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Vaginal thrush: symptoms, treatment, causes

by Josephine Andrews
Published: Last Updated on 372 views

In the case of vaginal thrush (vaginal mycosis, thrush), fungi, mostly yeast fungi, attack the vagina (vagina). The external genitalia (vulva) are often affected as well. Typical symptoms are itching and burning as well as a crumbly discharge. The vaginal fungal infection is usually treated with drugs that are specifically effective against fungi (antimycotics). Read everything you need to know about the causes and symptoms of vaginal thrush, diagnosis, treatment and prognosis here!

ICD codes for this disease:

ICD codes are internationally valid codes for medical diagnoses. They can be found, for example, in doctor’s letters or on certificates of incapacity for work.

B37

quick overview

  • What is vaginal thrush? Infection of the vagina (vagina) with fungi (mostly yeast fungi, especially Candida albicans), often the pubic area, the vulva , is also affected (vulvovaginal mycosis). It is estimated that three out of four women will get a vaginal thrush at least once in their lifetime. Infection is possible at any age.
  • Common symptoms: itching, burning sensation in the vagina and pubic area, redness, increased, whitish-crumbly discharge, possible pain during sex ; with additional infestation of the urethra also pain when urinating.
  • Treatment: antifungal agents ( antimycotics ), mostly applied externally (cream, vaginal suppositories, etc.), especially in severe cases internally (tablets). Antiseptics can also help.
  • Vaginal thrush in pregnant women: There is an increased risk of premature birth . The fungi can be passed to the newborn during vaginal birth.
  • Prognosis: Vaginal thrush is usually harmless, but very unpleasant and sometimes persistent. If the immune system is severely weakened, the fungus can spread in the body and infect internal organs.

Vaginal thrust: symptoms

The most important vaginal thrush symptoms are severe itching and a burning sensation in the vagina (vagina) and usually also in the pubic area (vulva). Itching is usually the first sign of vaginal thrush. It often appears long before other symptoms appear. The symptoms usually worsen before menstruation.

Increased , crumbly-whitish discharge is another sign of vaginal thrush. Like healthy vaginal discharge, it is odorless. Possible vaginal thrush symptoms include pain during sexual intercourse (dyspareunia). If the vaginal mycosis has spread to the urethra, pain when urinating (dysuria) is often added.

Important : Symptoms such as itching, burning and redness in the vagina do not always indicate a vaginal thrush. Other pathogens can also trigger such symptoms. These primarily include bacteria (including bacterial vaginosis with a foul-smelling discharge resembling fish), but also parasites such as trichomonads. Only about 35 to 40 percent of women with vaginal itching actually have a vaginal thrush.

Only a medical examination can clarify what or which pathogens exactly cause the symptoms. Therefore, consult a doctor, especially if the problems persist, increase, recur or there are special circumstances such as pregnancy.

What does vaginal thrush look like?

The vagina and pubic area can be swollen with vaginal thrush. Often (but not always) there are also grey-whitish deposits on the mucous membrane at the vaginal entrance and in the vagina. These deposits can be wiped off. Beneath it is an inflamed, reddened mucosa.

Female genital yeast infection can also cause small nodules to form on the surface of the skin in the intimate area.

This is what happens with vaginal thrush
If the vaginal flora is out of balance, fungi can spread in the vagina.

Vaginal thrust: treatment

Fungal infections can be treated with drugs that are specifically effective against fungi – so-called antifungals . The current medical guidelines also recommend such antifungal agents for vaginal thrush treatment. Antiseptics can also help.

Active ingredients against vaginal thrush are available in different dosage forms. The therapy takes place either locally in the affected area (e.g. with creams or suppositories) or with tablets to be swallowed (systemic treatment).

It is best to talk to your doctor before you treat a suspected vaginal thrush on your own. In most cases, there are other causes behind the symptoms.

