Vaginal fungus

and Martina Feichter, medical editor and biologist and Florian Tiefenböck, doctor Updated on

Sophie Matzik is a freelance writer for the medical team.

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Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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Florian Tiefenböck studied human medicine at the LMU Munich. In March 2014, he joined as a student and has supported the editorial team with medical articles ever since.After receiving his medical license and practical work in internal medicine at the University Hospital Augsburg, he has been a permanent member of the team since December 2019 and, among other things, ensures the medical quality of the tools.

More posts by Florian Tiefenböck All content is checked by medical journalists.

In the case of vaginal fungus (vaginal mycosis, thrush colpitis), fungi, usually yeast, attack the vagina. They are the second most common cause of vaginal infections. Typical symptoms are vaginal itching and burning and a crumbly discharge. The vaginal fungal infection is usually treated with drugs that are specifically effective against fungi (antimycotics). Read everything you need to know about the causes and symptoms of vaginal thrush, diagnosis, treatment and prognosis!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B37

Brief overview

What is vaginal thrush? Infection of the vagina with fungi (mostly yeasts, especially Candida albicans), often the pubic area, the vulva, is also affected (vulvovaginal mycosis). It is estimated that three out of four women will get vaginal thrush at least once in their lives. Infection is possible at any age.
Frequent symptoms: itching, burning sensation in the vagina and pubic area, redness, increased, whitish-crumbly discharge, possibly pain during sex; with additional involvement of the urethra, pain when urinating.
Treatment: Antifungal agents (antimycotics), mostly applied externally (cream, vaginal suppositories, etc.), especially in severe cases internally (tablets). Antiseptics can also help.
Vaginal thrush in pregnant women: There is an increased risk of premature birth. During vaginal birth, the fungi can pass onto the newborn.
Prognosis: vaginal thrush is usually harmless, but very uncomfortable and sometimes persistent. If the immune system is severely weakened, the fungus can possibly spread in the body and attack internal organs.

Vaginal fungus: symptoms

The most important symptoms of vaginal thrush are severe itching and a burning sensation in the area of the vagina and usually also in the pubic area (vulva). Itching is usually the first sign of vaginal thrush. It often occurs long before other symptoms appear. The symptoms usually worsen before menstruation.

Increased, crumbly, whitish discharge is another sign of vaginal thrush. Like healthy vaginal discharge, it is odorless. Possible symptoms of vaginal thrush are pain during sexual intercourse (dyspareunia). If the vaginal mycosis has spread to the urethra, pain when urinating (dysuria) is often added.

Important: Complaints such as itching, burning and redness in the vagina do not always have to be a sign of vaginal thrush. Other pathogens can cause symptoms like this too. These include above all bacteria (including bacterial vaginosis with a fish-like, foul-smelling discharge), but also parasites such as trichomonads. Only about 35 to 40 percent of women with vaginal itching actually have vaginal thrush.

Only a medical examination can clarify what or which pathogens are causing the symptoms. Therefore, consult a doctor, especially if the problems persist, worsen, recur, or there are special circumstances such as pregnancy.

What does vaginal thrush look like?

The vagina and pubic area can be swollen with vaginal thrush. Often (but not always) there is also gray-whitish deposits on the mucous membrane at the vaginal entrance and in the vagina. These deposits can be wiped off. An inflamed, reddened mucous membrane can be seen underneath.

A woman's genital fungal infection can also cause small nodules to form on the surface of the skin in the genital area.

This happens with vaginal thrush

If the vaginal flora is out of balance, fungi can spread in the vagina.

Vaginal fungus: treatment

Fungal infections can be treated with drugs that are specifically effective against fungi - so-called antimycotics. The current medical guidelines also recommend such antifungal agents for vaginal thrush treatment. Antiseptics can also help.

Active ingredients against vaginal thrush are available in different dosage forms. The therapy takes place either locally in the affected area (e.g. using creams or suppositories) or using tablets that can be swallowed (systemic treatment).

It is best to talk to your doctor before treating a suspected vaginal thrush on your own. The majority of the symptoms are caused by other causes.

In one study, for example, only one in three women who bought antifungal medicines for self-treatment actually had vaginal thrush. Apart from that, wrong and / or unnecessary therapies carry the risk that the germs become more resistant (develop resistances). This can make necessary treatments more difficult in the future.

