Recurrent Vulvovaginal Thrush
Referrals and onwards specialist care
The people we spoke to often saw GPs or sexual health services about recurrent thrush as their first contacts with health professionals. These professionals could arrange for people to get further care from a specialist, a process that is called a referral. This section covers:
- Paths to referrals
- Vulval dermatology
- Gynaecology
- Specialists for underlying conditions
- Dieticians
- Counselling
- Pelvic floor physiotherapy
- Private care
Paths to Referrals
Referrals could be made when a healthcare professional felt that a patient needed additional information, testing, or treatment that was not available in primary care.
The people we spoke to were referred to different healthcare professionals and at different points in seeking care. It was not always clear to patients who they should be seeing and what records were shared between healthcare professionals.
Teddy found it difficult to know which records were shared with what specialists.
Teddy found it difficult to know which records were shared with what specialists.
I don't think I did actually. I don't think I've... I didn't bring it up with my diabetes team because I assumed they would know because I assumed all my like records would be kind of together. I'm starting to actually think they're not, so I probably will bring it up at my next appointment. Because when I saw my kind of... I don't know what the term is for it, but I just think it was like my medical rap sheet of just like, ‘here’s what’s wrong with you.’ It didn't have my mental health stuff on it and it didn't have my sexual health stuff on it, and I was like... but I'm assuming they do have this information but just somewhere else, but I couldn't see it on the screen and was like, ‘I mean you should probably know this because this... I mean if... first of all if you know this you'll stop asking me about what my family planning information is because you'll know I'm not family planning because I have issues, so I think it would kind of streamline my medical appointments if they had all that information, so next time I... at my next like annual review I'm probably going to be like, ‘hey, so bonus fact, I have this and also my diabetes is probably related to it,’ so information, yeah, I think it would be good for them to know because I think it is all interconnected.
It sometimes took a long time to get a referral. Anna thought “I should have been referred like six years earlier than I was”. Kayla felt ignored by her GP and said “they left me for a long time before they referred me on to someone else to try and help “. Leah expresses frustration, saying, "I kept going back to the doctor’s... they kept giving repeat medication of the same thing for a year... they left me for a long time before they referred me on to someone else to try and help." Once a referral was made, there were often long wait times to be seen.
Some people felt they should have been referred to a specialist but were not. Others were not interested in a referral.
The people we spoke to had been referred to see various specialists including a gynaecologist (specialists in the vagina), dermatologist (specialists in skin), virologist (specialist in infection), rheumatologist (specialist in autoimmune disorders), and endocrinologist (specialist in hormones).
Other times, people sought out additional help directly whether though self-referrals or private care. People we spoke to self-referred to other healthcare professionals such as dieticians, counsellors, pelvic floor physiotherapists, and private care.
Vulval Dermatology
Vulval dermatologists look at the skin of the external genitals and could help give advice on recurrent thrush or rule out other conditions (such as lichen sclerosus). Lydia and Kayla had seen a vulva dermatologist who was “amazing” as she “looked at it more in depth”.
Kayla found seeing a vulval dermatologist very helpful.
Kayla found seeing a vulval dermatologist very helpful.
The vulval dermatologist, she explained it in much more detail, so you know explained what species of thrush I had and was just much more thorough. You know, like when she gave me the medication, she explained to me how I should be taking it and you know if there wasn't any improvement to give her an email back so she could tweak things a bit more.
However, Kayla found the long waits between specialist appointments frustrating: "I've still got the recurrent thrush like every day. But my appointments are like every six months apart”.
Once a referral was made, there were sometimes long waits to see the specialist. Ella said that she felt she was “on the waiting list for the waiting list at the moment," to see a vulval health specialist. Marie had heard about a vulval clinic from online research and was planning to ask for a referral.
Gynaecology
Some people we spoke to were referred to see a gynaecologist including Jody and Marie. Beth and Nysha had been referred to gynaecology multiple times. Nancy shared experiences with two gynaecologists, one of whom was attentive and provided helpful information, while the second she felt was less interested and did not offer additional advice. Zoya has been waiting for a gynaecology appointment for a few months.
Jody had positive experiences with a thorough gynaecologist who took time to understand the impact of thrush on their life (read by an actor).
Jody had positive experiences with a thorough gynaecologist who took time to understand the impact of thrush on their life (read by an actor).
I think actually one of the last gynaecologists that I saw, I think she was actually really... she was probably the best person that I saw throughout the whole kind of... the journey, and she was really quite thorough and was like keen to actually you know ask so many questions, maybe too... maybe what I thought was too many questions at the time because they... some of them seemed really random, but that was really appreciated like to have that time to really... to be understood and to kind of get the full picture across that it wasn't just you know this little problem, like this was something that was really like affecting me big time and was, yeah, really getting me down, really you know affecting relationships and making my life, yeah, quite... quite challenging.
Chloe was referred to a gynaecologist but found them unhelpful.
Chloe was referred to a gynaecologist but found them unhelpful.
After six months of the pessaries, and still getting the breakthroughs, they referred me through to a gynaecologist, and when I saw the gynaecologist he just basically said... because he again, he asked me: “Oh, are they just telling you you’ve got thrush following a... some form of smear?” and I was like, “No, I’m getting the symptoms too,” and his response to that was basically just: “Well, there’s nothing we can do, your body will just get used to it; hopefully the symptoms will get less severe when you do have it,” and that was basically that, like he didn’t really do anything, it was basically a case of ‘you’ve got thrush: live with it,’ tough shit basically.
