Our Health Information Line receives calls and emails from women on a broad range of health issues. This regular column features answers to some of the most commonly asked questions.
Question: I would like to know what I can do or take to stop recurring thrush problems.
Vaginal thrush is caused by the overgrowth of yeast-like fungi, called Candida, that are found naturally in the vagina. Symptoms include vaginal itchiness and redness, a burning sensation during urination, discomfort or pain during sex and the appearance of a thick white or creamy vaginal discharge.
Recurrent thrush occurs when a woman experiences four or more bouts of thrush in a year. There is often no vaginal discharge associated with the condition. Instead, it is characterised by burning sensations on and around the vulva, irritation, swelling, redness and pain. It can lead to vulval fissures (skin splitting) and can make sex intolerable.
Some women are more prone than others to thrush infections. Risk factors include frequent use of panty liners or antibiotics; ongoing corticosteroid (anti-inflammatory steroid) use; diabetes; or a compromised immune system. Some women may also be genetically more vulnerable, or may have a poorer immune response to the infection.
Initial thrush treatments include over-the-counter antifungal creams, pessaries and oral medications. If symptoms do not respond to treatment or recur after treatment, women should see their doctor to confirm symptoms are thrush-related and not caused by another condition, such as bacterial vaginosis, dermatitis, lichen sclerosis, or genital herpes. To confirm thrush, the doctor will take a low vaginal swab and send it away for microscopic examination.
The best treatment choice for recurrent thrush remains unclear. However, women often require oral antifungal medications for up to six months, followed by a lower maintenance dose, before all redness and irritation are resolved. Unfortunately, for many women thrush can return in the months after this treatment is completed, and because oral medications can cause side effects, they may not be suitable for all women.
Antifungal creams may be recommended in addition to oral treatments however they commonly cause secondary irritations and dermatitis, which can worsen discomfort. They should be ceased immediately if symptoms worsen or treatment seems ineffective. If continued when ineffective they can contribute to the incidence of drug-resistant strains. Occasionally, women may require more extreme treatments, such as combined boric acid and antifungal treatments. Women who are very inflamed and irritated may also need a weak steroid ointment initially. All treatments need to be supervised by a doctor.
Women may find relief for vulval discomfort by using salt baths as a soothing alternative to soap or by applying cold compresses, ice or pinetarsol gel to the outside of their genitals. Reducing factors that could make treatment less effective is also worthwhile. Young women who suffer consistent premenstrual episodes of thrush may benefit from changing their contraceptive pill from one high in oestrogen to a progesterone-only dose. Screening for undiagnosed diabetes may also be warranted.
Last updated: September 2012
© Women's Health Queensland Wide Inc. This article has been reviewed by the Women's Health Queensland Wide editorial committee. It was published in Health Journey Issue 3 2012.
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