Vaginal fungus treatment with antifungal drugs

If the vaginal thrush appears for the first time, antimycotics, which are applied to the site of infection (local treatment), usually help. They usually contain active ingredients from the group of imidazoles (e.g. clotrimazole, econazole, miconazole), polyenes (including nystatin) or ciclopiroxolamine. Some preparations are available from pharmacies without a prescription.

Combination packs are often offered, consisting of an antifungal cream for use in the external pubic area and vaginal suppositories or vaginal tablets that are inserted into the vagina. But there are also products that only contain an antifungal cream and an applicator that can be used to insert the cream into the vagina. The duration of treatment depends on the respective preparation.

If your symptoms have not improved after the first few days, consult a doctor (again). It may not be (just) a fungal infection.

If local vaginal thrush treatment does not help, or if the infection keeps coming back or flares up repeatedly, internal use of antimycotics in tablet form is usually necessary (systemic treatment). These drugs contain triazoles (such as fluconazole) and are prescribed by your doctor.

The doctor can also prescribe antimycotic tablets for the first vaginal fungus, if this is particularly pronounced and / or those affected so wish. Tablet therapy is usually as effective as topical treatment.

In the case of constantly recurring, chronic vaginal thrush, an antifungal treatment over several months may also be useful (suppression therapy). Those affected take the tablets according to a set schedule (e.g. three in the first week, then once a week and finally less and less). In the meantime, the doctor will check the symptoms and the fungal attack at regular intervals.

Fungus treatment with antiseptics

Vaginal fungus can also be treated with so-called antiseptics. These are agents that act comparatively quickly and unspecifically against various germs (especially bacteria and fungi, and thus potentially with mixed infections) - but also against those that naturally colonize the vaginal mucous membrane (vaginal flora).

The antiseptic agents against vaginal thrush are used locally as an ointment, solution or suppository. Tried and tested antiseptics contain dequalinium chloride, octenidine or povidone iodine. They are also considered an alternative if the yeasts are no longer sensitive, i.e. resistant, to certain antifungal agents.

Povidone iodine must not be used in thyroid disorders. In this case, the iodine contained can cause complications! The same applies to pregnant women.

Pregnancy: what to do about vaginal thrush

In the case of vaginal thrush during pregnancy, experts recommend locally applied antimycotics from the imidazole group - especially clotrimazole or miconazole. They are very effective, well tolerated and safe for the child throughout pregnancy.

The antiseptics dequalinium chloride and octenidine mentioned in the medical guidelines can (to a limited extent) also be used in pregnant women. However, povidone iodine is not suitable because the iodine it contains can disrupt the thyroid function of the unborn child.

Oral antimycotics (tablets) must not be taken during pregnancy or only if the doctor deems it absolutely necessary. They can cause malformations in the child if taken in the first few months of pregnancy.

Why treatment is so important during pregnancy

Doctors generally treat vaginal thrush during pregnancy - even if the fungi do not (yet) cause any symptoms, but only colonize the vagina. The reasons:

On the one hand, the yeasts can promote premature birth. On the other hand, the pathogens are very likely to pass to the child during vaginal birth. There they usually attack the oral mucosa and the genital area ("diaper rash") in the first few months of life.

Medicinal yeast infections are therefore particularly important in pregnant women in the last four to six weeks before the due date. It is important to rid the birth canal of all fungi in good time.

Always talk to your doctor in charge if you are pregnant and develop vaginal symptoms. Only he can determine the exact cause and discuss the appropriate treatment with you.

Co-treatment of the partner

Vaginal fungus is contagious. It can be transmitted through direct physical contact between two people, but also through contaminated objects. So, if you have a vaginal yeast infection, the fungus may have come from your partner. Conversely, this can infect you and also develop a fungal disease (e.g. penis fungus).

However, it is not absolutely necessary to treat a symptom-free sexual partner solely because of a vaginal thrush. Studies have so far not shown any clear advantages if the partner is also treated. Not even if it is also colonized with a fungus, but is symptom-free. Yeast fungi are - in small numbers - part of a man's healthy skin flora.

To what extent this colonization favors relapses of vaginal thrush has not been clarified with certainty. In certain risk situations, for example with a weak immune system, testing for fungi and appropriate therapy in the sexual partner can be useful.

