With recurrent thrush on the increase, we asked Tania Adib to clear up common myths about this common intimate health issue and advise on how best to prevent and treat it
Most women will suffer from an episode of thrush at some point, and while it’s easily treatable, the symptoms can make our lives extremely uncomfortable.
What’s more, it’s on the rise. Recent figures from the University of Manchester published in The Lancet Infectious Diseases reveal that recurrent thrush - four or more episodes a year - is set to increase from 138 million women a year in 2018 to 158 million by 2030. The 25-35-year-old age group is most affected, according to the research.
Despite the fact that thrush so common, it’s still somewhat shrouded in embarrassment and taboo. Unsurprisingly there are many misconceptions about the infection, which is thought to affect three out of four women at some point in our lives. Thankfully there are expert voices opening up the conversation about thrush and women’s intimate health. Canesten is one such knowledge hub has a wealth of online resources ranging from information on what is thrush to facts about symptoms of thrush and available treatments.
One leading doctor who is no stranger to the issue is Consultant Gynaecologist and Gynaecological Oncologist, Miss Tania Adib. We put your most frequently asked questions to her, from how can you ‘catch’ thrush to whether it is harmful in pregnancy and how to prevent it coming back. Here’s what she has to say:
What exactly is thrush?
“It's a fungal yeast infection caused by an overgrowth of candida albicans. Candida is a normally occurring organism in the vagina and most of the time it doesn’t lead to an infection. When the vaginal microbiome isn't functioning as well as it could be, candida can overgrow. And this is what we know as thrush, or to give it its medical name, vulvovaginal candidiasis.”
How can I tell if I have thrush?
“You would have a thick, white vaginal discharge, which is often likened to cottage cheese. You will often experience significant itching, which is really uncomfortable. The combination of a white discharge and itching are the most common symptoms of thrush. It does not really have a smell.”
What are some of the common myths and misconceptions about thrush?
“The most common misconception is that thrush is sexually transmitted. Also, that it's linked to cleanliness - that it means that you're not clean. Neither of those are true.”
How do you ‘catch’ thrush and who is most likely to suffer from thrush?
“Thrush can be linked to hormones, particularly oestrogen, as well as to the immune system and also to gut health. If any of those are not functioning as well as they could be, then you could be more prone to thrush.
“Anyone who has an immune condition can be more susceptible to thrush. For example, women with HIV can be more susceptible and women who have diabetes have more thrush. And if you take a course of antibiotics, then you might also have an episode. Thrush can be related to hormones, so women taking the oral contraceptive pill or HRT are more likely to suffer from thrush. Perfumed soaps too can affect the healthy balance of bacteria and pH levels in the vagina and cause irritation."
How common is thrush?
“It’s incredibly common, so women shouldn't feel stigmatised by having it. In fact, three out of four women will get it at least once in their lifetime. Recurrent thrush is also not uncommon. You can get thrush in the mouth, armpits and between the fingers as well as in the vagina. It doesn’t just affect women, occasionally men and babies can experience it too.”
Is it common to get thrush while pregnant?
“Yes. Women who are pregnant have slightly lower immune systems. Whenever your immune system is not working as well as it could be, you will be more prone to thrush. Pregnant women often have more episodes, but there’s no evidence that thrush harms the unborn baby.”
Why do you get thrush while on antibiotics?
“Antibiotics kill a lot of the good bacteria in the gut and this can cause an overgrowth of thrush both in the gut on the vagina.”
Is thrush linked to periods?
“Women can find that they are more prone to thrush at particular points in their cycle, particularly just before their period. Once women go through the menopause, some find that their thrush settles and they have far fewer outbreaks because their oestrogen levels are dropping. If the thrush is linked to hormones, those who experience thrush on a monthly basis related to periods will have far fewer episodes after the menopause if they don’t take HRT.”
Should we be careful with tampons, pads and even underwear if we’re prone to thrush?
“Thrush likes warm damp conditions. I would advise changing tampons and pads regularly - certainly every three or four hours. It’s important to make sure that the area is aerated. It's difficult to get air to the vulva and vagina - and if you have thrush you really want to help the area to breathe. Wearing cotton underwear and avoiding tight clothing, such as tights or skinny jeans, can all be beneficial.”
