What Is Vaginal Thrush?

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Vaginal thrush is another term for a vaginal yeast infection. It is very common, and the vast majority of people with vaginas will experience vaginal thrush at least once in their lives.

Most cases of vaginal thrush are easy to treat. However, some people experience recurrent thrush, also known as recurrent vaginal candidiasis. This type of vaginal thrush may be more difficult to treat effectively.

Fungal colonies: Candida albicans.
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Vaginal Thrush Symptoms

Common symptoms of vaginal thrush include:

  • Increased vaginal discharge, usually odorless. Discharge with thrush may be thick and white or thin and watery
  • Itching and discomfort around the entrance of the vagina
  • Pain or discomfort during sex
  • Discomfort with peeing

The skin of the vulva and around the vagina may also be red, irritated, or cracked. With severe thrush, sores may be visible, but sores on the vulva are more likely to be a sign of a different condition.

Did You Know?

Vaginal thrush is one of the most common types of vaginal infection. Another extremely common vaginal infection, with similar symptoms, is bacterial vaginosis. Both conditions involve an imbalance that leads to an overgrowth of bacteria or yeast that are ordinarily in the vagina at levels too low to cause problems.

One of the distinguishing symptoms of bacterial vaginosis is that the discharge usually has an unpleasant or fishy odor, while the discharge from vaginal thrush is odorless.

Causes

Vaginal thrush is caused by an overgrowth of a type of fungus. Most often, it is caused by an overgrowth of Candida albicans, but it can also be caused by other Candida species.

These fungi are normally present as part of the flora of a healthy vagina. Thrush occurs when something causes the amount of Candida to increase to a level where it causes symptoms.

Vaginal thrush is not thought to be a sexually-transmitted disease. It can be associated with sexual behavior. However, it's thought that the association with sex is not about disease transmission but changes in the vaginal environment that encourage the growth of yeast.

Vaginal thrush is also more common in individuals who have disruptions of their immune system, such as those caused by HIV.

Diagnosis

Most vaginal thrush is diagnosed based on a combination of symptoms and a vaginal swab. The swab is used to look for the presence of yeast in the vaginal secretions.

Vaginal pH tests may also be used to look for a change in the normal acidity of the vagina. If the vaginal pH is altered in the context of vaginitis symptoms, the infection is more likely to be bacterial vaginosis. Home tests look for this change in pH rather than directly for yeast in vaginal secretions.

The first time you experience symptoms that could be vaginal thrush, it is important to talk to a doctor. Similar symptoms could be associated with a number of different conditions. However, people with frequent or recurrent yeast infections may be able to diagnose themselves at home and use an over-the-counter treatment.

Vaginal Thrush in Transgender Women

Vaginal thrush isn't just something experienced by people who were designated female at birth. It is possible for transgender women to be diagnosed with vaginal candidiasis after a penile inversion vaginoplasty.

Transgender women who are experiencing discomfort or other symptoms after they have gone through the initial surgical healing period should consider seeking help from either their surgeon or a gender-affirming gynecologist.

A gynecologist may be more likely to correctly diagnose these symptoms, which can be treated with topical miconazole. However, for some women it may be easier to first reach out to either their surgeon or another clinician with expertise in transgender health.

Treatment

Vaginal thrush treatment usually involves topical creams or suppositories containing antifungal medications known as azoles. However, oral antifungal medication is also available by prescription. If a yeast infection is caused by a species of yeast other than Candida albicans, different medications may be needed.

Common medications for vaginal thrush include:

  • Diflucan (fluconazole): Oral, by prescription
  • Nizarol (ketoconazole); Oral, by prescription
  • Clotrimazole: Topical, over the counter
  • Metronidazole: Topical, over the counter

Treatment is different for recurrent episodes of vaginal thrush than it is for single, isolated episodes.

Treatment Resistant Thrush

Antibiotic resistance isn't only a problem for bacterial infections, like gonorrhea. Vaginal candidiasis may also be resistant to treatment with azoles. There are growing reports of treatment-resistant cases of vaginal thrush. People with azole-resistant candidiasis have limited options for effective treatment.

When prescribed an antifungal, it is extremely important to take the full prescription, even if symptoms go away before you're done. This reduces the likelihood of the infection becoming resistant to treatment.

This is also true for use of over-the-counter yeast treatments, where it is important to follow the instructions and take the full dose.

Coping

For most people vaginal thrush is a minor inconvenience. It is uncomfortable but generally easy to treat. However, for some people dealing with recurrent vaginal thrush, the difficulty with treatment and the ongoing symptoms can take a psychological toll.

Recurrent vaginal thrush symptoms can lead to depression, body image issues, anxiety about sex, and other quality of life concerns. Individuals who have vaginal thrush symptoms that aren't responding to treatment should talk to a gynecologist or other provider who is knowledgeable about sexual health.

Vaginal thrush symptoms are nonspecific and can also be associated with other infectious and noninfectious health conditions. If treatment isn't working, particularly if it's a home treatment, it's possible that you could be treating the wrong thing.

A Word From Verywell

Whether you call it vaginal thrush or a yeast infection, vaginal candidiasis can be an uncomfortable topic. Many people have difficulty discussing sexual health symptoms with their medical providers. They may have a difficult time talking about sex, and they also may be worried about the possible stigma of a sexually transmitted disease.

However, it is important to seek help if you are experiencing vaginal discomfort, discharge, or pain during sex. Treatment can make an enormous difference in your quality of life, but only if you're treated for the right thing.

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7 Sources
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