Treat penile fungus

If the sexual partner has developed penile fungus, it must be treated. This fungal infection usually first becomes noticeable through reddening of the foreskin and the glans. The tissue swells within a few days. Itching, burning and pain are added.

In the event of such complaints or in case of doubt, it makes sense for a man to also be examined and, if necessary, treated. As with vaginal thrush, antimycotics are available for this, possibly in combination with cortisone or antiseptics.

You can read everything you need to know about fungal infections in the male genital area in the article penile fungus.

Home remedies for vaginal thrush

Various home remedies for vaginal thrush are often touted in the media as well as in family and friends. Even if many women are convinced of their effectiveness: Many home remedies tend to damage the vaginal flora and do not help at all against vaginal thrush.

Home remedies most commonly recommended for vaginal thrush treatment include yogurt, vinegar, and garlic. They should be applied to the outer pubic area or inserted into the vagina and thus kill the fungi.

Instead, vinegar, garlic and other pungent substances disrupt the vaginal environment and possibly make it even easier for fungi and other pathogens to multiply.

Some experts also advise against tampons soaked in yogurt, for example. Natural or probiotic yogurt introduced vaginally is considered to be soothing for vaginal problems. However, this method has not been adequately tested. In addition, the bacteria contained in yoghurt differ in their composition and do not correspond to the natural vaginal environment. Last but not least, the dairy products could be contaminated with fungi.

Alternative medicine for vaginal thrush

There are a number of other therapeutic options for vulvovaginal candidiasis. They can work, but they have hardly been scientifically proven. Examples:

Boric acid suppositories can accelerate healing and are considered a therapeutic option for vaginal thrush caused by Candida glabrata. However, they have no official approval for vaginal thrush (off-label use) and are not used as part of the initial treatment. They can also disrupt fertility and damage the unborn child in the womb.
Propolis ("bee putty resin") has anti-inflammatory and antiseptic properties, among other things. There have been positive reports as a remedy for vaginal thrush caused by the fungus Candida albicans. But it carries the risk of contact allergies.
Salvia officinalis ("real sage") is said to have an antifungal effect with its essential oils. As a vaginal tablet, it has been shown to successfully relieve vaginal thrush, either alone or with clotrimazole, in a small study.

The medical guidelines name these alternative means, but emphasize that the scientific data are very limited. It is not a therapy recommendation.

Other tips for vaginal thrush

It is best to keep the following tips in mind during a yeast infection:

Because vaginal thrush is contagious, you should avoid sexual intercourse while it is infected. Condoms can also be useful in the first time after the treatment (the vaginal mucosa is then in regeneration).
Note: Antifungal agents applied for treatment may compromise the safety of latex condoms or rubber diaphragms.
To prevent the fungal infection from spreading, ideally only use lukewarm water in the genital area and, in particular, regularly lubricate dry skin.
Wear air-permeable underwear so that no warm and humid environment develops in the vaginal area - such conditions are ideal for fungal growth.
Shorten your pubic hair. A pronounced pubic hair favors a moist and warm environment.
Do not share your towel with others.
Change your laundry and towels every day and wash them at 60 degrees with a heavy-duty detergent.

A sugar-free diet is often recommended to "starve out" vaginal thrush. So far, however, it has not been proven that this actually works.

Vaginal fungus: causes and risk factors

If the balance of the healthy vaginal flora is out of balance, yeast fungi, for example, have the chance to spread - vaginal fungus develops. About 85 to 95 percent of all acute vaginal fungal infections are caused by the yeast Candida albicans. For the remaining cases, for example, Candida glabrata or Candida tropicalis are responsible.

You can get infected with the mushrooms during sexual intercourse, for example. Frequent and unprotected sex carries a particular risk. In other cases, the germ comes from the intestine and reaches the vaginal mucous membrane, for example when wiping it after a bowel movement.

If the vaginal flora is disturbed, other pathogens that cause disease sometimes spread in addition to a fungus (mixed infection).

Vaginal fungus: Vulnerable to incorrect underwear

Three questions for

Dr. med. Dorothee Struck,
Specialist in Obstetrics and Gynecology
1
Who is particularly susceptible to vaginal thrush?