In one study, for example, only every third woman who bought antifungal medication for self-treatment actually had a vaginal thrush. Apart from that, incorrect and/or unnecessary therapies harbor the risk that the germs will become more resistant (resistance will develop). This may complicate necessary treatments in the future.

Vaginal thrush treatment with antifungal drugs

If the vaginal thrush appears for the first time, antimycotics applied to the site of infection usually help ( local treatment ). They usually contain active ingredients from the group of imidazoles (eg clotrimazole, econazole, miconazole), polyenes (including nystatin ) or ciclopiroxolamine. Some preparations are available in pharmacies without a prescription.

Combination packs are often offered, consisting of an antifungal cream for use in the outer pubic area and vaginal suppositories or vaginal tablets that are inserted into the vagina. However, there are also products that only contain an antifungal cream and an applicator that can be used to insert the cream into the vagina. The duration of treatment depends on the respective preparation.

If your symptoms have not improved after the first few days, consult a doctor (again). It may not (just) be a fungal infection.

If local vaginal thrush treatment does not help or the infection keeps coming back or flares up repeatedly, internal use of antimycotics in tablet form is usually necessary ( systemic treatment ). These drugs contain something called triazoles (such as fluconazole) and are prescribed by your doctor.

The doctor can also prescribe antimycotic tablets for the first vaginal fungus if this is particularly pronounced and/or the affected person wishes this. Tablet therapy is usually as successful as topical treatment.

In the case of constantly recurring, chronic vaginal thrush, antifungal treatment over several months may also be useful (suppression therapy). Those affected take the tablets according to a fixed schedule (e.g. three in the first week, then once a week and finally less and less). Meanwhile, the doctor checks the symptoms and the fungal infestation at regular intervals.

Vaginal thrush treatment with antiseptics

Vaginal thrush can also be treated with so-called antiseptics. These are agents that act comparatively quickly and unspecifically against various germs (above all bacteria and fungi, and thus potentially in the case of mixed infections) – but also against those that naturally colonize the vaginal mucosa (vaginal flora).

The antiseptic agents against vaginal thrush are applied locally as an ointment, solution or suppository. Proven antiseptics contain dequalinium chloride, octenidine or povidone iodine. They are also considered an alternative when the yeast fungi are no longer sensitive, ie resistant, to certain antifungal agents.

Povidone-iodine should not be used in thyroid disorders. In this case, the iodine contained can cause complications! The same applies to pregnant women.

Pregnancy: what to do with vaginal thrush?

For vaginal thrush during pregnancy, experts recommend topical application of antimycotics from the imidazole group – especially clotrimazole or miconazole. They are considered to be very effective, well tolerated and harmless to the child throughout pregnancy.

The antiseptics dequalinium chloride and octenidine mentioned in the medical guidelines can (to a limited extent) also be used in pregnant women. However, povidone-iodine is not suitable because the iodine it contains can disrupt the thyroid function of the unborn child.

Oral antimycotics (tablets) should not be taken during pregnancy or only if the doctor considers it absolutely necessary. They can cause birth defects in the child if taken in the early months of pregnancy.

Why treatment during pregnancy is so important

Doctors generally treat vaginal thrush during pregnancy – even if the fungi do not (yet) cause any symptoms, but only colonize the vagina. Reasons:

On the one hand, the yeast fungi can promote premature births. On the other hand, the pathogens are very likely to be passed on to the child during vaginal birth. There they usually attack the oral mucosa and the intimate area (” diaper rash “) in the first few months of life.

Therefore, medicinal vaginal thrush treatment in pregnant women is particularly important in the last four to six weeks before the due date. It is important to free the birth canal from all fungi in good time.

Always talk to your doctor if you are pregnant and develop vaginal discomfort. Only he can determine the exact cause and discuss the appropriate treatment with you.

co-treatment of the partner

Vaginal thrush is contagious. It can be transmitted through direct physical contact between two people, but also through contaminated objects. So if you have a vaginal yeast infection, the fungus may have come from your partner. Conversely, this can infect you and also develop a fungal disease (eg penis fungus).

