Vaginal thrush

Vaginal thrush is a common yeast infection that affects most women at some point.

It may be unpleasant and uncomfortable, but can usually be treated with medication available from pharmacies or on prescription from your GP.

However, for some women, vaginal thrush can be difficult to treat and keeps coming back.

Symptoms of vaginal thrush

Typical symptoms of vaginal thrush include:

• itching and soreness around the entrance of the vagina (itchy labia)
• vaginal discharge – this is usually odourless and may be thick and white or thin and watery
• pain during sex, which may make you worry about having sex
• a stinging sensation when peeing

Sometimes the skin around the vagina can be red, swollen or cracked. Occasionally there may also be sores on the skin, although this is more often a sign of genital herpes.

What to do if you have vaginal thrush

If you've had thrush before and think you have it again, you can normally treat it with medicines bought from a local pharmacy. See 'How to treat vaginal thrush' below for more information.

It's a good idea to get medical advice from your GP or a sexual health clinic if:

• you have thrush for the first time
• you're under the age of 16 or over 60
• you're pregnant or breastfeeding
• you have unusual symptoms, such as coloured or smelly discharge, or sores on the vulva (skin around your vagina) 
• you have abnormal vaginal bleeding or pain in your lower tummy
• you've had two episodes of thrush within the last six months
• you've reacted badly to antifungal treatment in the past, or it didn't work
• you or your partner have previously had a sexually transmitted infection (STI) and you think it might have returned
• your symptoms don't improve after 7-14 days of treatment

Thrush isn't usually anything to worry about in these cases, but your doctor may want to take a swab from your vagina to confirm the diagnosis and/or carry out tests to check for any underlying cause.

They can also advise you about the most suitable treatment and give you a prescription, if necessary.

How to treat vaginal thrush

Mild thrush can usually be treated with a short course of antifungal medication. The symptoms will usually clear up within a week or two.

Treatment may need to be continued for longer if you have repeated bouts of thrush.

Several thrush medicines can be bought over the counter from pharmacies, while others are only available on prescription from your GP.

The main types are:

• pessaries – a special pill that you insert into your vagina using a special applicator
• intravaginal creams – these are also placed into the vagina using an applicator
• capsules – these are swallowed and may be more convenient to use than pessaries or intravaginal cream, but can have more troublesome side effects, such as vomiting or an upset stomach

These treatments are all equally effective. You can usually choose the treatment you prefer, although pregnant or breastfeeding women shouldn't take the capsules.

You can also get creams to apply to the skin surrounding the entrance of your vagina. These can help relieve itchiness and soreness, although you may find that an ordinary emollient (moisturiser) works just as well.

Read more about treating vaginal thrush.

What causes vaginal thrush?

Vaginal thrush is caused by yeasts from a group of fungi called Candida.

Many women have Candida in their vagina without it causing any problems, but thrush can develop if the natural balance of micro-organisms in the vagina is disrupted and Candida multiplies.

You're more likely to get thrush if you:

• are in your twenties and thirties – thrush is less common in girls who haven't started their periods and women who have been through the menopause
• are pregnant
• have sex when you're not fully aroused or you're worried it may hurt – this can lead to vaginal dryness and tightness during sex, which can trigger thrush
• take antibiotics
• have poorly controlled diabetes
• have a weakened immune system – for example, because of a condition such as HIV or a treatment such as chemotherapy

Vaginal thrush isn't classed as an STI, but it can be triggered by sex – particularly if you have trouble relaxing and your vagina is dry – and can occasionally be passed on to sexual partners.

Preventing vaginal thrush

If you get thrush frequently, you can:

• use water and an emollient (moisturiser) soap substitute to clean the vulva (skin around your vagina), but avoid cleaning this area more than once a day
• apply a greasier moisturiser to the skin around your vagina several times a day to protect it (but be aware that these moisturisers can weaken condoms)
• avoid potential irritants in perfumed soaps, shower gels, vaginal deodorants, wipes and douches
• avoid wearing tight-fitting underwear or tights – some women find that special silk underwear designed for people with eczema and thrush is helpful
• ensure your blood sugar level is kept under control, if you have diabetes

Some women eat probiotic yoghurt or supplements to prevent vaginal thrush, but there's little evidence to suggest this works.

Vaginal thrush is treated with medications you can buy over the counter from a pharmacy, or get on prescription from your GP.

If you've had thrush before and think you have it again, you can normally treat it with medication bought from a local pharmacy. Otherwise, you should see your GP for advice.

Find your local pharmacy

Thrush medications

Thrush is treated with antifungal medicines that are available as pessaries, intravaginal creams or capsules.

All these medications are equally effective, but you may find that one is more convenient to use than another.

Pessaries and intravaginal creams

A pessary is a pill that you insert into your vagina using a special applicator. Intravaginal creams are applied inside your vagina.

The main types used to treat thrush are:

• clotrimazole – available over the counter from pharmacies
• econazole, miconazole and fenticonazole – available on prescription

Over-the-counter pessaries are usually used daily for one to six days. Intravaginal cream is normally used once. Possible side effects include a mild burning sensation, slight redness or itching.

These treatments can also damage latex condoms and diaphragms, so you may want to avoid having sex, or use another form of contraception during treatment and for up to five days afterwards.

Capsules

If you would prefer not to use pessaries or intravaginal cream, antifungal capsules are available.

The main types used to treat thrush are:

• fluconazole – available over the counter from pharmacies
• itraconazole – available on prescription

Over-the-counter thrush capsules usually come as a single dose.

Possible side effects can include feeling sick, an upset stomach, diarrhoea and headaches.

Skin creams

If the skin around the entrance to your vagina (vulva) is also sore or itchy, you may find it helpful to use an antifungal skin cream in addition to one of the treatments above.

• Creams containing clotrimazole can be bought over the counter from pharmacies.
• They're available in packs that also include antifungal pessaries, intravaginal cream or capsules.
• They're normally applied to the skin two or three times a day for at least two weeks.
• Possible side effects include irritation, a stinging sensation or itching.

Alternatively, you could try using an ordinary emollient (moisturiser) near your vagina. This can help relieve your symptoms and causes fewer side effects than antifungal cream.

Emollients and antifungal skin cream can weaken latex condoms and diaphragms, so you may want to avoid having sex, or use another form of contraception during treatment and for up to five days afterwards.

Sex and sexual partners

Vaginal thrush isn't classed as a sexually transmitted infection (STI), so sexual partners don't need to be informed, tested or treated if they don't have any symptoms.

However, there's a very small risk of passing the condition on during sex, so you may want to avoid having sex until it's cleared up.

Some treatments can also weaken latex condoms and diaphragms (see above), so you may want to avoid having sex or use another form of contraception during treatment and for a few days afterwards.

If thrush keeps coming back

Speak to your GP if you experience frequent bouts of thrush.

They might run some tests to confirm the diagnosis and check for any possible underlying cause, such as diabetes.

They may also give you a prescription you can use whenever the symptoms return, or suggest trying a longer course of treatment lasting up to six months.

If you're pregnant or breastfeeding

Visit your GP if you have thrush and you're pregnant or breastfeeding.

Your GP will probably suggest using pessaries or an intravaginal cream. Capsules aren't recommended because they could harm your baby.

If you're pregnant, take care when using an applicator to insert a pessary or intravaginal cream, as there's a small risk of injuring your cervix (neck of the womb).

Antifungal skin cream or moisturisers can normally be used safely if you're pregnant or breastfeeding and the area around the entrance to your vagina is sore or itchy.