks of thrush, just a few simple steps can make all the difference:
- Wear crotchless tights with cotton underwear.
- Avoid tight jeans and trousers.
- Dry the genital area thoroughly after washing.
Hormones
Anything that affects the hormone balance can lead to thrush, including pregnancy, certain oral contraceptive pills and emotional stress.
In the case of pregnancy and oral contraceptive pills, increased levels of the hormone oestrogen produce more sugar in the vagina, providing a fertile breeding ground for thrush. After the menopause or "change of life" the body produces too little oestrogen and so thrush is less common.
Antibiotics
Antibiotics do not affect yeasts directly but kill other organisms that are responsible for the balance which keeps the vagina healthy. This allows the yeasts to grow unopposed.
If you suffer from thrush after taking antibiotics, you should bring this to the attention of your doctor every time you are prescribed a new course.
Broken Skin
Yeasts are more likely to flourish if the skin of the vulva is broken or damaged. This can easily happen if the skin is scratched.
Anything that is likely to cause an irritation - vaginal deodorants, disinfectants, bubble-baths or highly perfumed soaps - should be avoided if you are prone to repeated attacks of thrush.
General Health
Yeasts thrive on sugar, blood and unhealthy skin cells. Women with diabetes (a condition which results from too much sugar in the blood) are at risk of recurrent attacks, though patients who inject themselves daily with insulin are able to control their blood sugar - and their thrush.
As mentioned, you are more likely to suffer an attack if you are feeling run down, emotionally upset, anaemic or just short of sleep.
Thrush can also occur around the time of the menstrual period when the alkaline/acid balance of the vaginal secretion changes slightly. Some women find washing the vulva in a week solution of bicarbonate of soda helpful at this time.
Sexual transmission
Although it is possible to get a yeast infection by sexual transmission from a man, it is rare. However, if you have recurrent problems, it is worth your partner also being examined by a doctor.

How is thrush treated?

You cannot always be certain that symptoms of vaginal discharge and itching are due to thrush without having a proper medical examination. You should attend your general practitioner (GP), local family planning clinic or genitourinary (GU) clinic (formerly called Special Clinic) for advice and treatment. You can attend a GU clinic without a referral letter from your GP. If the doctor diagnoses thrush there are basically two treatment options available - topical or oral.

Topical Treatment
pessaries and/or creams
Pessaries look like large tablets or suppositories and are inserted into the vagina, usually with the aid of an applicator to ensure that they are placed high enough.
The length of treatment depends upon which type is prescribed. They are usually used at bedtime since they can fall out when standing up. Wearing a minipad and pants at night is recommended to avoid any possible mess or staining as the pessary dissolves. Creams may be prescribed and should be used according to the GP's instructions.
Oral treatment
tablets or capsules to be swallowed
These are as effective as pessaries and have the added advantage of eradicating any yeast in the bowel. Also, some women prefer them as they cannot cause any mess or staining. Pregnant women should not take these.

You should discuss the treatment options with your doctor so that they can decide what is best for you. Whichever preparation is prescribed, the course must be completed as advised.

How you can prevent thrush

If you are prone to thrush, there are a number of things that you can do to reduce the number of attacks:

Avoid wearing tights, nylon underwear and tight jeans and trousers.
Wear skirts and cotton underwear.
Wear skirts and cotton underwear.
Use pads rather than tampons.
Avoid perfumed soaps and other irritants.
Always wipe from "front to back", to avoid contaminating the vulva from any yeasts on the skin that have come from the bowel.
Dry the vulva properly after bathing or swimming.
Wear clean underwear each day.
Avoid scratching, as this spreads the infection.

Remember: Self-help and careful preventative measures are the most effective way to avoid this common and distressing condition. However, once an attack does occur there is much to be gained by seeking prompt medical advice and treatment.