However, it is not absolutely necessary to treat a symptom-free sexual partner just because of a vaginal thrush. So far, studies have not shown any clear advantages if the partner is also treated. Not even if it is also colonized with a fungus but is symptom-free. Yeast fungi are also part of a man’s healthy skin flora – in small numbers.

The extent to which this colonization promotes relapses of vaginal fungus has not been clarified with certainty. However, in certain risky situations, such as a weak immune system, testing for fungi and appropriate therapy for the sexual partner can be useful.

Treat penis fungus

If the sexual partner has developed a penis fungus, it must be treated. This fungal infection is usually first noticed by a reddening of the foreskin and the glans. Within a few days, the tissue swells. Itching, burning and pain are added.

With such complaints or in case of doubt, it makes sense for a man to also be examined and, if necessary, treated. As with vaginal thrush, antimycotics, if necessary in combination with cortisone or antiseptics, are available for this purpose.

You can read everything important about the fungal infection in the male genital area in the article penis fungus .

Home remedies for vaginal thrush

Various home remedies for vaginal thrush are often touted in the media as well as among family and friends. Even if many women are convinced of their effectiveness: many home remedies tend to damage the vaginal flora and do not help at all against vaginal thrush.

Home remedies that are most commonly recommended for treating vaginal thrush include yogurt, vinegar, and garlic . They should be applied to the outer pubic area or inserted into the vagina to kill the fungi.

Instead, vinegar, garlic, and other harsh substances disrupt the vaginal environment and may make it even easier for fungi and other pathogens to multiply.

Some experts also advise against tampons soaked in yoghurt, for example. Natural or probiotic yoghurt applied vaginally is considered to alleviate vaginal problems. However, this method has not been adequately tested. In addition, the bacteria contained in yoghurt differ in their composition and do not correspond to the natural environment of the vagina. Last but not least, the dairy products could be contaminated with fungi.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not get better or even get worse, you should always consult a doctor.

Alternative medicine for vaginal thrush

There are a number of other treatment options for vulvovaginal candidiasis. They can work, but they are hardly scientifically proven. Examples:

  • Boric acid suppositories can accelerate healing and are considered a treatment option for vaginal thrush caused by Candida glabrata. However, they have no official approval for vaginal thrush (off-label use) and are not used as part of the initial treatment. They can also disrupt fertility and harm the unborn child in the womb.
  • Propolis (“bee putty resin”) has, among other things, anti-inflammatory and antiseptic properties. There are positive reports as a remedy for vaginal thrush caused by the fungus Candida albicans. However, it carries the risk of contact allergies .
  • Salvia officinalis (“real sage “) is said to have an antifungal effect with its essential oils. As a vaginal tablet, it successfully relieved vaginal thrush in a small study alone or together with clotrimazole.

The medical guidelines identify these alternative means, but emphasize that the scientific data is very limited. It is not a therapy recommendation.

Other tips for vaginal thrush

It is best to observe the following tips during a vaginal thrush disease:

  • Because vaginal thrush is contagious, you should avoid sexual intercourse while you are infected. Condoms can also be useful in the initial period after the treatment (the vaginal mucosa is then regenerating).
  • Note: Antifungal agents applied as treatment may compromise the safety of latex condoms or rubber diaphragms.
  • To prevent the fungal infection from spreading, ideally only use lukewarm water in the genital area and regularly grease dry skin in particular.
  • Wear air-permeable underwear so that a warm, humid environment does not develop in the vaginal area – such conditions are ideal for fungal growth.
  • Trim your pubic hair. Pronounced pubic hair promotes a warm, humid environment.
  • Do not share your towel with others.
  • Change your laundry and towels every day and wash them at 60 degrees with a heavy-duty detergent.

A sugar-free diet is often recommended to “starve” the vaginal thrush. So far, however, it has not been proven that this actually works.

