Complaints & connections · borters.ch
Crumbly and odourless points to yeast, thin and fishy to bacteria — and the two need exactly opposite treatments.
Also known as: vaginal yeast infection · candidiasis · candida
Open in the tool — with search and all the links →This compilation is for information and replaces neither medical diagnosis nor treatment. If you have symptoms, see a doctor.
An overgrowth of yeast in the vagina — very common, harmless and readily treatable. About three in four women experience it at least once. The picture is typical: strong itching and burning on the outside, red swollen skin and a whitish, crumbly discharge that hardly smells. That absence of smell is the most important distinguishing feature, because the commonest confusion is bacterial vaginosis: thin, greyish discharge with a distinct fishy smell and little itching. It needs precisely the opposite treatment, an antibiotic rather than an antifungal. A considerable share of what is self-treated from the pharmacy as thrush is therefore not thrush — and that explains many courses in which nothing helps. What clears its path is usually known: a course of antibiotics, a raised blood sugar, pregnancy, damp clothing, steroids. What does not clear its path is poor hygiene — on the contrary, douches and intimate washes favour it, because they disturb the lactobacilli that keep the vagina acidic, and thus protected, by themselves.
A look and a swab separate yeast, bacteria and irritated skin in one appointment. Having it looked at properly the first time means knowing for years afterwards what it feels like.
Not every yeast species responds to the usual product. A culture with species identification explains many courses in which the same treatment failed three times.
Four episodes a year or more is an accepted reason to measure the long-term sugar once — not rarely that is the moment a diabetes shows up.
No douches, no intimate wash, no soap inside the vagina. The lactobacilli keep it acidic and protected by themselves — outside, plain water is enough.
Change out of wet swimwear, cotton rather than synthetics, drop scented panty liners, nothing tight at night. More effective against recurrence than it sounds.
It is not a sexually transmitted infection, and treating a partner without symptoms does not prevent recurrence. If the partner has redness or itching himself, he is treated — but for his own symptoms.
They are often used as an add-on after treatment, and the studies differ. They are not intended as a substitute for treating an acute episode.
Treatment is local and after advice. Towards the end of pregnancy colonisation is often treated even when it barely bothers.
Washes, wet wipes, panty liners and ointments trigger eczema here especially easily — and if it gets worse under treatment, the product is the suspect.
If several antifungal treatments achieve nothing and it itches mainly at night, the diagnosis is often wrong.
What clears its path and why it returns — antibiotics, steroids, a raised blood sugar, damp warmth.
Sit for ten minutes in hand-warm plain water, once or twice a day, then dab dry gently.
Frothy, yellow-green discharge with burning is not thrush. The swab tells the two apart, and with the single-celled organism the partner is treated too.
Antifungals as pessaries or cream act locally, usually within one to three days; a tablet works through the bloodstream and is just as good. They do not rebuild the vaginal flora — which is why it returns in some women, and why repeated episodes prompt a search for the reason rather than treatment alone.
About three in four women experience it once, about one in twenty repeatedly — it counts as recurrent from four episodes a year. A local treatment works in one to three days; symptoms recede in two to three days. In recurrent forms, treatment is less frequent but regular over six months. The vaginal pH stays normal below 4.5 with thrush — in bacterial vaginosis it rises above that; that is what separates the two.
Like curdled milk, clinging, with strong itching and red, swollen skin on the outside. The absence of smell is part of the picture.
That is bacterial vaginosis — the smell is often more noticeable after sex, the itching is slight. It needs an antibiotic; an antifungal does nothing there.
With yeast the outer lips are involved too, often with small splits. If it itches only inside and without redness, the picture fits less well.
Then it is often not yeast. Bacterial vaginosis, a contact eczema from washes and panty liners, lichen sclerosus, or a yeast species that does not respond to the standard product.
A course of antibiotics, raised blood sugar, pregnancy, steroids, damp clothing and wet swimwear left on. Not on the list: poor hygiene.
That is a category of its own with its own approach: first identify the organism and its species, then check the sugar, then discuss a longer maintenance treatment. Stringing single courses together achieves little here.
Here the burning is usually on the outside, as urine runs over irritated skin — not inside as with a bladder infection. Itching and crumbly discharge stand beside it.
The most important value when it recurs. Four episodes a year or more is one of the commonest occasions on which diabetes is first noticed.
An empty store makes mucous membranes more vulnerable and the itching stronger — with heavy periods it is worth checking anyway.
Worth doing only if it is unusually stubborn or keeps returning — the question is then about the defences, not the fungus.
Fever, sweating and faster breathing clearly raise the need. Drinking enough keeps the mucus thin and the circulation steady — in children and older people it is the most important point of all.
With low levels airway infections occur somewhat more often; correcting a deficiency makes sense, a high single dose during the infection does not act on it.
Needed by the defence cells. For lozenges at the start of a cold there are hints of a slightly shortened duration; at a high dose over months zinc lowers copper.
Antibodies and defence cells are protein. After several days with little appetite it is worth at least keeping the protein up — soup with egg, quark, yoghurt, lentils.
Clearly worthwhile and well studied when deficient; fewer data for the wider uses. Fat-soluble — check blood levels at high doses.
Oestrogen makes the vaginal lining store sugar, which both the protective lactobacilli and the fungus live on. This is why thrush is rare before puberty and after menopause — and common in pregnancy.
Recurrent thrush with no other reason is one of the classic first pointers to sugar that is too high. Four or more episodes a year is a good occasion for a fasting value.
With recurring vaginal thrush measuring blood sugar is worthwhile — poorly controlled diabetes is one of the few established causes. For a low-sugar diet with normal metabolism the evidence is missing.
Studied are lactobacillus strains, usually as a preparation. Results are mixed; supermarket yoghurt holds different strains from the study products.
Studied are certain lactobacillus strains for preventing recurrence, oral and local. Results are mixed; supermarket yoghurt contains different strains from the study products.
Effective against Candida in the laboratory. It does not belong in the vagina — the lining is sensitive and burns have been described.