Dr. med. Dorothee Struck
Pill supplements can make you susceptible or an unrecognized diabetes. Tampons are also an issue: women who use a lot of tampons even though they are not bleeding profusely are at risk. The tampons suck in too much vaginal wall fluid, which the vaginal flora needs to stay healthy. Cups or, if need be, tampons that are not chlorine-bleached can help. The bacteria don't like chlorine.
2
Can the wrong underwear promote vaginal thrush?

Dr. med. Dorothee Struck
Yes, especially if it is made of synthetic fibers and is therefore not breathable. If it is still tight, the woman wear tight trousers over them, maybe a panty liner with a plastic layer and then I have a warm and humid breeding climate in the genital area. That is where the vaginal mushrooms thrive!
3
Am I contagious to others?

Dr. med. Dorothee Struck
This is not a problem: in men, the fungi usually do not adhere well to the genitals. Infections have to do with a disturbed local immune system. Normally, a fit immune system throws mushrooms out again. And: Fungi can normally be found in the vaginal flora. The infection only occurs when you multiply massively. Help your bacterial flora by washing yourself only with water and doing regular lipid care.
Dr. med. Dorothee Struck,
Specialist in Obstetrics and Gynecology
Additional qualification as a doctor for naturopathic treatment, established with her own private practice in Kiel, author of several books and blog author, offers webinars on the topic of women's health

Risk factors

Various factors can favor that colonizing yeasts multiply, infect the mucous membrane extensively and cause its inflammation:

Defensive weakness: A weakened immune system often disrupts the vaginal environment. The immune system can be based on drugs that suppress the immune system (immunosuppressants such as cortisone or cancer drugs) or on diseases (e.g. HIV or AIDS or the diabetes mellitus).

Antibiotics: Vaginal thrush from taking antibiotics is not uncommon. The agents work against bacteria, but do not differentiate between useful and harmful. This may also eliminate the lactic acid bacteria in the vagina and thus promote vaginal fungus.

hormonal changes: The female estrogens in particular affect the vaginal flora. Hormone treatments, hormonal contraceptives and treatment with antiandrogens (for example in the case of severe acne) can promote vaginal thrush. The increase in symptoms before menstruation is also due to the changed hormone levels.

Pregnancy: The hormonal changes in pregnant women cause, for example, an increased sugar content and a reduced acid content in the vagina - ideal growth conditions for mushrooms.

Inappropriate clothing: Mushrooms grow particularly well in a warm, humid environment. Skin-tight clothing and underwear made of synthetic materials can therefore promote vaginal thrush: they promote sweating and possibly cause heat to build up.

Incorrect intimate hygiene: Both excessive (frequent washing with soap or other washing substances, vaginal rinsing, etc.) and poor intimate hygiene disrupt the vaginal flora and thus promote vaginal thrush.

Stress: Mental stress can also have a negative effect on the vaginal environment and thus pave the way for infections.

Genetic factors: Certain genetic variants are considered to be risk factors for, in particular, chronic vaginal thrush. The gene mutations mainly influence the defense process.

Nutrition: Some experts also see a certain risk in certain eating habits. In particular, foods rich in sugar / carbohydrates and foods and dairy products that contain yeast can promote fungal growth.

Healthy vaginal flora

In principle, the healthy vagina is never germ-free, but rather houses a natural vaginal flora: This mainly consists of lactic acid bacteria (lactobacilli). Some other bacteria and, in very small numbers, fungi can also be part of the natural vaginal flora (sometimes temporarily).

The lactic acid bacteria convert the sugar from the vaginal cells into lactic acid. This creates an acidic environment in the vagina in which pathogenic germs can hardly multiply.

Vaginal fungus: examinations and diagnosis

If you suspect vaginal thrush, a gynecologist is the right person to contact.

anamnese

The doctor will first talk to you in detail to collect your medical history (anamnesis). Possible questions from the doctor are:

Which complaints do you have exactly?
How long have the symptoms existed?
Have you had such complaints before?
Have you already tried any therapy (for example with over-the-counter antifungal medicines from the pharmacy)?
Do you have any underlying illnesses (such as diabetes, HIV)?
Are you using any medication (antibiotics, cortisone, etc.)?

Gynecological check

After taking the medical history, a physical exam will take place. The doctor proceeds in the same way as with the regular gynecological examination. A vaginal fungal infection can often be recognized by a whitish to grayish coating on the mucous membrane. If it is carefully wiped off, an inflamed, reddened vaginal mucous membrane appears.

