Recurrent Vulvovaginal Thrush
Medications
Medications are available to treat recurrent thrush. The people we spoke to accessed these treatments through prescriptions from a healthcare professional or purchased them directly from a pharmacist or store. The people we spoke to often had tried various medication options and combinations. Choosing a medication sometimes took a bit of guess work to find out what worked best for different people. This section covers:
- Oral antifungal tablets
- Internal pessaries
- Creams and gels
- Other medications (boric acid, gentian violet, pain killers, antihistamines)
- Timing thrush treatments
- Needing more medication over time
Oral antifungal tablets
Oral tablets of antifungal medication could be purchased from a pharmacist or prescribed by a healthcare professional. These tablets were made of the medication fluconazole. Tablets were considered easy to use and Leah and for some like Chloe they worked the best. However, fluconazole must not be used during pregnancy or if there is a risk of pregnancy.
KJ found the tablets cleared symptoms quickly.
KJ found the tablets cleared symptoms quickly.
But because it’s kind of like I get it and I know what it is and then I just go and get the medication, I’m able to sort of deal with it then and there and just go, ‘right, okay, I’ve got it, deal with it, get sorted, move on,’ sort of thing you know,
you know I’ve had... you know I’ve been all right in the last few years I suppose just having that slight recurrent episodes where I can just and get a tablet and within a few hours... you know a few days I’m all right, I’m fine, and I just get on with it and I deal with it, and I’m kind of like, I’ll get it and then I just wake up and think, ‘oh, it’s gone,’ you know the tablet’s obviously done its job and I’m all right.
A single oral tablet was meant to clear thrush within a week, but for the people we spoke to, when thrush cleared up, it came back soon after.
It could be nerve-wracking to ask a pharmacist for medication, but the people we spoke to gained more confidence over time.
Georgia was “a bit nervous” to ask for a tablet over the counter at first (read by an actor)
Georgia was “a bit nervous” to ask for a tablet over the counter at first (read by an actor)
I remember like the first time being a bit nervous about asking for a tablet over the counter, because before I’d always just got the cream because you could just pick it up off the shelf and then pay for it and not have to like ask for it; whereas I realised that if I wanted to try taking an oral tablet instead, I was going to have to ask for it, but like once I’d done it once, and it was fine, then I was quite happy to just go in and ask for what I wanted, apart from the times when it frustratingly wasn’t...like they didn’t have any ... and then I would have to go to somewhere else and... and then that would like delay getting it which then was a bit frustrating.
Sometimes pharmacies ran out of antifungal tablets and Georgia found this frustrating.
Not everyone had tried oral options or heard of them. Nysha had heard about antifungal tablets from a friend but had not tried them. Ella was unaware that antifungal tablets were available and was unsure how they would work as she said that “direct treatments on the area would be better”.
A few people we spoke to did not respond to oral tablets. Kayla had persistent thrush and said “I started off going to the GP who just gave me like a fluconazole tablet and kind of told me it will clear up within a week, and it didn't”.
Some people did not like to take tablets due to other health issues such as having stomach issues (Leah), having trouble swallowing following a tracheotomy (Emily), or being on contraindicated medication (Laura). Aditi worried about potential side effects of taking medication. Other people like Leah said the tablets made them feel rundown and preferred to use pessaries.
Sometimes healthcare professionals recommended buying the medication over the counter and did not provide a prescription. However, when people were taking tablets often, they found it very expensive. Georgia found that generic brands were cheaper than brand names. Some people visited sexual health clinics which offered free medication for thrush. Others returned to see GPs repeatedly and eventually got longer-term course of medication (see Longer-term medications).
Chloe said the costs of tablets was a barrier to getting treatment.
Chloe said the costs of tablets was a barrier to getting treatment.
So, I kind of use those because again obviously I can’t afford to be buying the Canestens and the fluconazole on a regular basis, and I... so I always seem to have it to a degree, like at least once a month I’ll get the symptoms, which I don’t tend to treat anymore if it’s... I’ll kind of put up with the little bit... bit of an itch and do the wiggle on my chair and what have you, and maybe put a liner on, but every couple of months I’ll have like a really bad flare-up where I’ll go and buy some... like a full duo, so I’ll get the cream and the thing, and one way that I know that I’ve definitely got it as well is because the... the cream tends to really sting when you put it on, so... yeah.
