Every step is agonising and it’s hard to resist the urge to scratch your genitals incessantly. To make it worse, your tour guide is a male with limited English and there is no pharmacy within a day’s walk.
This is how Debra (not her real name) described her extreme experience to me at a consultation. Debra’s may sound like an extraordinary circumstance, yet women with vaginal thrush can suffer extraordinarily, no matter where they are at the time.
Although most women will have experienced one or more episodes of uncomplicated thrush that results in temporary discomfort, some suffer from recurrent episodes. The persistent physical symptoms of these can be shameful and often debilitating.
Uncomplicated thrush is common. About 75 per cent cent of women will have vaginal thrush in their lifetime.
Thrush is caused by a fungal infection (Candida albicans) that lives in the vagina, often without causing symptoms. Why some women develop symptoms is unclear. When symptoms do occur, they include itching, burning and a “cottage cheese-like” discharge.
Vaginal thrush mostly occurs during a woman’s reproductive years. It is uncommon before her first menstrual cycle and after menopause (when periods cease), so hormones are likely implicated.
Many have thrush at a particular time of the month, specifically before menstruation. It also often occurs following a course of antibiotics and is common in women with diabetes.
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Medications are available without a prescription so many women treat themselves. Treatment consists of antifungal creams or vaginal tablets, which are put inside the vagina with a special applicator.
There is also the choice of oral tablets, which are more expensive and not recommended for pregnant women.
But it’s important that women see their doctor if these treatments don’t work or symptoms recur. This is because they may be suffering from an entirely different infection, which requires different treatment.
Although women can effectively be treated with medications available over the counter, there are about five per cent for whom the symptoms recur or never go away.
Recurrent thrush refers to four or more diagnosed episodes of vaginal thrush within 12 months. Because the four episodes have to be identified with a swab test, research into this area is difficult and costly.
Compared with research into uncomplicated thrush, the published studies for recurrent thrush are few and of poorer quality. No research so far has found a cure that works for all women.