Introduction

Vulvovaginal Candidiasis (VVC) is also known as vaginal thrush. It affects nearly 75% of all adult women at least once in their lifetime.

What is vulvovaginal candidiasis (vvc) and what causes it?

VVC is a yeast infection that is usually caused by Candida albicans. Candida is often found in the vagina without causing any symptoms. When an imbalance occurs, Candida can multiply and cause symptoms of VVC.

In most cases of VVC, it develops for no apparent reason. However, certain factors can increase your risk of developing VVC:

• Use of certain medications such as antibiotics or high-estrogen oral contraceptives.

• Pregnancy.

• Poorly controlled diabetes.

• Weakened immune system – for example, people on chemotherapy or steroids, patients with certain cancers.

What are the symptoms?

Vaginal Discharge

The discharge from VVC is usually creamy white and quite thick, but can be watery sometimes. The discharge does not usually smell.

Pain and Itch

Some women may experience pain or discomfort whilst having sex or passing urine as a symptom of vaginal thrush. Itching, redness, discomfort or pain of the vulva area is also possible.

What are the treatment options?

Topical Treatments

These are pessaries and creams which you insert into the vagina with or without an applicator. They contain anti-fungal medicines such as clotrimazole, econazole or isoconazole. A single dose of pessary inserted into the vagina is usually sufficient to clear a bout of thrush. However, some may also want to apply anti-fungal cream onto the skin around the vagina. All anti-fungal vaginal pessaries and creams essentially work the same way and show no differences in effectiveness.

Combination topical preparation of an anti-fungal with steroid is available and especially helpful if discomfort and itch of the vulva area is disturbing. You can obtain topical treatments without a prescription at pharmacies. Some reported side effects of these medicines are mild burning sensation, itching and redness. Consult your pharmacist or doctor if the symptom persists or become troublesome.

If you are pregnant, the use of topical antifungals is generally safe in the second and third trimester, but always consult your doctor or pharmacist first.

Note: Pessaries and creams may damage latex condoms and diaphragms and affect their use as a contraceptive. You should use alternative methods of contraception during treatment and for at least five days afterwards.

Oral Medication

Fluconazole, an anti-fungal taken by mouth in a single dose can be obtained from pharmacies without a prescription, on the advice of the pharmacist.

Side effects are uncommon; nausea, headache, and abdominal pain have been reported.

If you are pregnant or breast-feeding,do not use these treatments without medical advice.

You may also consider application of anti-fungal cream onto the skin around the vagina, if discomfort and itch is disturbing.

Oral and topical anti-fungal treatments are thought to be equally effective. Oral medications may be more convenient, but work slightly slower than most topical treatments.

Others

The following methods may also help relieve the symptoms of VVC:

• Avoid using perfumed products such as soaps and shower gels around the vaginal area, as these may cause further irritation.

• Use sodium bicarbonate sitz bath for prompt relief of vulva irritation while awaiting onset of antifungal agents. Add 2-4 tablespoons of sodium bicarbonate to 2 inches of warm bath water. Sit in the sitz bath for 15 minutes, 2-3 times in first week, followed by 1-2 times weekly as needed to control symptoms.

Do I need to see a doctor?

Simple and uncomplicated VVC may be treated with self-medication. However, symptoms like vaginal discharge and itch can be due to other causes. Do not assume that all vaginal discharge or itch are due to VVC. Consult a doctor if you:

• Are under 16 or over 60 years of age.

• Are pregnant.

• Are on certain medications like antibiotics or steroids.

• Have abnormal vaginal bleeding.

• Have symptoms that differ from a previous bout of VVC.

• Have had 4 or more episodes of VVC in the last 12 months.

• Have had a previous sexually transmitted infection.

• Have a weakened immune system.

• Continue to experience symptoms despite use of self-medication.

What can I do to prevent recurrence of VVC?

Hygiene

The normal conditions of the vagina may be altered by excess washing and rinsing out (douching) of the vagina, bubble baths, scented soaps, etc. As a result, the natural defences in the vagina may be affected, allowing the Candida species to thrive. Therefore, washing the external vaginal area with water and unscented soap is recommended instead.

Clothes

Tight-fitting clothes often trap heat and moisture, which are favourable conditions for the growth of Candida species. Loose fitting clothing is therefore recommended.

Sexual Intercourse

VVC is not a sexually transmitted disease. However, friction during sex may cause minor damage to the vagina which promotes growth of Candida species. Well lubrication is therefore recommended during sexual intercourse to avoid the recurrence of VVC.

Probiotics

Probiotics may help to optimise the conditions in the vagina but the evidence on its role in VVC prevention is lacking. Probiotics can be obtained through foods like yoghurt or supplements.

Disclaimer

Information provided by this patient information leaflet is solely for informational purposes only and is not intended as a substitute for the advice provided by your physician, pharmacist or other healthcare professional. You should not use the information for diagnosis or treatment of a health problem or disease. Always speak with your physician, pharmacist or other healthcare professional before taking any medicine or supplement, or adopting any treatment for a health problem. Under no circumstances will Pharmaceutical Society of Singapore be liable to any person for damages of any nature arising in a way from the use of such information.