Recurrent Vulvovaginal Thrush
Signs and symptoms
We present first-hand accounts from individuals who responded to a study advert for people who had ‘recurrent vulvovaginal thrush’ (thrush that keeps coming back, recurring, or returning). The symptoms of vulval and vaginal discomfort can be caused by a variety of conditions. Therefore, these accounts represent a range of experiences which include thrush, but may also include other conditions that contribute to or exacerbate the symptoms described.
Thrush (sometimes called a yeast infection or candidiasis) can cause different symptoms. Recurrent vulvovaginal thrush, is when a person has episodes of thrush affecting the vulva (the female genital area including the skin surrounding the opening of the vagina) and/or vagina (the passage between the vulva and the cervix/opening of the uterus) four or more times in one year. This section covers:
- Physical sensations, signs and symptoms of thrush
- Experiences of thrush coming back often
- Possible differences in symptoms when thrush changes from “one-off” to recurrent
- Possible association with other health conditions
Physical sensations, signs and symptoms of thrush
Some people we talked to, like Georgia, had initial sensations that told them that thrush might be on the way. Sometimes these feelings could then turn into more obvious or intense symptoms of thrush.
Georgia describes having first signs that turn into symptoms of recurrent thrush (read by an actor)
Georgia describes having first signs that turn into symptoms of recurrent thrush (read by an actor)
Yeah, I would say I would start to notice it flaring up probably... probably the first place that I’d think, ‘maybe I’ve got thrush here,’ would be going to the toilet, I’d be like, ‘ah, like doesn’t just... it doesn’t feel quite right, it feels a little bit sensitive,’ and then normally very quickly that would then become like very uncomfortable like in terms of like sensitive to touch, very, very itchy, and like I think I describe it as like feeling very itchy on the inside, like really burning, feeling very painful, and just really difficult to relieve, that’s what I found so uncomfortable about it, was I feel like I was just sort of like, ‘I can’t do anything about this and it’s really uncomfortable,’ but I would... and then... and then you kind of always feel it because whenever you sit down, which is a lot of the time, either like sitting on a bike to commute, or sitting on a chair at work, or sitting down at home, you’re putting pressure on that area and then it’s sort of reminding you that it’s there.
The main symptoms of thrush people described were vulva and/or vaginal discomfort and itching, which could be intense. Some people also described having sensations of “burning”, “stinging”, or “soreness”. Others described their vulva as feeling dry, inflamed, and like it was covered in small tears or, as Harry said, “split skin”. Kayla said the skin sometimes looked red, and Beth and Sai described having a rash.
People often also experienced an increase in discharge from the vagina, which was sometimes described as having a curdy or ‘cottage cheese’ like texture. Although this was not the case for all of the people we spoke to, Lydia and Billie said that they did not experience this change in vaginal discharge.
KJ explains how recurrent thrush felt during a flare-up.
KJ explains how recurrent thrush felt during a flare-up.
Yeah, and it’s not as severe I think now that... I mean it can be uncomfortable and not nice, but I don’t think... I remember the earlier experiences with thrush being really quite severe and horrible, and really not nice, and really sort of like burning, red raw, split skin, you know really not nice, you know almost like when you just want to stay in bed and you don’t want to go far and you just want to sleep and sort of try and sleep it off and... you know but now I’m sort of obviously... I’ve not had anything that severe, you know a severe episode.
There can be many different causes for vulval and vaginal itching and discharge, and not everyone with these symptoms will have thrush. Examinations and swabs can help work out what the correct diagnosis is and point to suitable treatments.
Experiences of thrush coming back frequently
Recurrent thrush is defined as four or more episodes in a twelve-month period. How often people had flare ups of symptoms they associated with thrush could also vary. Some people found their symptoms appeared every three or so months, while others had them every few weeks. Anna recalled a time when she was having eight or nine episodes of thrush a year. Joy has been having thrush return every month for the last 9 months. Some people noted that thrush occurred every month around their periods. The times when symptoms re-appeared were sometimes called “flare-ups”.
