Recurrent Vulvovaginal Thrush

If you've got difficult symptoms that haven't got better with the treatment that you've tried, there are lots of really important reasons why we would suggest going and getting further assessment. And that includes making sure, that you might have a strain of thrush that's perhaps resistant to the treatment you've tried or there might be other things happening that either kind of aggravate the thrush that's there, or it might be that something else altogether, for example, another skin condition or another difficulty in that area are causing the symptoms, that have been thought to be thrush.

So, it's really important if things aren't getting better or if you've got ongoing symptoms or any concerns to get assessed by a health professional. And usually, the first thing that they will suggest is to have an examination as part of both understanding the problem, but also creating an opportunity to do some further testing, like specific types of swabs and look and kind of considering those other possibilities so that you can get the right treatment and the right care for you and the right tests.

But we do recognise that that can, for some people or sometimes feel that could potentially kind of uncomfortable or worrying thing to encounter. And there are things that I guess we can think about that sometimes can try to help. If there are things that you know from your experience, maybe being examined or make facing examination easier, then talk to your doctor about those. Try and plan the examination and see if you can build those in. Examples include thinking about where and when and with who you have the examination, having at a time when it's planned, or when you've anticipated or known that's going to happen. Sometimes, talking the steps through can help, and sometimes having a friend or an advocate or a supportive person of your choosing with you can help.

There might be things that make it feel particularly worrying or uncomfortable, and if you can create some space to talk to your doctor beforehand, including sharing together ideas about how you could together work to make it feel more manageable and more kind of acceptable, then that can be a really useful thing to do as well.

Sometimes it takes a bit of time to build up to these things, or to build the trust and to build the relationship, and trying to work to do that is also something that can be really helpful.

There are times when none of this feels possible, and there are things that can be considered in that space. And self-taking swabs are a really good example of that, and that can be an incredibly helpful thing to do. But I guess the difficulty is that if despite a swab and despite treatment, you're still not feeling better. It can still create spaces and opportunities for more tailored or more accurate care for you if you can take those next steps.

So, I think I think we recognise it's difficult, but having your voice and working in partnership with your health care professional to try and navigate a space, where, to manage that. If it's something that would be helpful to you for your health, can be can be worth doing, and it is absolutely okay to find a way to have your voice as part of that process.

I preferred the self-swabbing. I’d always choose self-swabbing between the two if given the option, but I did believe that it was necessary the first time for the nurse to see it because she saw the gravity of it, because I had like red skin and it was quite, you know, inflamed, that’s the word I’m looking for, so I think once she saw the gravity of it, it sort of clicked that I wasn’t just complaining, it wasn’t just a routine thing, it’s actually quite an annoying thing.

So, I would just go and take a pill the day I spotted it, from the over-the-counter, but by the time I'd got to the GP, which was two or three days later, most of the symptoms had kind of cleared up, so unless I pre-emptively booked an appointment, I couldn't... and that’s not to say... I'm very lucky with my GP, I can call and get an appointment probably for the next day, they are very quiet, which is almost unheard of in the UK because I know they're very busy, but I... just because of work commitments, all of that stuff, I’d have to time it to get there, so she only actually saw active thrush maybe once, but yeah, she was like, “I don't even want to put the speculum in because it looks so painful, I'm not going to even bother with that because I can see what it,” yeah.

Early on there were a couple of physical exams. But then from quite... quite quickly I was coming in saying, “I've got thrush, I know I've got thrush,” and no one looked, it was very... very rare, yeah, I mean barely any physical exams, if I think about it like maybe one at the beginning and then just a conversation with me sat on a chair describing my symptoms, and then prescribing me the same stuff. No one looked. I think I asked a couple of times for people to look, and so they did.

