There is a tendency to associate any itch in the vagina and vulval region with ‘thrush’. But what is thrush and what else could cause an itch down there?
What is Thrush
An overgrowth of Candida albicans or ‘thrush’ though is the most common, with at least 75% of women experiencing at least one episode of thrush in their lifetime.
And while it is easy to use over-the-counter creams and tablets for thrush, self-diagnosis can be tricky, and many more serious problems can be overlooked this way, delaying the correct diagnosis.
Even worse, repeated use of topical antifungal creams may actually trigger irritant dermatitis, and so the cycle of pain, itch and redness continues.
Other causes of itching
The list of potential causes of vaginal and vulval itching includes: dermatological conditions, such as Lichen sclerosus, Lichen planus, Lichen simplex chronicus, psoriasis, atopic dermatitis, seborrhoeic dermatitis, irritant contact dermatitis, corticosteroid dermatitis and cytologic vaginitis.
So it’s important to remember that prompt and correct diagnosis can reduce the consequences of these vaginal and vulval skin conditions.
ALWAYS, ALWAYS have a doctor perform a swab from the high and low parts of the vagina for ‘microscopy, sensitivity and culture’ which means that any infections will be correctly diagnosed in a laboratory and the correct antibiotic or antifungal recommended.
On a side note, it’s also useful to consider having a screen for sexually transmitted infections such as Chlamydia trachomatis, Neisseria gonorroheae, Mycoplasma genitalium and bacterial vaginosis, if vaginal discharge is a prominent symptom and if you’ve had sex without a condom.
Vaginal Thrush Treatment
When it comes to thrush, there is no evidence to suggest that tablets are better than cream for treatment, but my preference is to recommend the tablets to avoid the potential for the development of a secondary dermatitis.
And if you are experiencing repeated episodes of thrush, which is defined as four episodes a year, then tablets are a must.
Recurrent thrush is a challenging problem that affects between 5-8% of women in their childbearing years.
And while I could blog about thrush for pages and pages, I want to highlight a recent update published in The Australian and New Zealand Journal of Obstetrics and Gynaecology. 1
This article examined the evidence for the various treatment recommendations, with the suggestion that a 12-month course of oral (tablet) antifungal treatment can result in a more lasting cure than the standard 6 months of treatment.
More research is needed on this topic, however, and treatment does need to be tailored for an individual woman’s circumstances and medical history.
An experienced doctor will be able to provide you with a number of options to consider.
If you are concerned about recurrent episodes of thrush, ask your doctor to give you a ‘back-up swab’ to use yourself, if, and when, your symptoms occur.
The results will be sent electronically to your GP or Specialist and they can then contact you with the results and discuss the best treatment option. This is a service that I offer to my patients as a matter of routine.
If it’s not thrush, then a vulval biopsy may be required which, don’t worry, is not as scary as it sounds!
Your doctor will wash down the area with antiseptic, inject some local anaesthetic and wait for that to work. Then a small sample of the skin – typically 4mm – is removed and placed into a specimen collection pot to be sent for examination under a microscope. A suture, or stitch is put in place to close the small hole in the skin and to help healing. The suture dissolves in approximately 10 days.
Some skin conditions are more easily recognised than others and then a biopsy is not required.
Treatment starts by removing any causes of dermatitis. Common irritants include: soap, bubble bath, essential oils, sanitary pads and liners, prolonged use of antifungal creams, lubricants, douches, waxing and shaving products, nylon underwear, pantihose, G-strings, tight clothes, gym clothes (especially sitting around in wet, sweaty gym clothes!) and friction from bike seats.
The next step is to replace the hydration of the skin with bland emollients: ointments that are non-perfumed, non-irritating and without preservatives and colours.
My favourite is Dermaveen and the washes I recommend are from the QV, Cetaphil and Dermaveen ranges. Simple, inexpensive and effective.
I’m very pleased to be able to recommend Olive and Bee as an emollient and lubricant. This 100% Australian-made and owned natural intimate cream, contains only Extra Virgin Olive Oil and Bees Wax and is now available online at oliveandbee.com.au
If you have concerns about your recurrent thrush or obtaining vaginal thrush treatment, book an appointment and let’s make sure it gets resolved once and for all.
Dr Tonia Mezzini is known for offering the best possible advice and treatment options for a person’s sexual health care needs. In particular, she cares for patients with:
• Menopause and hormonal concerns
• Chronic pelvic pain in men and women
• Painful periods and endometriosis
• Vulval pain syndromes and vulval skin conditions
• Low libido and pain with intercourse
• Polycystic Ovarian Syndrome
• Gender-affirming hormone therapy
• Complex contraceptive choices
• Sexually transmitted infections such as recurrent genital herpes
• Recurrent bacterial vaginosis
• Recurrent thrush
1) Matheson A, Mazza D. Recurrent vulvoaginal candidiasis: a Review of guidelines recommendations. Aust NZ J Obstet Gynaecolo 2017;57:139-145.