Thrush: like most things pertaining to our vaginas , it’s not widely discussed and on the whole shrouded in a sense of embarrassment, yet three in four women will get it over the course of our lifetimes, and six per cent of us will experience the kind of recurrent thrush that “severely affects quality of life” according to recently published research in The Lancet . It’s this boomerang variety of thrush (medically known as vulvovaginal candidiasis) in particular that’s seeing soaring diagnoses, with The Lancet’s systematic review estimating that cases will increase from 138 million women annually to 158 million by 2030. As it stands, as with many women’s health issues such as heavy periods , thrush hasn’t been taken all too seriously up until now, but the review’s authors impress just how debilitating the condition is, and not just for the women suffering either:
“The high prevalence, substantial morbidity, and economic losses of recurrent vulvovaginal candidiasis require better solutions and improved quality of care for affected women.”
The reasons behind the surge in thrush cases aren’t currently clear, but the sooner we get chatting about our experiences and seeking help, the better. If you’re in any doubt as to whether you have it, or may have in the past, typical thrush symptoms in women according to the NHS include:
- White discharge (like cottage cheese), which doesn't usually smell
- Itching and irritation around the vagina
- Soreness and stinging during sex or when you pee
Thrush is a fungal condition caused by an overgrowth of the candida fungus and while The Lancet highlights that it’s most common in the 25-34 age group, incidences among women undergoing the menopause are also growing. Old wives’ tales around how to get rid of it abound (probably another indication that it’s an area that deserves more research and exposure), so we looked into what could be causing it, the treatments that work and a few thrush untruths. You can put the yoghurt back in the fridge for starters.
Your workout routine
The recent emphasis on wellness and self-care has led many more of us to take up regular exercise and ‘athleisure’ is now acceptable attire in the nation’s boardrooms as well as at brunch. Brilliant for work culture and our overall fitness, not so great for thrush avoidance if we sit around in our gym kit. Consultant Gynaecologist Dr Vanessa Mackay explains why:
“One of the ways in which I think that our modern lifestyles could be contributing to a rise in thrush cases is because more of us are working out, which is great, but in tight fitness wear that we don’t always change out of straight away. Thrush thrives in warm, moist environments like this - the same applies if you wear non-breathable underwear or tights on a regular basis.”
Changing into clean, dry clothes and ideally sensible cotton pants will make the candida fungus feel far less welcome.
While thrush is most common in younger women, Dr Mackay has noticed an increase in women going through the menopause who suffer from thrush and she thinks that a common symptom reliever could be to blame:
“There has been an increased uptake of hormone replacement therapy (HRT) which could be contributing to more reported cases of thrush among women in this age group. This is because oestrogen , a key component of HRT, makes cells more vulnerable to glycogen growth, which in turn promotes the growth of the candida fungus.”
As if the menopause weren’t enough to be dealing with. If you’re taking HRT and have noticed thrush symptoms, visit your GP, particularly if your thrush is recurring.
In the same way that the oestrogen within HRT can make for a cushy life for candida, some oestrogen containing hormonal contraception can do the same. This is another ‘take it to your GP’ issue if thrush doesn’t respond to over the counter treatment (your options are coming up), and especially if you experience thrush more than twice in a six month period. Your doctor could prescribe a different form of contraception to suit your needs that might also reduce the likelihood of thrush returning but be sure to discuss your requirements and symptoms with a relevant medical professional.
Oh hey hormones. Specifically your old friend oestrogen. It’s good for lots of stuff, for instance heart health, bone strength and keeping skin supple , but oestrogen oscillations throughout your monthly cycle can cause thrush to creep up in the week prior to your period starting in particular. Dr Mackay explains that experiencing thrush during the week of your period too is not uncommon:
“Thrush can actually get worse during your period as blood causes the pH of your vagina to change, making it more acidic. This can provoke a change in bacteria which makes yeast overgrowth more likely.”
Joy of joys. Again, if this is you a visit to the docs is in order if thrush hasn’t responded to treatment and it’s becoming a monthly thing alongside menstruation.