Julia said that buying tablets from the pharmacy was a better option than waiting to see the GP (read by an actor)
Julia said that buying tablets from the pharmacy was a better option than waiting to see the GP (read by an actor)
It’s a tenner, it’s still a tenner. But it’s not... like you said, it’s not a viable... like I don’t feel it’s a viable option because I suppose by the time you get to see a GP, [sighs] like over a week later, and it’s just what you... [sighs] do you... don’t want to sit with it for a week, so it... the... the cost difference is marginal, £3 between a prescription and a... and buying it over the counter, but the difference is if you’re going to get a GP you’d have to wait forever and you’d have had it for a week by then, whereas if you just go and buy it at the pharmacy, it’s really good, you can get it at the pharmacy full stop, isn’t it? And if you get it from a pharmacy then it’s... you can get it that day, can’t you?
Internal Pessaries
Pessaries are antifungal medication (typically clotrimazole) that go directly into the vagina at bedtime. Pessaries are available on prescription or off the shelf at supermarkets or pharmacies. They are available in different strengths or durations. Beth and Nysha were prescribed a pessary from their doctor.
Some people preferred pessaries like Emily and Sasha and found they worked better than tablets. Other people were more comfortable using them as they were applied directly to the area instead of taking a medication orally.
Nysha found pessaries helpful.
Nysha found pessaries helpful.
It’s always been the... the main... the one thing that’s always helped is the pessary for me, the... that you take at night-time, I found that really useful. Initially the pessary on its own was... that’s all I needed, but over time I've... I now know that I need the cream as well to continue on with, just to make sure it completely goes, without that then I'm having to go back and say, “You need to give me the tablet and the cream or else I'm going to be back here.” Like I said I've tried like things like Vagisil, is it Vagisil? Yeah, I tried Vagisil which was OK for a little while but it doesn't completely get rid of it. I don't... I don't... Canesten or whatever the... sorry, Canesten’s the only brand name I know, that... the pessary and the cream for me are the two things that will always work, go hand in hand and that’s what I found useful.
Others did not like using pessaries such as KJ or Lydia who found them uncomfortable. Zoya and Georgia had tried pessaries but felt tablets worked faster or better. Laura could not use certain pessaries due to an allergy. Julia found pessaries were a “mess” since bits of the pessary would not dissolve overnight and would fall out of the vagina in the morning.
Joy found it difficult to insert a pessary while having thrush (read by an actor)
Joy found it difficult to insert a pessary while having thrush (read by an actor)
I don’t mind having a choice because sometimes, you know, it may be that we... it may be that sore down there that I think to myself, ‘well, maybe I couldn’t even put... be able to put the pessary in,’ because sometimes it can be that red and swollen, it is good to have the choice, because if I couldn’t, and I really needed to, then I would absolutely take the oral, so I absolutely do like that there is the option there. Because, you know, what if it is too sore down there, you know? Red, angry, swollen, [sighs] God, yeah.
If people had dry skin, vulval irritation, or vaginal pain, pessaries could increase discomfort. Billie said “I really don't like the internal pessaries, I find them really uncomfortable to use”.
Creams and gels
Antifungal creams can be applied externally to the vulva to help relieve itch and reduce discomfort. Sometimes these creams would also include steroid medication which helps people like Billie and Beth feel better. Certain gels and creams were also intended to be inserted into the vagina using an applicator.
Some people were unsure whether they were not using enough cream and this was why it was not working. Others felt that they were using more than was recommended to make sure that it worked.
Sai and Imani found antifungal cream and gel helpful to get rid of thrush. Sasha did not typically use medication to treat thrush but let it “play out”, and would use cream a couple of times. Imogen used cream growing up before switching to other medication. Anna found that doctors can prescribe stronger antifungal creams than what was available over the counter.
Antifungal creams were used by Nysha and KJ alongside oral tablets and they found this combination helpful. Others like Laura and Joy used cream and pessaries. Sometimes male partners were also treated with the cream as well such as Billie which she felt made the thrush go away quicker.
Beth said that sometimes the cream was enough to treat thrush, but other times she needed a tablet or pessary as well.
Beth said that sometimes the cream was enough to treat thrush, but other times she needed a tablet or pessary as well.
OK, I've got that cream that I use, and then I will either get the little oral capsule or a pessary from the pharmacy if I need it, and sometimes I don't need it and sometimes it’ll just sort of like... it’ll be like a bit of an irritation for a couple of days, then it’ll go again, or like a week and it’ll go its own and other times I'm like, ‘oh no, I need to like go and get a pessary or go and get like a tablet.’
