The Fabulous Pharmacist: Everything you need to know about your vagina and thrush

Our guest columnist Laura Dowling, aka the Fabulous Pharmacist, gets real about thrush and busts some myths about genital care 

Laura Dowling. Photograph Moya Nolan

Most women will get candida in their lifetime

Thrush is an umbrella term for yeast infections from the candida species. Most women will have candida in their genital region at some stage in their life.

Candida breeds in warm, moist conditions, and there’s nothing warmer or more humid than a vagina.

Getting thrush doesn’t necessarily mean there’s a problem. For example, if you were to screen 100 women by taking a swab from their vagina, a certain number of them might have candida, but that isn’t a problem unless they have symptoms or they’re symptomatic.

So what are the symptoms?

Symptoms can range from a discharge to pain, inflammation or an itch, depending on the individual. 

If you have symptoms you think could be thrush, such as a discharge that resembles cottage cheese, I’d encourage you to ask for a first-line treatment, an over-the-counter cream or a pessary at your pharmacy.

But if you are continually treating thrush infections, and it isn’t thrush, or it becomes resistant, it’s essential to get examined by a GP who can run a culture. 

This means taking a swab from the vagina and growing the fungus or culture, and seeing what type it is.

What else might it be?

It could be bacterial vaginosis, which is a different infection, and happens when the bacterial levels in the vagina are out of balance. It is treatable, but just in another way.

It’s important women understand that if an infection is continuous, to get it checked out because it could be an STI (sexually transmitted infection). 

About 70% of STIs are asymptomatic. For instance, chlamydia can cause issues with fertility if left undiagnosed.

What if it turns out to be an STI?

The HSE runs a confidential and discreet SH:24, a free online sexual health service. Enter your email address and home address in a dedicated portal, and you will be sent a free STI kit you can use at home.

The test is simple. You prick your finger and squeeze the blood into the vial. Then, you send it off and will quickly get the results via text. 

You will be contacted if a team member needs to talk to you to advise about treatment. 

The home test takes away the embarrassment and the shame (which there shouldn’t be anyway) of needing to see your doctor about an STI, which hopefully makes checking it out a lot more doable.

Is there any way of preventing thrush?

There isn’t a way to prevent thrush, but there are aggravating factors you can address. 

Some women prefer not to wear nylon or polyester and opt for cotton underwear instead to allow the air to circulate around their genitals.

There is no point in laying blame or thinking you could have avoided this or that.

Some women live with candida and never get symptoms, while others will have symptoms that flare. It depends on your body.

There are many old wives’ tales to be wary of like putting yoghurt on a tampon and inserting it. It’s important women don’t go down this route as there is no medical evidence for it.

What if you are too embarrassed to talk to someone?

There shouldn’t be any shame surrounding your vagina. It’s another body part.

Pharmacists have seen it all before and are trained to understand what you are going through and respond appropriately.

Equally, over-the-counter staff are usually well-trained and can answer your questions.

If you have a problem or feel like you need privacy, most pharmacies have care rooms where you can speak to your pharmacist.

Pic: iStock

What other vagina tips do you have?

Some products, like sanitary towels, can irritate your genitals or cause discomfort. Sometimes, just wearing period knickers can be a good idea. 

Some women ask if it’s okay to have sex if you have a thrush infection. It can cause discomfort, so you may not want to, but there is no evidence to support that you can give it to a partner, nor do you have to treat them.

Don’t fall for any of the personal hygiene gimmicks or think you have to wash your vagina with a ‘special’ product. All you need is a little water. 

You might want to wash your vulval area with a gentle cleanser that isn’t a soap, but douching or inserting cleanser into your vagina is not advised.

There’s a delicate microbiome balance in your vagina. And we have to respect that.

It’s critical women over 40, especially those who have thrush or recurrent thrush, realise it might be declining estrogen levels that need to be addressed.

Many older women may think they have thrush when they have itchiness, dryness, or soreness due to low estrogen levels.

Thrush cream can soothe the area, but it might only act as a moisturiser and not treat the issue.

In many cases, an estrogen pessary and/or cream (prescription only) can help sort it out.