Written by Ada’s Medical Knowledge Team
What is candida vulvovaginitis (vaginal thrush)?
Candida vulvovaginitis, also known as vaginal thrush, vaginal yeast infection and vaginal candidiasis, is a common infection of the vulva and vagina. The condition occurs when Candida, a naturally occurring fungus, overgrows and causes symptoms such as vaginal itchiness and irritation, pain during sexual intercouse and vaginal discharge.
An estimated 75 percent of women will experience vaginal thrush in their lifetime, with a further 40-45 percent experiencing recurrent episodes. Most often, the condition is caused by changes in the environment of the vagina and gastrointestinal tract, which may be triggered by factors such as the use of certain medications or contraceptive devices, pregnancy and conditions including diabetes and HIV.
Vaginal thrush can be unpleasant and cause significant distress, but can often be effectively managed with treatment. This will usually involve the use of antifungal medications or skin creams.
Candida vulvovaginitis symptoms
- An itching and/or burning sensation around the vulva and vaginal opening
- Pain during sexual intercourse
- Pain when urinating
- Soreness, redness and swelling of the vulva
- Vaginal discharge, which can range from watery to thick and chunky
Women experiencing the condition may not develop all of these symptoms and they can vary in their severity from case to case. Those experiencing possible symptoms can use the free Ada app to carry out a symptom assessment.
Causes of candida vulvovaginitis
Candida is a naturally occurring group of fungi found in the gastrointestinal tract and, less often, the vagina, mouth and on the skin. Normally, Candida is present in small amounts and causes no symptoms.
Thrush occurs when the balance of microorganisms and, consequently, the pH levels in the vagina, are disrupted and Candida multiplies, causing the symptoms described above. This overgrowth of Candida is typically triggered by changes in the environment of the gastrointestinal tract and vagina.
Changes in the environment of the gastrointestinal tract and vagina can occur as a result of a variety of factors, including:
Antibiotics: Typically, antibiotics work by killing bacteria, including those present in the vagina. This can upset the balance of bacteria in the vagina and cause an overgrowth of Candida.
Contraceptives: The use of hormonal contraceptives containing estrogen, including the birth control pill, can make candida vulvovaginitis more likely. This is also true of contraceptive devices, such as vaginal sponges, diaphragms and IUDs, though not typically the use of spermicides.
Pregnancy: Being pregnant can make candida vulvovaginitis more likely. Treating the condition in pregnant people requires a different approach to what is usual, but poses little risk to the baby. Read more about infections during pregnancy »
Weakened immune system: People with a weakened immune system are more likely to develop candida vulvovaginitis. A weakened immune system can occur as a result of conditions such as HIV, as well as the use of medications, including those associated with chemotherapy, steroids and those often prescribed following an organ transplant.
Diabetes: People with diabetes stand a higher chance of developing candida vulvovaginitis, especially if it is poorly managed. Read more about Diabetes »
Sexual activity: Candida vulvovaginitis is more likely in women who are sexually active. The condition is not a sexually transmitted infection (STI), but can, in some cases, be passed on to sexual partners of both sexes.
Age:Candida vulvovaginitis is more likely in post-pubescent and premenopausal women.
Diagnosing candida vulvovaginitis
Women experiencing any possible symptoms of vaginal thrush should consult a doctor for evaluation. The symptoms of the condition are similar to those of a number of others, including bacterial vaginosis, dermatitis and trichomonas vulvovaginitis, making proper diagnosis an important step towards receiving effective treatment.
In addition to visiting a doctor, the free Ada app can be used to carry out a symptom assessment.
A diagnosis can usually be confirmed following an examination by a doctor. The affected person may also be asked about their medical history and whether they have had the condition before.
Diagnosing recurrent or persistent infections
Vaginal thrush becomes recurrent if it is experienced four or more time per year. Roughly five to eight percent of women will develop the recurrent form of the condition.
As with women experiencing symptoms for the first time, when symptoms occur, women who have already had the condition should consult a doctor, when symptoms occur, rather than attempting to self-diagnose. According to one study, only 11 percent of people who self-diagnose candida vulvovaginitis do so accurately.
In addition to an examination and a discussion of the affected person’s medical history, those experiencing recurrent bouts of candida vulvovaginitis are likely to have a swab sample taken from their vagina. Recurrent episodes may be due to the presence of a less common type of the Candida fungus, one that is resistant to the types of medication that are typically prescribed. By examining the vaginal discharge in a lab, doctors will be able to identify whether or not this is the case.
