Vaginal thrush is very common. 50-75% of all women will experience one or more episodes during their lifetime. Up to 3-5% experience more than four vaginal infections each year. The condition is most common among fertile women, which is due to hormonal factors. The condition has several names, including vaginal thrush, vaginal yeast infection, genital fungal infection, vulvovaginitis, and candida vaginitis.
Vaginal thrush is not dangerous and is not classified as a sexually transmitted infection. In some cases, balanitis (inflammation of the foreskin) may occur in a partner, but this is rare and usually resolves on its own.
Acute yeast infections can cause severe itching, burning/soreness and altered discharge. The itch can be located on the labia, the vaginal opening and the vagina. Red and inflamed mucous membrane is seen, often with a white coating. The mucous membrane can become so inflamed that smaller wounds and fissures appear. The discharge is typically seen as white, thicker and mushy - and is often described as "cottage cheese".
Chronic, or constantly recurring, yeast infections often produce less pronounced symptoms than acute fungal infections. There is a slight to moderately pronounced soreness and occasionally an unpleasant dryness in the vagina. Itching is absent or less pronounced. The discharge can vary – everything from watery discharge to thick, mushy discharge. Some experience the discharge as unchanged. The chronic form can have a major impact on sexual life due to intercourse pain.
For a safe diagnosis of a vaginal thrush, a clinical examination should be carried out. Skin and mucous membranes are examined and the doctor takes discharge samples to detect fungi directly under a microscope and/or for further laboratory examination. In the case of chronic vaginal thrush, fungi are rarely found directly under the microscope, and it may be crucial to send in one or more swab samples of the discharge for yeast culture. However, a negative culture does not rule out the diagnosis.
Vaginal thrush is caused by a yeast, usually Candida. This yeast is found naturally in the intestinal system and genitals in both men and women, without causing any kind of discomfort. An estimated 60% of all fertile women have the yeast as a natural part of the microbial flora in the vagina.
In some cases, the yeast can increase in quantity and establish a symptomatic vaginal thrush. The increase in yeast is usually due to an imbalance between normal bacterial flora and fungi, for example after a course of antibiotics. The normal bacterial flora in the vagina will normally prevent fungal growth, where a course of antibiotics could weaken this protective mechanism. The fungus thus gets more room to play and better growing conditions.
Other causes of fungal infection in the vagina are excessive washing, including the use of (intimate) soap. This can cause pH changes and changes in the natural bacterial flora. Other causes are pregnancy, diabetes, hormone therapy and a weakened immune system.
Vaginal thrush can resolve on its own without requiring treatment if it does not cause symptoms or discomfort.
If symptoms occur, antifungal suppositories (pessaries) can be inserted into the vagina for treatment. The suppositories will dissolve and mix with the discharge. Such suppositories are often combined with antifungal cream, which is applied at the entrance to the vagina and possibly on the labia. Suppositories and cream can be bought in ready-made combination packs. In some cases, especially with severe inflammation of the mucous membranes and severe itching, it may be appropriate to use a cream that also contains anti-itch and anti-inflammatory cortisone.
If the treatment with suppositories and cream does not provide sufficient effect, there may be an indication for treatment with tablets/capsules. This should be done in consultation with a doctor. Such tablets/capsules have potential side effects and interact with a number of other medicines.
Other advice during and after a treatment is; douching must be avoided, prefer intimate oil to intimate soap, use pads (not tampons), avoid tight-fitting clothes and wash underwear at 60 degrees without fabric softener and fabric softener.
Many women experience recurrent vaginal thrush after treatment. This despite the fact that all treatment advice has been followed. In case of frequent relapses, long-term treatment with tablets/capsules may be appropriate. In rare cases, it may be relevant for the partner to undergo treatment at the same time. There is a lack of good documentation on the effect of probiotics (lactic acid bacteria/lactobacilli) in the treatment, but it may help to prevent relapse. Lactic acid bacteria prevent fungal growth by reducing vaginal pH.
There are several conditions that can cause itching, burning/soreness and changed discharge in the vagina, including bacterial vaginosis (bacterial imbalance) and various sexually transmitted infections (chlamydia, mycoplasma and gonorrhea). Genital herpes can also cause similar symptoms. You can read more about genital herpes here. In addition, there are skin diseases that can occur in the abdomen and cause itching, including eczema, psoriasis and lichen sclerosus.
Several studies have shown that in up to half of the cases where the woman herself has diagnosed a fungal infection in the vagina, there is another condition. One should therefore have a low threshold for contacting a doctor, especially if there are significant complaints, persistent symptoms and/or new symptoms after a new partner. Repeated fungal treatment should be avoided if the diagnosis is not certain.