Do I need a special soap or wash if I have thrush?
“The skin on the vulva is really sensitive and delicate and so it’s best to keep things as simple and natural as possible. Avoid harsh or highly-scented soaps as they can aggravate your already sensitive skin. Many women don't even need soap to wash in that area. If you do use a wash, it needs to be very bland and free of additives. Some women like to use just a bland moisturising cream or ointment.”
Can I have sex or use condoms or lubricant if I have thrush?
“Thrush is not a sexually transmitted disease, so there’s nothing to stop you, but If you have active thrush and you have intercourse, it will rub against the walls of the vagina and make it more irritated.
“Lubricants themselves are bland and well-tolerated and condoms are also designed to be well tolerated too so they are not going to cause thrush. However, it’s worth remembering that if you are using an anti-fungal cream to treat thrush. The cream may damage the condom so will not be effective as a contraceptive.”
How do you as a doctor treat thrush?
“It slightly depends on the symptoms and where I think the thrush is affecting the patient mainly. I would normally treat it with an antifungal oral tablet containing fluconazole or itraconazole in combination with an anti-thrush cream. This is applied to the vulva. It’s a combination that works really well. Fluconazole is usually not recommended in pregnancy. Some studies have found that taking fluconazole in pregnancy can harm your baby."
“You can also use a pessary that you put into the vagina. This is also a good option if you don't want to take anything by mouth or if you are pregnant. Normally again I would use that with a cream that you put on the vulva as well to treat the fungal infection thoroughly as well as for comfort to stop the itching.”
Vaginal thrush can be related to imbalance of gut bacteria. Do probiotics help?
“Absolutely. I would say that probiotics were vital. Your gut health has a real effect on vaginal health. So, taking either a probiotic by mouth or a vaginal probiotic is incredibly effective.”
How long does it take for thrush to clear up with treatment?
“It’s normally quite quick, within 48 hours usually. If you take an oral tablet or a pessary, it's normally just a one-off treatment with the cream that you use for three or four days. Normally one course of treatment is enough. In a small minority, it can become recurrent, in which case we need to continue the treatment for a little bit longer until it clears.”
Do I need to see a doctor if I have thrush?
“You can get the thrush treatments I mentioned on prescription, but they are also available over the counter at pharmacies and in the Women’s Intimate Health aisle at your nearest supermarket. Your pharmacist may be able to advise, but if you are unsure, you can visit your GP.”
How do you stop thrush from coming back?
“I would advise absolutely to take a probiotic regularly, again, either by mouth or vaginally, whatever you feel more comfortable using. You should reduce sugar in your diet as much as possible. And you should employ the good vulval care that I mentioned earlier: avoidance of any harsh soaps and either use water or an emollient to clean the vulva. Wear and to wear cotton underwear and loose clothing.”
How does sugar in make thrush worse?
“Thrush feeds on sugar and thrives in conditions where there is a lot of it of sugar, so reducing it in your diet will reduce episodes of thrush.”
What happens if thrush is left untreated?
“It doesn't develop into anything nasty, but it can become a real nuisance with continued itching and discharge, which are just really uncomfortable. Long-term lead to redness of the tissues.”
How do I know if I have thrush or bacterial vaginosis?
“Bacterial Vaginosis (B.V.) is quite different from thrush. but can also cause similar symptoms such as itching and burning. It most commonly produces a slightly green-tinged discharge which has a fishy odour. The symptoms can be similar to thrush or a sexually transmitted infection and it is important to seek advice if over the counter treatment is not effective.
If a patient has really significant symptoms, I'll give her antibiotics. But there are lots of women who don't have such acute symptoms and do not realise they have it - we might just pick it up on a swab. In that case, I wouldn’t treat with antibiotics. I'd advise going to your local pharmacy and getting some pessaries for B.V. They will rebalance the microbiome and it will resolve.”
And lastly, any words of wisdom about thrush?
“Eat a healthy, balanced diet, moderate your sugar intake, take an oral probiotic and don't use harsh soaps.
Written in partnership with Canesten.
Global burden of recurrent vulvovaginal candidiasis: a systematic review, published August 2, 2018