When I was younger, I used to not be comfortable going to gynaecologists because of all the physical examinations and the uncomfortable questions, but as I grew up, I realised that even... unless I don't openly describe what the symptoms are or how I'm feeling, I will not get an answer for what I'm looking for, so it was in my best interest that I take... like I engage with the doctor as much as I can, so...  Yeah, and now... and now I'm extremely comfortable going with the gynaecologist’s visits as well.

There was like one I had in person and I kind of expected that she was going to need to take a swab and send it off, and she was... yeah, she was really lovely, she kind of explained what she was doing the whole time, like check that I wasn’t uncomfortable, all that kind of stuff, so that was really a good experience.

Yeah, it was... I didn't... [sighs] I think at that... at this... because at that point I was used to having like smears done and things. I think... going off, side topic, I think around the age of 30 I just thought, ‘you know what, these are things that are going to have to happen, as a woman, these are things that I'm going to go through, and yeah, they can be uncomfortable but what you can do is just try and relax and just do it,’ but at the point where they were doing the swabs, you know you... I was just so desperate, I didn't care, I was like, ‘do what you've got to do, ’didn't bat an eyelid, and now I don't even... it doesn't faze me like having anyone... well, that sounds a bit random, but you know going for internal... it doesn't bother me, just if you've got to do it that’s fine, I'm not prudish about it anymore.

Yeah, when I was younger and constantly going back and I’d just describe my symptoms, and they’d be like, “Oh yeah, that’s probably thrush,” and there would be... and then that’s it, they'd write me a prescription and send me home, I'd take the meds, I'm like, ‘OK, it’s fine,’ but I think since I've got a bit more... like through the system, I understand how things work from a medical point of view a bit more just purely out of going to the doctor’s loads, I will more than likely ask for it now, to say like ‘I just want to confirm through some sort of swab because like I don't want to be taking these meds and it’s currently... you know it’s... it’s not thrush, you've given me it and then it actually it brings thrush on maybe further down the line’, so I’d always ask for it now.

I forgot to mention which is also possibly more relevant: I have vaginismus as well, and that meant that I couldn't get diagnosed with it because I can't do the physical exams, so I was kind of just... I kind of just worked out that I had it, but yeah, I couldn't get a prescription to... for any medication for it, like regularly, because I couldn't get diagnosed because I couldn't do the diagnostic process.

But yeah, that doctor was very sure about it, and was like, ‘oh, if you're not willing to... if you're not like comfortable with the kind of process to formally diagnose you with this, you can still just get like the over-the-counter stuff, treatments for it,’ which is what I still get, it’s like I have to pay for this but it’s at the expense of me not having to put myself through a fairly painful medical procedure, so it’s like, oh, there’s swings and roundabouts.

I was sent to the nurse practitioner, and I was a nervous wreck, I... I you know I was like shaking, you know and she got the speculum out to do the swab I said, “Please don't hurt me, I... you know, I'm really stressed about this,” because having been through... I think most of us who’ve had recurring thrush over a number of years, you've had so many swabs and so many examinations that you become white coat syndrome, terror of coming back.

Personally, my own GP during this period when I went in to have a thrush test, I think maybe it was one of the times that they hadn’t given me my... they hadn’t given me my own kit, so I had gone in to see a nurse, I arrived and I started speaking to the nurse and I said during the initial conversation, “I'd like you to know that I have vulvodynia, so please can you just be aware of that.” Instead of saying, ‘can you talk more about that?’ or, ‘I don't know what that is,’ the nurse sort of looked at me and said, “Oh, OK:” I could tell something was up, so when I got onto the bed in the GP room, I just... so... so I just knew that something was a little bit up, so I just said to her...you know, which I felt quite proud of, I just said, “Do you... do you know what I've just said?” “Er, er, is it something to do with the vagina maybe?” Now for me I think that is absolute negligence. You were about to touch me with a swab and you don't understand what I have just said to you – it’s extremely negligent. I'm... I don't... I'm an open person and, yes, that professional might not know that, but I would much rather you say to me, ‘I don't know what that is, would you mind just taking the time to explain that to me?’ I will never judge someone with that. I'm fully aware of the fact that my condition is not something that’s talked about, it’s got a lot of stigma around, it’s very under-researched. As much as I don't like that, I understand that that’s the case, and I'm happy to help that and change that as much possible. But if you... if you just pretend to know what I've said, but you don't, then that’s not fair, and that’s not doing your job right as a professional.

