Everything you need to know about vaginal thrush

Vaginal thrush is a very common condition affecting around three-quarters of women at some point during their lifetime. It is an infection caused by the overgrowth of a type of yeast called Candida albicans and, consequently, is also known as vaginal candidiasis. 

Candida albicans is naturally present in your vagina at low levels. When it overgrows, causing vaginal thrush, it can lead to significant discomfort but does not usually cause any long-term health problems.

Here, we will take a look at symptoms of vaginal thrush, how it is diagnosed and treated, and what you can do to reduce your risk of vaginal thrush. First, it helps to understand more about Candida albicans.

What is Candida albicans?

Candida albicans is a fungus, specifically a type of yeast, which is naturally found in your gut and mouth, on your skin and, in women, in the vagina and vulva. 

Depending where Candida albicans overgrows, it can cause oral thrush, thrush in the genitals (along the tip of the penis in men and in the vagina and vulva in women) and in breastfeeding women, on the nipples.

These yeast infections often occur due to a weakened immune system, taking certain medications, uncontrolled diabetes and/or hormonal changes. 

Symptoms of vaginal thrush

Vaginal discharge is normal. Healthy vaginal discharge is usually clear and can vary in thickness from day to day. However, changes in the colour, smell and/or thickness of your vaginal discharge alongside other symptoms can be a sign of a problem. 

In vaginal thrush, the discharge is usually whitish-yellow and lumpy — it is often described as looking like cottage cheese. However, the discharge does not usually smell. 

It is accompanied by soreness, swelling and itchiness of your vagina and vulva (the external opening of your vagina), a burning sensation when you urinate and pain during sexual intercourse.

Conditions often mistaken for vaginal thrush 

Bacterial vaginosis

Bacterial vaginosis is caused by an overgrowth of certain bacteria in your vagina, while vaginal thrush is caused by an overgrowth of yeast. While often mistaken for vaginal thrush, the symptoms of bacterial vaginosis differ significantly.

Unlike vaginal thrush, bacterial vaginosis causes a foul-smelling vaginal discharge — it is often described as fishy in odour. The discharge is not lumpy but watery and is greyish-white in colour. 

What’s more, bacterial vaginosis doesn’t usually cause soreness, itchiness or pain in or around the vagina and vulva. 

Sexually transmitted infections (STIs) 

Several STIs are often mistaken for vaginal thrush as they can also cause changes in your vaginal discharge and itchiness in and around your vagina. 

This includes genital herpes that develops on the inside of the vagina and causes itchiness and a burning sensation, as well as trichomoniasis and gonorrhea, which both cause a foul-smelling, greenish-yellow discharge, itching and pain when urinating. 

Causes and risk factors for vaginal thrush

Vaginal thrush is not an STI; however, sex can lead to vaginal thrush by disrupting the balance between the yeast Candida albicans and a type of bacteria that also naturally occurs in your vagina called Lactobacillus. This bacteria controls the levels of Candida albicans in your vagina, so if levels of this bacteria decrease, Candida albicans can take over. 

If you are having unprotected sex that involves the insertion of a penis, finger, tongue or sex toy that hasn’t been properly cleaned, new bacteria can be introduced into your vagina that disrupts the levels of Lactobacillus. This allows Candida albicans to overgrow. 

Levels of Lactobacillus in your vagina can also be disrupted if you are taking certain antibiotics, have uncontrolled diabetes, are stressed or have a weakened immune system. 

Hormonal changes can also trigger an imbalance between the bacteria and yeast in your vagina, which is why you are at greater risk of developing vaginal thrush if you are pregnant or taking certain hormonal contraceptives or hormone replacement therapy (HRT). 

When to seek help for vaginal thrush

You should see your GP or visit a genitourinary medicine (GUM) clinic if you develop symptoms of vaginal thrush for the first time or if you are aged under 16 or over 60, are pregnant or breastfeeding, or have a weakened immune system due to health conditions (eg diabetes or HIV) or treatment (eg chemotherapy or immunosuppressants). 