Detection of fungus in the microscope

To determine which pathogens are responsible for the infection, the doctor takes a swab of the vaginal lining. He then examines this under the microscope: Typical, sometimes thread-like structures (hyphae and sprout cells) indicate a fungal infection.

In addition, the doctor pays attention to changes that either speak for a different pathogen or a mixed infection.

Mushroom culture

Sometimes microscopic examination does not give a clear result. Then the germs are grown in the smear (pathogen culture): In the laboratory, the smear is placed on a suitable nutrient medium and optimal growth conditions are created for germs so that they can multiply. This makes it easier to identify them.

The doctor instigates a mushroom culture, especially in the case of chronic courses.

The laboratory can also use the mushroom culture to test whether the germ that has been grown is resistant to certain drugs. This is particularly important in the case of vaginal thrush, which is caused by rarer Candida species (i.e. not C. albicans).

Vaginal fungus: course and prognosis

With timely and consistent therapy, the prognosis for vaginal thrush is favorable. As a rule, a fungal infection does not last longer than a few days to weeks and heals without consequences.

The infection proves to be very protracted less often, for example in the case of a weakened immune system. Under certain circumstances, the vaginal fungus can even spread in the body with severe immune deficiency and attack internal organs (candida sepsis).

Infection of newborns

Candida sepsis can very rarely also occur in newborns who become infected with the fungus during "normal" birth through the vagina (vaginal birth) in the mother (especially in very early premature babies). More typical is then a fungal attack in the mouth (oral thrush) and in the genital area ("diaper rash").

This is one reason why pregnant women should always take vaginal mycosis seriously. The other is that research has shown that the fungal infection increases the risk of premature birth. This may also be the case with permanent or recurring fungal colonization.

Relapses

After a vaginal yeast infection has healed, a relapse can occur (repeatedly) if favorable factors persist, such as incorrect intimate hygiene or a weak immune system. If at least four vaginal yeast infections occur within a year, doctors speak of chronic recurrent vulvovaginal candidiasis.

As far as possible, risk factors for vaginal thrush should therefore be eliminated or reduced. Otherwise, doctors try special long-term treatments to counteract the stubborn vaginal fungus.

Vaginal fungus: prevention

If you want to prevent vaginal thrush, you should avoid or reduce known risk factors as much as possible. This means:

Avoid synthetic clothing and clothing that is very tight in the genital area and may even chafe.
Only wear underwear made from breathable materials such as cotton. This prevents a build-up of heat and moisture in the intimate area.
Do not use plastic-coated panty liners and pads. They too can cause moisture and heat to build up in the vaginal area. Perfumed sanitary towels are also unfavorable: The fragrances can irritate the sensitive mucous membrane and make it more susceptible to infections.
Tampons dry out the vaginal mucous membrane and can thus promote vaginal thrush in sensitive women. Then it can be helpful to change the tampons often or to switch to breathable pads (organic pads).
Pay attention to careful, but not excessive, intimate hygiene. Only use lukewarm water or, at most, slightly acidic products (syndets) to clean the genital region so as not to disturb the vaginal environment. Avoid using intimate sprays and vaginal douches.
When using the toilet, you should always wipe yourself from the front (vaginal entrance) to the back (anus). If you do it the other way around, fungus could get into your vagina from the intestines. According to some experts, this can then cause a yeast infection.
Thoroughly clean used sex toys.

Special probiotic preparations, which contain mainly certain lactic acid bacteria in a concentrated manner, may ensure that the vaginal mycosis does not flare up (anymore) or less often. If swallowed, they can counteract yeast fungi in the intestine, from where fungi can repeatedly get into the vagina. The scientific data on this are promising, but (still) limited.

Probiotics for swallowing (with Lactobacillus acidophilus or Lactoferrin) seem helpful, especially in chronic cases. Probiotics can also have a preventive effect during antibiotic therapy. But here too there is (still) a lack of sufficient data.

In certain cases, drug prevention against vaginal thrush can be useful. For example, a doctor may recommend preventive use of antifungal drugs at intervals (from twice a week to monthly) for women who have diabetes or are receiving immune suppressive therapy.

Additional information

Guideline:

Guideline "Vulvovaginal Candidosis" of the German, Austrian and Swiss Societies for Gynecology and Obstetrics (DGGG, OEGGG, SGGG) Status: September 2020

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