Vulvovaginal thrush

What is vulvovaginal thrush?

Thrush is a common infection of the vulva and vagina, and sometimes the mouth. It affects 75% of women at least once in their lifetime. Thrush treatments are usually effective, so see your doctor if you notice any symptoms.

Symptoms

Typical symptoms of thrush include:

• itching or burning of the vagina and vulva
• thick white vaginal discharge
• painful sex (dyspareunia)
• stinging when weeing
• swelling or redness of the vulva and vagina
• splits in the skin of the vulva.

Causes

Thrush is often caused by an overgrowth of candida in your vagina.

It’s also thought that higher oestrogen levels can make women more prone to thrush. Oestrogen increases the amount of sugar (glycogen) in your vagina, which creates a perfect environment for candida to grow and thrive.

Thrush is more likely to affect women who have periods, as they have higher levels of oestrogen. The condition is rare in girls who haven’t gone through puberty and in postmenopausal women (unless they are on oestrogen therapy).

You may also get thrush if you:

• take antibiotics
• take a higher-dose combined oral contraceptive pill (COCP)
• use menopausal hormone therapy (MHT)
• are pregnant
• are about to have your period (due to hormone changes)
• have other health conditions, such as obesity, diabetes, iron deficiency and immune system disorders
• have vulval skin conditions, such as vulval psoriasis, lichen planus or lichen sclerosus
• use cortisone ointments.

Diagnosis

Many women think vulval itching may be thrush and treat it with an over-the-counter medicine from the pharmacy. It’s important to see your doctor for an accurate diagnosis, especially if over-the-counter medicine doesn’t work.

When you see your doctor, they will ask about your symptoms and medical history. They should examine your vulva. They may also take a swab from your vagina (and vulva if it’s sore) and send it to a laboratory to see if candida is present.

Treatment and management

Most cases of thrush are treated with an antifungal cream or a vaginal pessary (a tablet placed into your vagina) that contains clotrimazole, miconazole or nystatin. The cream or pessary is inserted into your vagina using a special applicator.

Treatment time can range from one to six days, depending on the product and severity of symptoms. Many women who have mild symptoms only need one to three days of treatment. Sometimes a second course of treatment is needed if symptoms return. It’s important to finish the full treatment – don’t stop when symptoms get better.

Recurrent thrush

Around 5% of women experience recurrent thrush. Recurrent thrush is when you have four or more episodes of thrush over 12 months. This is usually due to persistent infection rather than a new infection. But it may also be due to other health conditions, such as:

• iron deficiency
• diabetes
• immune disorders
• use of medicines such as antibiotics.

If you think you have recurrent thrush, it’s important to see your doctor. They may investigate if your thrush is caused by other underlying conditions. Depending on your situation, they might recommend:

• combined vaginal and oral antifungal medicine
• oral antifungal medicine (usually fluconazole) taken regularly for up to six months
• a change in contraception
• a lower-oestrogen dose of MHT.

Thrush and sex

When you have thrush, sex can cause a burning feeling or pain. If this happens, you might want to avoid sex until your treatment has finished.

If you use condoms during sex, apply the thrush treatment cream after sex, as it can weaken condoms.

Thrush is not a sexually transmitted infection (STI). But sexual activity can make symptoms worse, and it may cause a male sexual partner to have a red or sore penis.

What you can do

It’s important to take extra care of your vulva and other affected areas when managing this condition. For example, wipe from front to back after going to the toilet, avoid using soap or talcum powder on your vulva, avoid tight-fitting clothes and wear cotton underpants.

Learn more about vulval care.

Risks and complications

Untreated or recurring thrush can lead to ongoing vulval discomfort or pain during sex. It might also lead to cracks or splits (fissures) in your vulva, which may get infected.

When to see your doctor

Thrush symptoms can be like those of other vaginal or vulval conditions. You should see your doctor if:

• you experience thrush-like symptoms for the first time
• you are unsure whether your symptoms are related to thrush
• your symptoms have not improved after treatment
• you continue to have painful sex after treatment
• you treated your thrush with over-the-counter medicine and symptoms haven’t improved
• you have recurring thrush
• you have thrush-like symptoms while you are pregnant or breastfeeding
• you have pain in your pelvic or vulval area
• you experience abnormal vaginal bleeding.

Related resources

Download our fact sheets or visit resources for more information, including translated fact sheets.

This web page is designed to be informative and educational. It is not intended to provide specific medical advice or replace advice from your health practitioner. The information above is based on current medical knowledge, evidence and practice as at April 2023.