Myths and Suggestions
Myths About Thrush
The majority of itchy vulval conditions are due to thrush
Acute thrush is very common, everyone has heard of it and it even features on advertisements on television for anti-fungal treatments. However, although thrush is usually the first thought of patients, pharmacists and even doctors, there are many conditions other than thrush that can cause vulval problems, particularly when it comes
to long-standing complaints.
For a patient with a long history of vulval symptoms, chronic thrush represents the minority (about 20%) of all cases. If you are using anti-fungal medication without a definite diagnosis of thrush, preferably made by a doctor who has examined you and taken a vaginal swab, and you are not improving, stop now and see your doctor.
It’s normal to be itchy
Just about everyone has at some stage experienced itching of the vulva or vagina. It might have been because they were hot and sweaty, or wore a pad too long, or their clothes were too tight. It might have been because they had a vaginal infection. But that sort of itch doesn’t last long and gets better when the cause is put right or treated.
Being itchy all the time is not normal. If you experience itching that doesn’t go away it’s time to see your doctor.
I was advised to use an antifungal cream …and I’m not better….was that OK?
Many women are given antifungal creams by a person who hasn’t examined them. This is not OK. As a result many patients are given antifungal creams for something that isn’t thrush and without a vaginal swab being taken to find out what is wrong.
Don’t ever use an antifungal cream or anything else for that matter by someone who didn’t take a proper history and do an examination and also a vaginal swab.
Children suffer from vaginal thrush
This is completely untrue. Healthy girls who haven’t yet started their periods do not suffer from thrush. A child with an itchy vulva should never be assumed to have thrush, and anti-fungal creams will not be effective.
Post-menopausal women can suffer from vaginal thrush
After menopause, your levels of female hormone are too low for you to have thrush. The only exceptions to this rule are:
- women using hormone replacement therapy including vaginal creams and pessaries
- women with poorly-controlled diabetes
- women with an underlying vulval skin disease such as lichen sclerosis
- women who have used too much cortisone cream on the vulva
- women who have low immune systems due to severe diseases.
Probiotics and the anti-candida diet are the “natural” answer for thrush
This is a very popular recommendation. There are however no clinical trials that show that either of these methods are effective. The anti-candida diet is very difficult to stick to and probiotics are expensive. If natural therapy works for you that’s great but please see your doctor if it isn’t helping.
Oral antifungal drugs are too dangerous to take long term because they will harm your liver
The first oral anti-candidal medication available in Australia was ketoconazole. This medication did have a real risk of liver damage. As a result all patients on ketoconzole have to have regular monitoring liver function tests.
The more recent oral anti-thrush medications itraconazole and fluconazole, do not have a high risk of liver damage even when taken long term. They have an excellent safety record The main concern about these medicines is that they may not mix with other drugs you are taking, including some antihistamines that are available without a prescription, so always ask your doctor to check.
Chronic thrush can be managed by a weekly dose of fluconazole
Single doses of the oral antifungal drug fluconazole can be bought over the counter at the chemist and are advertised on TV. If you have taken several doses of this medication and find that it works for a short time, but your symptoms come back, see your doctor. Don’t continue to self-medicate.