Vaginal thrush: causes and risk factors

If the balance of the healthy vaginal flora is out of balance, yeast fungi, for example, have the chance to spread – vaginal thrush develops. About 85 to 95 percent of all acute vaginal fungal infections are caused by the yeast Candida albicans . Candida glabrata or Candida tropicalis, for example, are responsible for the remaining cases.

You can get infected with the fungi during sexual intercourse , for example. Frequent and unprotected sex carries a particular risk. In other cases, the germ comes from the intestines and gets onto the vaginal mucosa when wiping after a bowel movement.

If the vaginal flora is disturbed, other pathogenic pathogens sometimes spread in addition to a fungus (mixed infection).

risk factors

Various factors can favor colonizing yeast fungi multiplying, infecting the mucous membrane extensively and causing inflammation:

Immune system weakness : A weakened immune system often also disrupts the vaginal environment. The immune deficiency can be based, for example, on drugs that suppress the immune system (immunosuppressants such as cortisone or cancer drugs) or on diseases (e.g. HIV or AIDS or diabetes mellitus).

Antibiotics : Vaginal thrush caused by taking antibiotics is not uncommon. The agents work against bacteria, but do not distinguish between useful and harmful. You may also eliminate the lactic acid bacteria in the vagina and thus promote vaginal fungus.

hormonal changes : especially the female estrogens influence the vaginal flora. Hormone treatments, hormonal contraceptives and treatment with antiandrogens (eg in the case of severe acne) can promote vaginal thrush. The increase in symptoms before menstruation is also due to the altered hormone levels.

Pregnancy : The hormonal changes in pregnant women cause, for example, an increased sugar content and reduced acidity in the vagina – ideal growth conditions for fungi.

unfavorable clothing : mushrooms grow particularly well in a warm and humid environment. This is why skin-tight clothing and underwear made of synthetic materials can promote vaginal thrush: they promote sweating and possibly cause heat to build up.

Improper intimate hygiene : Both excessive (frequent washing with soap or other detergents, vaginal douches, etc.) and inadequate intimate hygiene disturb the vaginal flora and thus promote vaginal thrush.

Stress : Psychological stress can also have a negative effect on the vaginal environment and thus pave the way for infections.

Genetic factors : Certain genetic variants are considered risk factors for chronic vaginal thrush in particular. The gene mutations mainly influence the defense process.

Diet : Some experts also see a certain risk in certain dietary habits. In particular, foods high in sugar/carbohydrates and foods containing yeast and dairy products can promote fungal growth.

Healthy vaginal flora

Basically, the healthy vagina is never germ-free, but houses a natural vaginal flora: This consists mainly of lactic acid bacteria (lactobacilli). Some other bacteria and, in very small numbers, fungi can also (sometimes temporarily) also be part of the natural vaginal flora.

The lactic acid bacteria convert the sugar from the vaginal cells into lactic acid. This creates an acidic environment in the vagina in which pathogenic germs can hardly multiply.

Vaginal thrush: investigations and diagnosis

If vaginal fungus is suspected, a gynecologist is the right contact person.

anamnese

The doctor will first talk to you in detail to collect your medical history (anamnesis). Possible questions from the doctor are:

  • What complaints do you have exactly?
  • How long have the symptoms existed?
  • Have you ever had such symptoms before?
  • Have you already tried any therapy (eg with over-the-counter antifungal agents from the pharmacy)?
  • Do you have any underlying diseases (such as diabetes, HIV)?
  • Do you use any medication (antibiotics, cortisone, etc.)?

Gynecological check

After the anamnesis, a physical examination takes place. The doctor proceeds in the same way as with regular gynecological examinations . A vaginal fungal infection can often be recognized by a whitish to greyish coating on the mucous membrane. If it is carefully wiped off, an inflamed, reddened vaginal mucosa will appear.

Detection of fungi under the microscope

In order to determine which pathogens are responsible for the infection, the doctor takes a swab of the vaginal mucosa . He then examines this under the microscope: Typical, sometimes thread-like structures (hyphae and shoot cells) indicate a fungal infection.