If your vaginal thrush persists despite treatment or you develop vaginal thrush more than four times in 12 months, you should also see your GP or visit a GUM clinic. 

Getting a diagnosis

You can often get a diagnosis of vaginal thrush based on your symptoms and a physical examination of your genitals, without the need for a test. 

However, you may be tested to confirm your diagnosis or if you are having recurrent vaginal thrush. The test involves using a cotton swab to collect a sample of discharge from your vagina. This sample is sent to a lab for testing. 

If you have had vaginal thrush before and recognise the symptoms, you can go to your local pharmacy and request an over-the-counter treatment. However, if you have had vaginal thrush four or more times in the last year, you should still see your GP or visit a GUM clinic.

Treating vaginal thrush 

Vaginal thrush is usually treated with antifungal medication. This can be taken orally as a tablet, as a pessary inserted into your vagina or applied as a cream onto your vagina. 

Follow the instructions provided by your doctor, nurse or pharmacist, and make sure you complete the course of treatment. Your symptoms should resolve within 7–14 days of starting treatment. 

Thrush during pregnancy 

If you have vaginal thrush during pregnancy, you will be advised to use an antifungal pessary or antifungal cream rather than taking a tablet. 

Vaginal thrush does not put your pregnancy at risk or affect your future fertility. There is also no evidence that having vaginal thrush while pregnant affects the baby. 

If you have vaginal thrush during a vaginal delivery, you may pass thrush onto your baby. However, your baby can be effectively treated with antifungal drops placed on their tongue. 

How does thrush affect your sex life?

Vaginal thrush is not an STI. However, if you have vaginal thrush, you can still pass on thrush to your partner if you have sex during this time. 

Also, having sex while you have vaginal thrush can be uncomfortable and further aggravate any irritation, redness and swelling of your vagina and vulva. Sex while you have vaginal thrush can also increase the time it takes for your symptoms to resolve. 

If you are being treated for vaginal thrush, it is important to know that certain antifungal treatments reduce the effectiveness of barrier contraceptives (ie condoms, diaphragms and caps). If you are using one of these types of contraception, you should avoid sex until you complete your treatment. 

Dealing with recurrent thrush

You may frequently (four or more times a year) get thrush if your immune system is weakened, you have uncontrolled diabetes, are taking certain antibiotics or are not following good hygiene practice during sex.

If you are dealing with recurrent thrush, avoid sex until your infection has resolved, and once it has resolved, make sure any sex toys are cleaned before use, remove any wet clothing as soon as possible, and avoid douching (washing the inside of your vagina) and using any products on your genitals that are scented. 

During an infection, wearing cotton underpants and breathable clothing below the waist, and applying an unscented moisturising cream on your vulva can help relieve some of your discomfort.

It is important to see your GP or visit a GUM clinic if you have recurrent vaginal thrush, particularly if it isn’t responding to over-the-counter antifungal treatments. You may need to have your vaginal thrush tested to see if the yeast has become resistant to certain antifungal treatments. If it has, you will be prescribed a different antifungal treatment.

Complications of thrush

If left untreated, symptoms of vaginal thrush can get worse, which can lead to skin in your genital area cracking and becoming infected. 

Less common complications of vaginal thrush include developing oral thrush, fatigue, lower back pain, abdominal pain and pelvic pain. 

How to prevent vaginal thrush

You can reduce your risk of developing vaginal thrush by regularly changing your menstrual products (eg tampons and pads) when you are menstruating, wearing breathable underwear (ie made from cotton), changing out of wet clothes as soon as you can (eg after swimming or exercising) and ensuring you always clean yourself from front to back after opening your bowels.

You should also avoid douching, hot tubs, hot baths and using any products on your genitals that are scented.

As poor health and stress can also increase your risk of vaginal thrush, try to find ways to manage your stress levels (eg mindfulness, a healthy bedtime routine, etc) and boost your immune system (eg following a healthy, balanced diet, exercising regularly, etc). 

If you have diabetes, make sure your blood sugar levels are well-managed. If you are struggling to do so, speak to your diabetes care team.