Treatment will typically involve the use of antifungal medication, which will usually take the form of an oral tablet and/or topical skin cream.
Following treatment, most cases of thrush will resolve in a few days. If symptoms do not disappear in this timeframe, a doctor should be consulted.
Two of the most commonly prescribed antifungal tablets are:
Itraconazole is typically reserved for severe cases and is generally only available with a prescription from a doctor. 
Possible side-effects include:
Topical skin creams
Although oral medication can be more convenient, women affected by soreness or itchiness around the vagina may find that antifungal skin creams provide more immediate relief.
Over-the-counter and prescription varieties are available, with most requiring only a single dose to relieve symptoms. This is usually carried out using an applicator in order to allow the cream to reach the inside of the vagina, although some may also wish to apply a small amount to the skin surrounding the vagina.
Side-effects, including skin irritation and itchiness, are possible but uncommon.
Good to know: Antifungal skin creams can weaken condoms and diaphragms. For around five days after their use, sexual activity should be abstained from or an alternative contraceptive method found.
Treatment for recurrent infections
Recurrent infections are usually treated using the same methods as a single bout, but for longer periods of time. For skin creams, this is usually around two weeks, though the doctor will advise on exactly how long to continue use.
After this period, a method known as maintenance treatment may be employed. This involves taking one dose of the tablet or skin cream every week, usually for around six months. For most women, maintenance treatment is effective in preventing candida vulvovaginitis recurring.
Treatment during pregnancy
Pregnant women should always consult a doctor before beginning treatment for vaginal thrush during pregnancy. Common medications used to treat the condition, including fluconazole, are not appropriate for use during pregnancy. Instead, a doctor will prescribe a pregnancy-appropriate antifungal medication.
Vaginal thrush is common in pregnant women due to the bodily changes pregnancy triggers. It should not be considered cause for serious alarm.
Treatment for sexual partners
Although there is a small chance of passing candida vulvovaginitis to a sexual partner, the condition is not a sexually transmitted infection and does not usually require the sexual partners of affected people to seek treatment.
There are a number of practices and habits that are thought to help prevent vaginal thrush. It should be noted, however, that these practices are not medically proven to be effective and may only be useful in some cases.
Preventive methods include:
- Maintaining good hygiene: Washing the vagina with scented soaps, spermicides and other, similar products may help to alter the environmental conditions of the vagina, in turn helping Candida to thrive. Some women may find it beneficial, therefore, to wash using only water and unscented soaps.
- Wearing loose clothing: Some women may find that wearing loose-fitting, airy clothing around their lower body is beneficial in helping to prevent candida vulvovaginitis. It is thought that the warm and moist conditions created by tight clothing can help Candida to grow.
- Avoiding friction during sexual activity: While candida vulvovaginitis is not a sexually transmitted infection, it is thought that friction during sexual intercourse can make it more likely. Consequently, ensuring that the vagina is well lubricated may help to prevent the condition.
Q: Is candida vulvovaginitis contagious?
A: In the majority of cases, candida vulvovaginitis is not contagious. However, in rare instances, the infection can be transferred between sexual partners, both male and female.
Q: Is candida vulvovaginitis a sexually transmitted infection (STI)?
A: No, candida vulvovaginitis is not classed as a sexually transmitted infection. This is despite the fact that, in rare cases, the infection can be passed between sexual partners. It is generally not necessary for the sexual partners of people with the condition to receive treatment themselves.
Q: Can men get candida vulvovaginitis?
A: Yes, men can contract the same infection as that involved in candida vulvovaginitis, although in cases such as these, the condition is referred to as thrush in men, or male candidiasis. This is rare, but usually the result of having unprotected sexual intercourse with a person already affected by the condition.
Symptoms of thrush in men include:
- A burning sensation, redness and irritation around the head of the penis and behind the foreskin
- Discharge from the penis, which is usually white with a thick or chunky texture
- A bad smell from the penis
Men experiencing possible symptoms of thrush should see a doctor for evaluation. In addition, the free Ada app can be used to carry out a symptom assessment.
Other names for candida vulvovaginitis
- Vaginal thrush
- Candida vaginitis
- Vaginal yeast infection
- Vulvovaginal yeast infection
- Vulval candidiasis
NCBI. “Over-the-counter antifungal drug misuse associated with patient-diagnosed vulvovaginal candidiasis.” March, 2002. Accessed December 6, 2018. ↩