In addition, the doctor pays attention to changes that speak either for another pathogen or a mixed infection.

mushroom culture

Sometimes the microscopic examination does not provide a clear finding. Then the germs are cultivated in the smear (pathogen culture) : In the laboratory, the smear is placed on a suitable culture medium and optimal growth conditions are created for germs so that they multiply. That way you can identify them more easily.

The doctor initiates a fungal culture, especially in the case of chronic courses.

The laboratory can also use the fungal culture to test whether the cultured germ is resistant to certain drugs. This is particularly important in the case of vaginal thrush, which is caused by rarer Candida species (ie not C. albicans).

Vaginal fungus: course and prognosis

With timely and consistent therapy, the prognosis for vaginal thrush is favorable. As a rule, a fungal infection does not last longer than a few days or weeks and heals without consequences.

Rarely, the infection proves to be very protracted, for example in the case of a weakened immune system. Under certain circumstances, the vaginal fungus can even spread in the body and affect internal organs (candida sepsis) in the case of severe immune deficiency.

infection of newborns

Candida sepsis can very rarely also occur in newborns who become infected with the fungus during “normal” birth through the mother’s vagina (vaginal births) (especially in very early premature babies). More typical is a fungal infection in the mouth (oral thrush) and in the genital area (“diaper rash”).

This is one reason why pregnant women should always take vaginal mycosis seriously. The other is that, according to research, the fungal infection increases the risk of preterm birth. This may also be the case with permanent or recurring fungal colonization.

relapses

After a vaginal thrush infection has healed, it can (repeatedly) come back if there are still favorable factors such as incorrect intimate hygiene or a weakened immune system. If at least four vaginal fungal diseases occur within a year, doctors speak of chronic recurrent vulvovaginal candidiasis.

As far as possible, risk factors for vaginal thrush should therefore be eliminated or reduced. Otherwise, doctors try to counteract the stubborn vaginal fungus with special long-term treatments.

Vaginal thrust: prevention

If you want to prevent vaginal thrush, you should avoid or reduce known risk factors as much as possible. This means:

  • Avoid synthetic clothing and clothing that is very tight in the intimate area and may even chafe.
  • Only wear underwear made from breathable materials such as cotton. This prevents a build-up of heat and moisture in the intimate area.
  • Avoid plastic-coated panty liners and pads. They can also cause moisture and heat to accumulate in the vaginal area. Scented pads are also unfavorable: the scents can irritate the sensitive mucous membrane and make it more susceptible to infections.
  • Tampons dry out the vaginal mucosa and can thus promote vaginal thrush in sensitive women. Then it can be helpful to change the tampons often or to switch to breathable pads (organic pads).
  • Pay attention to careful but not excessive personal hygiene. Only use lukewarm water or at most slightly acidic products (syndets) to clean the genital region so as not to disturb the vaginal environment. Do without intimate sprays and vaginal douches.
  • When going to the toilet, you should always wipe from the front (vaginal entrance) to the back (anus). If you do it the other way around, fungi could enter the vagina from the intestines. According to some experts, this can then cause a vaginal thrush infection.
  • Thoroughly clean used sex toys.

Special probiotic preparations, which primarily contain certain lactic acid bacteria in concentrated form, may ensure that the vaginal mycosis does not flare up (anymore) or flares up less frequently. Swallowed, they can counteract yeast fungi in the intestine, from where fungi can get into the vagina again and again. The scientific data on this are promising, but (still) limited.

Probiotics for swallowing (with Lactobacillus acidophilus or Lactoferrin) seem to be helpful, especially in chronic cases. Probiotics can also have a preventive effect during antibiotic therapy. But here, too, there is (still) a lack of sufficient data.

In certain cases, medication to prevent vaginal thrush can be useful. For example, a doctor may recommend prophylactic use of antifungal drugs at intervals (from twice a week to monthly) in women who have diabetes or who are on suppressive therapy.

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