Vaginal thrush explained: causes, treatment and self-care

What thrush is and why it happens

Thrush is an overgrowth of a yeast called candida that normally lives harmlessly in and around the vagina. Certain things upset the balance and let it multiply: a recent course of antibiotics, pregnancy, poorly controlled diabetes, and a weakened immune system all make thrush more likely. Hormonal changes and, for some women, tight or non-breathable underwear can play a part. Importantly, thrush is not a sexually transmitted infection — you can get it without any sexual contact, and it is nothing to be embarrassed about. Understanding the triggers helps, because tackling an underlying cause, such as improving diabetes control, can reduce how often thrush comes back.

Recognising the symptoms

The typical symptoms are itching and soreness around the vagina and vulva, and a thick, white discharge often described as looking like cottage cheese, which usually does not smell. Some women notice stinging when passing urine or discomfort during sex. Symptoms can range from mild to intensely irritating. However, similar symptoms can be caused by other conditions, so thrush should not simply be assumed — a strong or fishy-smelling discharge, or a greenish or frothy one, points away from thrush and towards other causes such as bacterial vaginosis or a sexually transmitted infection. That is why persistent, unusual or recurrent symptoms are worth having checked rather than repeatedly self-treating.

Treatment options

Thrush is usually treated with antifungal medicine, and for most women this is available directly from a pharmacy without a prescription. Treatment comes as an antifungal pessary or internal cream inserted into the vagina, an external cream to soothe the itching around the vulva, or an antifungal capsule taken by mouth — a pharmacist can help you choose. These treatments are effective for most straightforward cases. Some situations need a GP rather than pharmacy self-treatment: pregnancy, being under 16 or over 60, having symptoms for the first time, recurrent thrush, or symptoms that do not clear with treatment. In pregnancy, oral antifungal capsules are generally avoided and internal treatments are used instead.

Self-care and preventing recurrence

Alongside treatment, simple measures can ease symptoms and reduce recurrence. Using an unperfumed emollient or soap substitute to wash the area, avoiding perfumed soaps, shower gels and vaginal washes, and not douching all help, because harsh products irritate delicate skin and disturb the natural balance. Wearing cotton underwear and avoiding tight synthetic clothing may help some women. There is no need to treat a male partner routinely unless he has symptoms. If thrush keeps coming back — four or more times a year is called recurrent thrush — a clinician can confirm the diagnosis, look for an underlying cause such as diabetes, and consider a longer treatment plan.

When to see a clinician

See a GP or sexual health clinic if this is your first episode, if you are pregnant, if you are under 16 or over 60, if treatment has not worked, if symptoms keep returning, or if you have unusual features such as a smelly discharge, bleeding between periods, pain in the lower tummy, or sores and blisters. These can indicate a different condition that needs its own treatment, so it is important not to keep buying over-the-counter thrush products for symptoms that are not actually thrush. A clinician may take a swab to confirm what is causing the symptoms. Thrush itself is not dangerous, but getting the diagnosis right ensures you get the treatment you actually need.