You’ll not be surprised to hear that thrush’s apparent partner in crime oestrogen is partly responsible for a greater predisposition to thrush during pregnancy, but Dr Mackay highlights that you can often also be immunosuppressed in pregnancy, which also makes you more susceptible to bacteria imbalance and yeast overgrowth. Visit your GP before starting any treatment to be on the safe side.
Thrush isn’t an STI but it can occasionally be passed on through sex (men can suffer from thrush too – commonly referred to as balanitis). Never skip foreplay either - not only because you damn deserve it but also because if you go in dry, so to speak, you’re more likely to cause irritation and inflammation, which can make thrush all the more likely. The NHS also recommends abstaining from sex until thrush has gone to avoid passing it on, and to be honest, dodging extreme discomfort or making thrush worse
If you’re taking antibiotics, a bout of thrush is a surprisingly common side effect. Antibiotics can disrupt the natural balance of bacteria in both our gut and vagina, which can cause candida overgrowth. Be sure to finish your full course of antibiotics as advised by your doctor but seek out thrush treatment and consider taking a probiotic to balance out your vaginal flora.
Or rather, poorly controlled diabetes, as Dr Mackay underlines:
“Thrush can actually be a key marker in diabetes diagnosis, as unstable blood sugar can lead to candida yeast overgrowth.”
You could experience oral thrush too if you have underlying or poorly controlled diabetes but if you’re at all concerned, particularly if you have any other symptoms of diabetes , a sharpish visit to the GP is in order.
Yes, really. Dr Mackay reckons that the popularity of perfumed intimate products such as deodorants, washes, soaps, gels and lotions could be contributing to a rise in thrush, as products such as these can change the pH of your vagina and irritate skin, providing a more favourable environment for the candida fungus. Dr Mackay advises sticking to plain old water (no soap) with a non-perfumed emollient if you please, but water will suffice. Incidentally, she’s staunchly anti vaginal douching (it’s more likely to cause problems than cleanse). Speaking of bathing habits, while taking a long, hot bath is indeed a key tenet of the self-care movement along with aforementioned workout/ fitness wear trends, they’re not ideal where bacterial and pH balance in the vagina department is concerned. Opt for a more lukewarm bath or shower instead to minimise your risk of getting thrush. A soak in the tub isn’t so relaxing if it leads to fungal overgrowth.
Most thrush sufferers will be familiar with your high street chemist’s anti-fungal cream, pessary and pill offerings, and all can prove very effective (Canesten is a solid option). If you’ve suffered from thrush before and recognise the symptoms, a trip to the pharmacy can knock thrush on the head in around a week. If you’re unsure, most chemist’s have a private room where you can discuss your symptoms with a pharmacist without your neighbour’s eavesdropping on your vaginal burning situation.
In the case of recurrent thrush, this is defined by experiencing thrush more than twice in six months and warrants a visit to the GP for further investigation. Dr Mackay emphasises that, unless you’ve put repeated episodes of thrush down to another cause as listed above, thrush could be returning due to bacterial resistance. This can happen after around 20 courses of antifungal treatment, and while there are currently no new breakthrough treatments to speak of (if they could get cracking on that...cool), your GP may be able to suggest alternative remedies. Just don’t be tempted to try this lot…
A few thrush myths
Eating live yogurt may well help to address bacterial balance from within, and at the very least it provides health giving calcium and protein, just don’t go applying it to your bits. Applying live yogurt topically is one much touted natural thrush solution, but Dr Mackay advises against it as it’s likely to further disrupt the natural bacterial equilibrium in your vagina, not to mention introduce other “foreign bodies” that could make thrush worse or provoke a different kind of infection altogether. It’s to be poured on your granola, not your vagina.
Washing it away
Not possible (see douching). Dr Mackay confirms that, actually, overwashing is likely to make thrush worse as it will further dry out skin and cause skin to become sore. Once a day is plenty.
Dr Mackay disputes that common dietary suggestions such as eating less sugar can make a difference - there’s currently very little evidence to imply that changing your diet provides any thrush relief. Clearly blood sugar control if you suffer from diabetes is a different issue, but otherwise there are unfortunately no known food hacks for seeing off thrush.