So, I then explained to her what it... what it was, and I also then did the swab; I took the swab and I did it myself. So, I think that’s an experience that is really worrying, because number one) it’s worrying that you were about to do something that involves a woman’s vagina and vulva and you don't know about vulval pain conditions. And number two) you would rather say that you know to avoid embarrassment or an issue or you just want to get the appointment done, or that sort of thing.

I got them tested each time with the GP, who handily just gave me... because I didn't have to book an appointment, she just gave me a swab to use and then hand it in to get tested, which is very convenient and easy to do and brings peace of mind as well.

That the... I suppose more the... the flippancy that a GP will recommend, ‘just get a self-testing kit,’ and then you can obviously buy a pessary, and maybe there are, as a result of that, more people who are trying to self-manage that GPs don’t know about. It’s great that there’s like self-testing kits available: are you doing the swab properly; are you doing it high enough; and what do you do with the results?

It’s not recorded anywhere, is it, if you’re doing it yourself? Although I appreciate it’s a convenient option to try and identify whether you genuinely have BV or thrush, and then subsequently to treat it, but that’s not being recorded in your medical notes.

I felt more confident in the self-test kits than going to a GP or a nurse, because every time they did a swab they said, “It’s fine,” so I wouldn't get any sort of treatment or help from there, so the tell... the test kits kind of showed me that it was what I was thinking, but they were still very temperamental. One week I could do one: I'd have evidence for what I was feeling. The other week it would be the other way. So, they weren't entirely reliable, but at the time they gave me the reassurance that I needed that it wasn't in my head.

Yeah, so I believe I did this... this one at home and I then sent it off and they did the... they did the test and they found out that I have quite a rare type of thrush and that fluconazole it isn’t able, or, and never was able to treat it. So, I think that was difficult at the time because I had taken quite a lot of fluconazole, so when you sort of were told that actually none of that was ever going to make any difference – it’s quite a difficult thing to hear really, because it’s time and especially when you...like me when you've got a lot of other health problems.

And I did have a talk with my doctor and he did say... this is after probably having a conversation with the pharmacist, who said, “Maybe you should go get screened for diabetes.” So, I go to my doctor, “Doctor, I’ve had serious bouts of thrush and this is... you know, this is my way of life,” He’s like, “Do you smoke?” I said, “No.” He went through I think a list of things he was trying to check if I do, and I was saying, “No, I’m not doing any of those things,” and then he said, “OK, let’s test for the diabetes,” and then they found that I did not have diabetes, so, ‘what is going wrong?’

I should add as well that because I had a pelvic floor physio, she’d said to me, “It’s a good idea to go to sexual health [Clinic] because they do better tests down there, ”so I've been through the whole mountain of tests for everything, and at one point a GP, not my main GP, actually tested me for HIV, not that I have a problem with that, I understand they have to do a full flush of tests, but she didn't tell me, I found out when I rang up for my results, and they were negative, but I think you should be told about something like that, personally.

I remember I’ve had like... the only annoying thing with the GP is I’ve had so many like STI checks, like reoccurring, and it’s just like I know I don’t have an STI because like either I’m not sleeping with people, or other sort of things, but they always seem so determined and like thinking that you have an STI, and not that it mattered if I had an STI, but I’ve never had an STI, and I know around sexual health and, yes, so that’s really frustrating when GPs are just always like really just thinking like you’ve got... must have an STI, but not... but I mean I’ve done... I’ve... it’s difficult because I feel like I’ve always had to have so many swabs and so many different tests of things, but yeah, I don't know.