For those people who had thrush that cleared up and then returned again, it sometimes took a while to recognise this was turning into a pattern for both patients and healthcare professionals.
When thrush kept coming back, Teddy noticed it was a recurrent issue
When thrush kept coming back, Teddy noticed it was a recurrent issue
I think I... I mean through about a three or four-month period at the start of university where I was never like fully comfortable, like physically, because of thrush, obviously it’s very like itchy and painful a lot of the time, I was like I wanted to claw my insides out, this is very stressful, which is a really gross image, I'm really sorry, but... yeah. But I was like, it would go away kind of, but there would still be like a vague discomfort there for a good four months, and it was like, ‘I don't think this is normal, WebMD doesn't like this anymore.’ So yeah, that was kind of when I realised, ‘I think this is a recurring thing,’ and I was like, ‘why isn’t this going away?’
When the number of thrush episodes she had in a year increased, Chloe began to realise it might not be “normal”.
When the number of thrush episodes she had in a year increased, Chloe began to realise it might not be “normal”.
To be fair, I don’t think it was probably until it started to become something... something that was happening more than twice a year, because in my head like I just thought women got thrush, that was that, and twice a year, you know, ‘it is fine,’ and because the doctors weren’t really saying anything about it, they were just kind of giving me medication, and don’t get me wrong, like I’d been on enough antibiotics a few times because of my physical health, which I know can obviously impact... impact it, but no one was ever really saying anything to me, and it wasn’t probably up until my mid-20s that it was getting a bit like, ‘well, I don’t really think it’s particularly normal, it’s really annoying.’
Leah noticed she was getting thrush every few weeks in line with her menstrual cycle (read by an actor)
Leah noticed she was getting thrush every few weeks in line with her menstrual cycle (read by an actor)
It’s really weird, because I get it, and then when I’m on my period, it seems to clear it all away, and then it seems to be OK for a couple of weeks and then it’ll come back again, it’s really... really strange. I don’t know if periods have got anything to do with it; the doctor did say that was odd. But I suppose because it’s sort of like so clearing things out, I don't know but then I... but then two weeks later I’ll get it again. It’s just like I say, it’s just constant really, and it’s just so annoying, as you can imagine... as you know, itch, itch, itch, and it... makes it bleed and it’s just so aggravating, it’s unbelievable.
Some people found that their symptoms did not fully resolve between episodes, but that they had ongoing background irritation. Jody, Teddy, and Harry said that between flare-ups of symptoms, they felt some lingering background discomfort. Harry said that this was because the skin did not have time to fully heal before the next episode of thrush appeared.
Beth Sarah says that it feels like the thrush never goes out of her system but is “always kind of there” in the background (read by an actor)
Beth Sarah says that it feels like the thrush never goes out of her system but is “always kind of there” in the background (read by an actor)
It was just discharge, itching before, then I would treat it, it would probably go for... it would take a couple of weeks to go, I’d feel like I was just getting somewhere and then it would... it would come back really, really quickly, and the only way it was... I could keep it like on a... I knew it was there, that I can’t explain it, but like it just felt like it was always there in the background, there was a bit of a background kind of itch, or irritation, but it was kind of manageable if I was kind of taking the weekly medication.
Not everyone had symptoms that went away and came back, a few people felt they had a slightly different experience involving “persistent” or “chronic” thrush. Ayesha told us how they experienced symptoms which did not seem to ever go away, so she felt this was persistent thrush. Lydia explained she had a case of persistent thrush that was initially not responding to treatment and that it took months for a thrush swab result to be negative.
Possible differences in symptoms when thrush changes from “one-off” to become recurrent
Some people, noticed their symptoms changed over time as their thrush became recurrent. Elliott and Nysha found that their symptoms used to clear quicker in the past, but that now they either last longer or come back more regularly.
KJ, Chloe, and Joy thought their symptoms were either milder or less impactful the longer that they experienced recurrent thrush. Chloe said “I don’t know if it [was] just I was tolerating it more because like my body was sort of almost getting use to the thrush, so it wasn’t appearing to be like as much of a nuisance, it was more just a ‘oh gosh, here we go again’”.
