Thrush in pregnancy

Of all the minor complications of pregnancy, vaginal thrush has to be one of the most common. In fact, most women have had at least one episode of vaginal thrush in their lives long before they are pregnant. Thrush is also known by its other names – vaginal candidiasis or moniliasis. It is more common during pregnancy than in any other time. But be reassured, there is no evidence that thrush in pregnancy is harmful to the developing baby.

The surge of hormones, alterations in the vaginal Ph, change in diet and general metabolic changes during pregnancy mean that thrush is experienced by more women. Most women are pretty familiar with the symptoms of vaginal thrush. At the first symptom they are able to recognise it and are keen to seek treatment so that it can go away. Thrush isn’t so much painful as very irritating. 

Women who have thrush 4 or more times in a year are said to have recurrent thrush. Alternative treatment options may be necessary if, during your pregnancy, you find it does not clear up with conventional treatment. 

What causes vaginal thrush?

• A yeast organism is responsible for causing thrush; this is known as Candida Albicans. Candida is a simple, one-celled organism, which is easy to get and not so easy to clear up. Most women have thrush cells known as Candida ssp lying dormant on their skin and within their vagina. These are kept in check by “good” bacteria. If the conditions are right, such as being run down, being pregnant or taking antibiotics, this can cause the healthy numbers of Candida cells to multiply and develop into a full blown thrush infection.
• Once you’ve had a thrush infection, it can lie dormant in your body, just waiting for the right conditions to flare up again. During pregnancy, the Ph of the vagina becomes more alkaline and less acidic. Essentially, it becomes more sugary and the glycogen in the vaginal cells becomes a food source for the yeast. This is why women who have uncontrolled diabetes tend to have more thrush infections.
• An increased vaginal discharge often occurs during pregnancy, leading to a permanently moist environment. Thrush thrives in warm, moist conditions and the vagina is a perfect environment for it to multiply. Hormonal changes during pregnancy, in particular a high level of oestrogen, also contribute.
• Women who have a weakened immune system, who are taking steroid medication or having chemotherapy can also be at a greater risk of getting vaginal thrush. 

What are the symptoms of vaginal thrush?

• A white vaginal discharge with a cottage cheese-like consistency
• Intense vaginal itching, which makes it hard to concentrate on anything else
• Vaginal soreness and irritation
• Pain, scalding and burning when peeing, especially if there is swelling of the vaginal tissues and labia 

Will thrush harm my baby?

There is no evidence suggesting that thrush will harm an unborn baby. But if a mother has thrush when she gives birth, the baby can get it as well. Babies who develop thrush have white plaques or patches in their mouth and sometimes a diaper rash. They can also contract thrush if they are breastfeeding and their mother has thrush on her nipples.

Thrush does not migrate up into the womb and it is generally restricted to the vaginal and surrounding tissues. 

What can I do to treat vaginal thrush?

The first thing to do is to have it correctly diagnosed. If you are one of the lucky few who’ve never had vaginal thrush before and the symptoms are unfamiliar to you, then it’s important you have a correct diagnosis from your healthcare professional. If you are familiar with the symptoms, then a chat with your pharmacist is necessary. 

There are a range of thrush specific treatments; including pessaries, creams and ointments. They all contain an anti-fungal component as their active ingredient. If you have been on a course of treatment and have not improved, then it may be time to change to another treatment option which contains a different active compound.

Some women find they are combating vaginal thrush all the time. In these cases oral treatment with medication, rather than topical creams can make a real difference. Tablets help to rid the body of the yeast organism via the gut and can be very effective. However, oral treatment for thrush is not recommended during pregnancy, which means the treatment of choice is generally pessaries/cream or a combination of both. 

Remember

Recurrent thrush can be caused by reinfection from the bowel. This is why it’s so important to be very careful about using toilet paper correctly. 

If you have vaginal thrush:

• Wipe from the front to the back
• Wash and dry your hands very carefully after going to the bathroom
• Don’t use cheap or harsh toilet paper; this just adds to the irritation
• If it really stings when you are weeing, then pour warm water over your vulva at the same time – this helps to neutralise the acidity of the urine
• To help minimise the burning sensation, fill a small bath with warm water and sit in this to wee
• Drink plenty of water which will help to dilute your urine and reduce burning and scalding when you wee

Tips for combating vaginal thrush:

• Only wear cotton underpants. Read the fabric label and avoid wearing any pants that include nylon, polyester, modal, bamboo or Lycra.
• Be diligent about how you launder your underwear. Hot water, detergent and double rinsing can be beneficial. Avoid using the dryer and rather hang underwear in the sunlight. A final rinse with an anti-fungal fabric conditioner can be helpful.
• Wear your “big” undies; tight underpants don’t allow for adequate air flow, which is really helpful for getting rid of thrush.
• Avoid wearing tight jeans, leggings, tights and pantyhose. Air ventilation helps to clear thrush infections.
• Speak with your doctor about whether your partner needs to be treated. Men can be asymptomatic but still have thrush. Thrush can flare up again after intercourse because of reinfection.
• Aim to keep your vaginal and vulval area cool and don’t become overheated until the thrush has cleared.
• Avoid eating too much bread and bread products. Yeast in foods can contribute to systemic yeast problems.
• Limit your intake of processed foods and sugar. These can contribute to thrush infections.
• Only take antibiotics if they are absolutely necessary. Ask your prescribing doctor if there is an option of taking an antibiotic that is less likely to increase your chances of getting thrush.
• Shower at least twice a day, change your underwear twice a day and your towels every couple of days.
• Avoid using any harsh soaps or body washes, bubble baths, and scrubs in your vaginal area, especially those containing strong perfumes.
• Eat some natural yoghurt every day, and look for one which contains natural acidophilus and bifidus cultures.
• Avoid having sex until the thrush has cleared up. Although there’s no real danger to you, your baby or your partner, sex will cause more skin and mucousal irritation and your partner is at risk of getting it as well.
• You may find it soothing to dissolve some bicarbonate of soda or vinegar in the bath water and sit in this for a soak. 

Treatment for vaginal thrush:

• Pessaries – these are compressed, oval shaped tablets which contain a concentrated dose of anti-fungal agent. They usually come with an applicator so they can be inserted high into the vagina. They come in either a one or six course pack. During pregnancy, the 6 day/night pack is usually recommended.
• Vaginal creams that come with an applicator. The cream is inserted high into the vagina, most commonly at night so the active ingredient is in longer contact with the mucousal surface.
• An external skin cream which contains the same ingredients as the vaginal cream, but in a different concentration. Using this on its own will not treat the vaginal thrush.

Note: You may find that wearing a panty liner when you’re having treatment for thrush is helpful to avoid underwear staining. 

When would my partner need to be treated for thrush?

If he develops any itching, redness, swelling or irritation on his penis or the surrounding skin, then he may have thrush as well. The current recommendation is that male partners do not require treatment unless they are showing symptoms. The treatment is essentially the same; anti fungal creams and ointments. 

Will having thrush mean I can’t get pregnant?

No, thrush does not affect fertility or increase your chances of having pregnancy complications. It is limited to the mucousal areas of the vagina and the surrounding skin.

Remember

Having vaginal thrush is not a sign of poor hygiene or being unclean. It is an incredibly common condition, which, once recognised, is easily treated and managed. Speak with your health care professional and/or pharmacist about treatments.