Antifungal creams didn’t help everyone, and caused further irritation for some people like Zoya.
Zoya found that the cream made symptoms worse.
Zoya found that the cream made symptoms worse.
Yeah, so the first year was really difficult, I was just on Canesten, you know all the ones, and the cream actually made it a lot worse for me: I was more inflamed because it said to use that you know to help soothe, it... it didn't soothe it, it... it was so... it was a lot worse, and I remember just... when I used to get my packets I'd just use the... [baby coughs] the suppository, I'd not use the cream, I used to chuck the cream out because it was so bad.
Beyond using antifungal creams, some people we spoke to found benefits from using emollients (lotions, moisturisers, and ointments that form a film on the skin) to relieve dryness and itching of the vulva. Emollients were used as a soap substitute, daily moisturiser, and barrier cream by Lydia and Jody who said they helped immensely. Chloe found vaginal moisturisers improved the skin health and allowed her to be more comfortable during activities. Others like Imani stressed the importance of avoiding feminine hygiene products such as scented washes, soaps, or shower gels that can lead to thrush. (You can read more about emollients and bathing practices in: Prevention and changing daily practices).
Other medications
Sometimes people could not use the most common antifungal medication or were not finding them helpful. Some thrush was resistant to fluconazole.
For Kayla and Ayesha who had persistent thrush, they were recommended alternative options. Ayesha was given boric acid suppositories which she found helpful for a few months before they stopped working. Kayla was recommended gentian violet (an antifungal dye) after trying traditional medication routes that did not work.
Kayla tried using gentian violet but did not find it effective.
Kayla tried using gentian violet but did not find it effective.
A vulval dermatologist who then looked at it more in depth and has tried all different treatments: some that haven't really been used before, like the gentian violet, where they painted my vagina every week with like a purple antifungal paint to see if that would work, but that didn't work either.
Marie had heard about boric acid but said it “frightens her”.
Marie had heard about boric acid but said it “frightens her”.
But you know there are other things like I think they're called ‘boric acid pessaries’, I haven't tried those, but that frightens me, and so that you can buy these pessaries off the internet, and that worries me a little bit because things could go wrong.
Some people tried to relieve pain using medication intended for other purposes. For instance, Teddy tried using painkillers like ibuprofen and paracetamol which did not help.
Anti-histamine tablets were used by Harry, Lydia, and Imogen to reduce discomfort after being recommended this treatment by a healthcare professional. Imogen was told that she was experiencing an allergic reaction to thrush and that antihistamines could help.
Imogen was recommended antihistamine tablets by a healthcare professional.
Imogen was recommended antihistamine tablets by a healthcare professional.
And when I finally got an appointment to see the GP yeah, she was just like, oh, yeah, you're already inflamed. I think. I think you get like an allergic reaction to the thrush.
And so, she was like, you know, for that and basically, the contact dermatitis, which I started getting last year, she was like, oh, yeah, you should be taking antihistamines when you get that. And obviously, what, like, how am I learning new information now?
It like, makes me feel like I have been drip fed, like gynaecological health care, over 31 years, like, I have never been given a full, you know, amount of information at any one point. Like, it's just tiny, tiny bits. And it makes me really angry, because I don't think I should be like learning new stuff now
Timing thrush treatments
Overtime, people described how they got treatments for thrush as soon as they developed symptoms, rather than waiting till it got bad before taking medication.
When Teddy feels thrush coming on, they “nip it in the bud”.
When Teddy feels thrush coming on, they “nip it in the bud”.
I think I'm in denial a lot less about it, because when I have got it, I was like I can tough this out, I don't... I can ignore this until it goes away, until it started to not go away, but now I get a symptom I’m immediately like, ‘I'm going to treat this because I, like, don't want to be in pain or uncomfortable because I don't deserve to be,’ but I think it was a lot easier to just kind of bury my head in the sand when I first had it and be like, ‘pretend we do not see it, I am not getting this ever again, and I... I don't have it now, I will just ignore it, I'll pretend I'm not in like the immense discomfort anytime I sit down, it’s fine,’ but I think I'm, yeah, in... I'm a lot more willing to nip it in bud quickly, just because I know what I'm dealing with now, I think.
