Vaginal thrush. The in’s the outs and the things to do in-between

Blog Post

Date: 12 September 2017

As women, we are lucky to be blessed with many wonderful attributes. We can carry a developing child in our womb and we can certainly put up with a lot of pain as proven during child birth. We bounce back well generally and I can honestly say we are made of tough stuff.  However, sometimes we can also be driven to the point of insanity by a common little fungal yeast infection called Candida Albiacans.  This yeast infection is generally known as vaginal thrush which is a common infection suffered by women.

An overgrowth of yeast causes vaginal thrush, not bacteria. The yeast is mainly present in the bowel, but may also be present in the mouth, on the skin and in the vagina.

It’s very common for women to suffer from vaginal thrush whilst pregnant or when experiencing hormonal changes due to oestrogen levels changing in the body. Hot weather, tight fitting synthetic clothing, vaginal deodorants, some soaps, health conditions such as Diabetes, reduced immune system function using steroids and antibiotic use can all contribute to the condition.  This condition can be painful, reoccurring and can be very unpleasant at the best of times. When experiencing changes in the vaginal balance, hormonal changes or pregnancy, there is less options available on how to deal with the condition.

Generally, our bodies have Candida in it without any side effects as the natural secretions of the vagina control it. On some occasions however, there can be an overgrowth which results in burning when urinating, itching sensation that causes a swelling of the vagina and surrounding area along with a cottage cheese like discharge which is creamy in colour and possibly associated with a smelly odour.

Now contrary to some people’s beliefs, vaginal thrush is not a sign of a dirty person or a sexually transmitted infection.  It is a naturally occurring phenomenon and can sometimes be passed on between partners during sexual activity, so it is best to abstain from intercourse when symptoms are present.

As indicated above, there are many ways a yeast infection can flair up and other common ways that yeast can overgrow include:  

  • Hormonal changes
  • Reactions to medications, such as antibiotics and steroids
  • Medical conditions such as, HIV and Diabetes
  • Immune supressing medications
  • Some cancers and their treatments

Did you know that 3 in 4 women have suffered from vaginal thrush? That’s 75% of the female population and  generally aged between 20-40 years and 5% of those cases are reoccurring. 66% of those women who have suffered from vaginal thrush also tend to get it wrong when they self-diagnose as the symptoms of vaginal thrush, as they are very like those that are present with genital herpes and urinary tract infections.  It’s always best to go and see a Doctor to get a proper diagnosis and advice on the best ways to manage the condition.

If the following symptoms or situations occur it is recommended to see the Doctor:

  • Is a first-time sufferer whose thrush has not previously been diagnosed by a physician
  • Is younger than 16 or older than 60 years of age
  • Has had at least two episodes of vaginal thrush in the past 6 months without consultation from her GP about the condition for more than 12 months
  • Has a previous history of sexually transmitted infection or has been exposed to a partner with one
  • Is or might be pregnant as this restricts the treatment options available
  • Has an unpleasant smelling vaginal discharge
  • Has abnormal or irregular vaginal bleeding or blood-stained discharge
  • Has pain in the lower abdomen
  • Has experienced an adverse reaction to antifungal products
  • Has pain on urination (this is quite rare with thrush and should be addressed immediately by the pharmacist)
  • Has valval or vaginal sores, ulcers, or blisters. These are more commonly associated with herpes infections
  • Has had 4 or more yeast infections in a year. This is known as RVVC (recurrent vulvovaginal candida’s) and around 5% of women will develop this as they may be unknowingly suffering from other chronic health conditions where vaginal thrush is a symptom

Most products recommended for vaginal thrush are pharmacist only medicines. As pharmacy assistants we need to ensure we follow strict protocols when dealing with customers who present in the pharmacy with symptoms relating to possible vaginal thrush.  We need to ensure that we use our protocol questions and refer all situations of vaginal thrush to the pharmacist before a product can be recommended, as most items for vaginal thrush are classified as S2 or S3, pharmacy and pharmacist only medications.

These antifungal medications come in a range of forms such as creams, pessaries and one off oral capsules which can be used in conjunction with a topical application on the vagina to assist with external symptoms if present. Depending on the treatment of chosen creams and pessaries, they may be used from anywhere between 1-6 days and the whole course should be used for optimal results.  Oral treatments are not recommended for pregnant women as they contain fluconazole, which is not recommended for use during pregnancy, neither is the use of applicators for cream or pessary insertion.  Treatments of cream and pessary are best used at night whilst laying down to benefit from the full effects of the medication.  If symptoms are reoccurring or if treatment has not previously been successful, it is best to refer to the pharmacist who can in turn refer the customer back to their Doctor to discuss further available options.

Whilst doing some investigating for this article, I found some weird and interesting items that are said to aid in the treatment of vagina thrush like yoghurt tampons, garlic, oregano and tea tree oil treatments. These are not proven treatments and we shouldn’t recommend these to our customers to aid in their relief of their symptoms. Here are a few tried and trusted tips you can provide to your customers in order to make this less than comfortable condition a bit more bearable:

  • Wipe front to back when going to the bathroom as this reduces the transference of bacteria and yeast from the bowel to the vagina.  This will then reduce the chances of developing vagina thrush and any possible urinary tract infections
  • Wear loose fitting clothing, cotton underwear, avoid synthetics and skin-tight clothing
  • Change pads and tampons regularly
  • Avoid using perfumed soaps and cleaning products on the vagina. Recommend using a fragrance free ph. balanced feminine hygiene products instead
  • Live stress free, eat a good varied healthy diet, reduce the amount of sugars and fats consumed in as they may assist in the overproduction of yeast in the vagina
  • Maintain a good sleep pattern, between 7-8 hours per night
  • Use a water based lubrication when taking part in sexual activity or when inserting tampons into a dry vaginal environment
  • Avoid condoms that contain spermicides
  • Shower after exercising
  • Use products like Aci-Jel to assist with vaginal dryness and acidity that can occur more commonly during the menstrual cycle

Many customers may enquire about the benefits of using a probiotic supplement to aid the prevention of vagina thrush, particularly if they are using an antibiotic.  If recommending probiotics in the pharmacy, whilst it is correct to say that a probiotic may reduce the common effects of antibiotics on the intestine, such as diarrhoea and help to recolonise the good bacteria or flora of the gut, the research into the use of probiotics for vaginal thrush remains inconclusive and it is therefore not possible to recommended them as a first line treatment or preventative option.

There is so much debate and information available out there in relation to the condition of vaginal thrush, some good and some looks slightly misguided if you ask me , but by following the recommended tips we are supplied by our pharmacist and undertaking trainings online and with reps, we can assist our customers in being more aware of their bodies.  Recommending to our female customer to have regular check-ups with their GP and providing clear, easy to understand information and tips, we can help them reduce the occurrence and aid in the prevention of vaginal thrush symptoms.


References

  • Pregnancy, birth, and baby
  • sahealth.gov.au
  • Canesten Australia
  • Virtual Medical centre
  • Web MD
  • ABC health and wellbeing
  • MyDR.com.au

Contact: Sherree Walters, Workplace Trainer/Assessor, Queensland Branch

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Page last updated 12 September 2017