Specialists for underlying conditions
Some people we spoke to were referred to specialists who could look into underlying conditions that contribute to recurrent thrush. These included virologists (specialist in infection), rheumatologists (specialist in autoimmune disorders), and endocrinologists (specialist in hormones). Sasha planned to see a rheumatologist for a potential autoimmune condition called Sjögren syndrome which can contribute to recurrent thrush. Kayla was referred to a virologist to see if there was a reason behind her recurrent thrush. Chloe hoped to explore the potential connection of recurrent thrush with hormone imbalances with an endocrinologist.
Counselling
Counselling was accessed by some people we spoke to looking to discuss the emotional impact of recurrent thrush. It could be accessed through the NHS or privately. Some people we spoke to accessed psychosexual counselling which involved talking about how recurrent thrush was impacting intimacy and body image among other issues.
Imogen discussed recurrent thrush in psychosexual counselling.
Imogen discussed recurrent thrush in psychosexual counselling.
Ouu, we definitely talked about the thrush, and it was like because that was her discipline, it was just immediate like, ‘yeah, this is the cause, OK, well let’s work on how this has impacted you and then everything will be great,’ you know, like which didn’t chime... like it all felt much more sort of deeply rooted and complex than the way she was presenting it. Yeah, so we definitely talked about it and how it had made me feel about my body, and then it was more sort of like practical like, ‘OK well, how can you enjoy your own body?’ and like talking about masturbation and like that sort of thing, so the thrush was a big part of... well, you know, what we started talking about because that was what she was taking as the reason I was experiencing my sexuality in the way that I was.
Dieticians
Some people visited a dietician or nutritionist who provide advice on food and healthy lifestyles. While some people found advice about diet helpful, others had doubts about the long-term effectiveness of these options. Imogen and Leah were told to cut down on sugar and increase water intake. Emma was told to avoid bread and mushrooms.
Leah found the nutritionist empathetic but was unsure about the effectiveness of the advice (read by an actor)
Leah found the nutritionist empathetic but was unsure about the effectiveness of the advice (read by an actor)
I thought they were more empathetic, but I suppose you’re paying for a nutritionist though, aren’t you? You’re paying for someone one-to-one, you’re paying them a lot of... you know, it’s a lot of money. I mean I think the advice that I got was about over £100, but if you want... you could have stayed with this lady for 12 weeks and I think it was three or four hundred pounds, so of course they’re going to be sympathetic, they’re going to be at your beck and call, they’re going to offer the advice, but yeah, she just told me to cut out sugar, which I did for a while, but it’s very hard to stick to. It’s not... it’s not... it’s not normal life, is it? It’s like when you... that’s like when people say they’re on diets: you can’t be on a diet for a life, you’ve got to just make lifestyle changes, is where, like I say you can’t ignore sugar for the rest of your life.
She wanted me to go on this completely 12-week programme; I think I did it for six weeks. I did a six-week programme with her, and not a 12-week programme with her, but she reckoned the 12-week was the best, but it’s just... it was just so hard, it was like cutting out dairy and everything and it was just... it made me more miserable in a sense because it was like... and it never even... it didn’t help, it didn’t help to get rid of it anyway. I think a lot of these nutritionists feel like it is down to diet, but I don't know if it is or not, do you know what I mean, I’m not sure?
Other people were told that their diet did not play a role with recurrent thrush. You can read more about how people experienced diet changes here.
Pelvic floor physiotherapy
Pelvic floor physiotherapy is a specialised service that uses exercises, education, and manual therapy to help alleviate discomfort surround the pelvis. While nobody we spoke to was referred directly to these services to treat recurrent thrush, some people sought help for issues that they felt thrush had caused or made worse. For instance, Marie was told by her pelvic floor physiotherapist that recurrent thrush led to pelvic floor dysfunction which she was currently treating. Ella said that pelvic floor physiotherapy was an additional thing in a “smorgasbord of little tools and tricks” that support their vulval and vaginal health.
Private Care
Private healthcare involved paying to see a healthcare professional. Reasons for seeking out private healthcare included seeing a healthcare professional sooner, obtaining a second opinion, or accessing more information and support.
Ayesha accessed a private GP and felt very well supported.
Ayesha accessed a private GP and felt very well supported.
I was believed the first time and it looks like they've... I think like you as well, just dealt with so many women who have like the same problems and the same issues, and because they're so knowledgeable around it, they can identify the patterns and come to a diagnosis much quicker.
Yeah, so I have a lot of anxiety around talking to doctors and nurses, or being in those healthcare settings, because of these preconceptions of, ‘I won’t be taken seriously, I won't be listened to, or supported, so why am I here?’ So yeah, I... I... I try and... this is why I kind of work my two jobs now because the second job allows me to pay for all the private care, and I feel like I trust in that just a tiny bit more than public, because at least with the private, they're dealing with more desperate people like me, so they might have more experience and more options.
Marie was looking for a private gynaecologist due to the prolonged nature of the issue and said “I can't afford to wait now; it’s gone on too long”.
Not everyone saw private care as an option due to financial considerations. Anna thought that private care might offer more answers but was inaccessible and said “I definitely got the sense that if I was richer, I would have been able to fix it faster”.
The impacts of private care and the financial considerations of recurrent thrush were explored by the people we spoke to and you can read about that here (Finances and work).
To read more about how people interacted with their GPs, sexual health centres, and pharmacies see (Encounters with Healthcare Professionals).
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