Leah recommends keeping treatment on hand at home as a “safety blanket” (read by an actor)
Leah recommends keeping treatment on hand at home as a “safety blanket” (read by an actor)
I think like always having the thrush cream available, and the pessaries at home, because I do think like you can grab hold of it a lot quicker if you treat it a lot quicker. I’ve found in the past when I’ve left it and thought, ‘oh, it’ll go away,’ and it doesn’t, it actually gets worse, so I think... I think when you get the first sign of thrush, you do need to treat it yourself, and I think you need to have that medication in the house. Have the cream, it helps me a lot, and it reassures you, it gives you a sense of... I mean I carry one in my bag as well and I think it gives you that reassurance that, you know, if you do have a flare-up at work, and in the afternoon, and start to get that twinge, I can put a bit of cream on and carry on with my day and feel less irritated, because the cream does help a lot, like the irritation of the skin.
So, I think it’s just having that at home, do you know what I mean, and having... having that in the house does make me feel a lot better.
So, I think... yeah, I think that’s good advice for people who do get it reoccurring just to have things on hand, so you’ve got that peace of mind. It’s like when you get headaches and stuff, if you suffer with headaches you’d take paracetamol with you, wouldn’t you, so it’s the same sort of thing as having that safety blanket.
Some people found it helpful to take antifungal tablets early to prevent thrush from starting or getting worse.
Julia found it helpful to take antifungal tablets pre-emptively before important occasions (read by an actor)
Julia found it helpful to take antifungal tablets pre-emptively before important occasions (read by an actor)
So yeah, and like I guess I do take... really naughty, I do... very occasionally I’ll take a pre-emptive... like a... a just-in-case, if I’m going away with my husband or I just... and I know that it’s the right time and I’m just before my period, I’ll just take it without... take a capsule without symptoms because these are all things that now I’m thinking about it are quite naughty and you really shouldn’t do, but I would rather... I guess I... I guess... you can’t tell anyone, because, no, this has to be anonymised, [chuckles] but I guess I would rather lie to pharmacists, and be a bit sneaky, than get thrush: I’m sick of it, absolutely sick of it because we... it’s... you know, it’s 20 years like that... or more, yeah, that it’s just back, and back, and back, and back again.
Other people spoke about having a “maintenance routine” and always being prepared by having medication in the house or carrying it in their bag. Ella said it was her “job to be vigilant” by using a cream or pessary before thrush worsened.
Needing more medication over time
Some people found that antifungal medication worked less well over time or that they needed to use more medication more frequently to get relief. This concern was shared for individuals using creams, pessaries, and tablets. Thrush could become resistant to antifungal medication which could be investigated through testing (see Having examinations and taking swabs).
Jody felt they had become more resistant to antifungal creams (read by an actor).
Jody felt they had become more resistant to antifungal creams (read by an actor).
So, I think at the start it was just a case of getting like the topical creams that you just pick up from the pharmacy, and I think that would kind of work as a temporary solution, but I think my body, after a while, became a bit sort of resistant to it and it just wasn't even touching it, and then from there it went into more like the internal stuff like using the... all the different types of pessaries that you can get and then the oral pills as well, yeah.
Harry found that she needed to take another antifungal tablet after five or six days when thrush had not gone. She said “it almost seems to be less reactive to the medication after a while, it seems to kind of just get used to it”. Leah worried about becoming immune to pessaries.
Elliott found that they needed more tablets over time (read by an actor)
Elliott found that they needed more tablets over time (read by an actor)
So, yeah, that one’s interesting because when it was happening in my early 20s I would just take a tablet, it would literally just sort it out and I would just use the cream and I’d just do it for like say the seven-day to 10‑day period, it wouldn’t be an issue. It’s only since starting the T (testosterone) where that’s not working, like it’s like it’s... it’s not responding to the medication in the same way, and then, yeah, so I’d say all of like... I would say only up until this last year, before I would just get it and just do the normal easier round and it’s only this time where it’s now like needing more than,— and yeah, and it’s staying.
In order to get multiple tablets in a short time frame, the people we spoke to would visit different pharmacies or purchase them online. Julia and Elliott bought pills and cream online from private retailers.
Marie said that she had tried “numerous pessaries, probiotics, creams, you name it – I've tried it” but that she thought overtreating “can be dangerous sometimes; you can do more harm than good if you're not careful”.
When thrush kept coming back or not going away, longer-term courses of treatment were sometimes offered which you can read more about here (Longer-term treatments).
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