You can find out more about the impacts of recurrent thrush in other sections, including those on: emotions and wellbeing, sex and intimate relationships, social life, hobbies, exercise and friendship, work and finances.
Possible association with other health conditions
The signs and symptoms described above can be caused by recurrent thrush, but other health conditions may also be involved, either by increasing the chances of symptomatic thrush infections or by also affecting the vulval skin and causing potentially overlapping or similar symptoms.
Health conditions that affect the immune system can increase the likelihood of symptomatic recurrent thrush, such as diabetes, HIV, and other autoimmune health conditions such as Sjogren’s syndrome (an autoimmune condition that affects parts of the body that produce fluids, like the eyes and mouth), and mannose-binding lectin deficiency (a condition that affects the immune system and has been linked to recurrent thrush). Having iron deficiency, low vitamin D levels, and is also thought to contribute to symptoms.
Teddy found that recurrent thrush was worse when their diabetes was not managed and Joy was unsure how her HIV status was related to recurrent thrush. Sasha was under investigation for Sjogren’s syndrome. KJ has thyroid problems she thought might add to her problems with thrush.
A doctor speaks about what can cause recurrent itching
A doctor speaks about what can cause recurrent itching
And I guess at the heart of this, it's just worth kind of always remembering that not all itches is thrush, even if there is thrush yeast there, if it's not getting better, it's really important to be checked to make sure that there isn't something else that could be contributing to the itch or exacerbating those symptoms or something that's happening alongside it, whereby both of those things might need treating in order to help you feel better.
It's also worth remembering that sometimes the things that we use to treat thrush, can potentially aggravate itch. So sometimes it's even possible to become kind of sensitised to things like panty liners or fragrances and panty liners or some of the thrush creams.
The most important thing about recognising this is that if you've got symptoms or discomfort or anything that you're experiencing that doesn't feel the same as it had before, or that isn't getting better with things that usually work for you or that you've tried, it's really important to hold an open mind and to take that and get further appraisal and assessment. Because the critical question is whether there might be something else that's contributing to it, something that's making it more likely, something else that's causing the symptoms, or something that's happening alongside the thrush that is exacerbating the symptoms because if we can recognise that, then we can try and tailor the treatment so that you're getting the right treatment for the right condition and for all of the things that might contributing to your difficulties to try and help people feel better.
Because we recognise how discomforting and uncomfortable and distressing this can be.
Other vulval conditions that cause itch can be mistaken for, or present at the same time as, recurrent thrush. These include lichen sclerosus, lichen simplex, contact dermatitis, vulvodynia, and genitourinary syndrome of menopause. Further investigation into these conditions can be initiated by patients or healthcare professionals.
Patients can ask their health professional to investigate them for these conditions. Physical examination can be used to identify these conditions, but health professionals may not initiate an examination without a patient requesting it. If a skin condition is suspected, referral to a dermatologist may be needed.
Lichen sclerosus (a chronic skin condition affecting the vulva) is a condition that is sometimes missed and misdiagnosed as recurrent thrush. A key symptom is itching and soreness, which can be easily mistaken for thrush. Kayla learned from a dermatologist that she had lichen sclerosus, and was upset that she had been treated for thrush for so long without knowing this information. Ella also lived with lichen sclerosus and found that this was vital information to have while treating what had been called recurrent thrush for decades.
Some people we spoke to also felt they developed hypersensitivity due to recurrent thrush. Sasha found that overusing antifungal cream brought on dermatitis. Harry was told by her healthcare professional that she had developed vulvodynia (persistent pain of the vulva and vagina) from recurrent infections. Marie associated her pelvic floor dysfunction with recurrent thrush and Beth felt that having repeated irritation led her to develop vaginismus (involuntary vaginal muscle spasms).
You can learn more about identifying and treating recurrent thrush here and Medications and Longer-Term Prescriptions.
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