Sounds like thrush. What causes vaginal thrush? Yeast infections affecting the vulva and vagina - vulvovaginal candidiasis - are a common cause of vaginal irritation. A particular type of yeast called Candida albicans is responsible for up to 80-92 percent of cases of vulvovaginal candidiasis. The remainder is caused by Candida glabrata. In many cases a precipitating factor for the infection is not found but several factors have been associated with the onset of vaginal yeast infections including: • Changes in hormone levels. Vaginal candidiasis is rare in those who have not yet menstruated and is less common in post-menopausal women. In many woman it is triggered by the hormonal changes that take place during the week before their periods, and during pregnancy, particularly in the third trimester. High dose oral contraceptive pills (OCP) have also been associated with vulvovaginal candidiasis. No link has been established with low dose OCPs. • Sexual activity. While not considered a sexually transmitted disease, vaginal sexual intercourse and other forms of sexual activity can transmit candida organisms. Some men whose partners have vulvovaginal candidiasis develop symptomatic yeast dermatitis (inflammation of the skin) on the penis. • Diabetes. People with diabetes are susceptible to yeast infections when their diabetes control is poorly controlled. • Antibiotics. Because antibiotics kill off friendly bacteria as well as infectious strains, they may cause an imbalance in the yeast environment, causing vulvovaginal candidiasis in some women. • Suppressed Immune System. Women with a weakened immune system (due to chemotherapy, HIV or immunosuppressive drugs) are more susceptible to vaginal yeast infections. • The use of vaginal sponges and intrauterine devices has also been associated with candidiasis in a number of cases. Studies have failed to establish an association between douching and vulvovaginal candidiasis. Similarly the use of sanitary towels or tampons have not been shown to increase the risk. Some studies claim that wearing tight clothing can also provoke an infection but this theory is unproved. What are the typical symptoms? Sometimes no symptoms are present, but normally, an infection will produce some or all of the following symptoms: • Itching of the vulva. • Thick white curd-like discharge from the vagina. • Irritation in the region of the vulva/vagina. • Burning on passing urine. • Pain during sexual intercourse (dyspareunia). Do I need to visit my doctor? If you think that you may have a vaginal yeast infection, it is important to ask your doctor to confirm the diagnosis as some of the symptoms associated with thrush can resemble other conditions, including sexually transmitted diseases such as trichomonas, chlamydia and gardnerella. Consulting your doctor will also rule out the possibility that the irritation is caused by a more serious infection such as cancer of the vagina or cervix, or by the presence of a foreign body. Your doctor will undertake a history and examination. On examination, the white curd-like discharge is visible and the vulva/vagina may look red and swollen. A sample of the discharge is taken and examined under the microscope for the presence of yeast. If you suffer from recurrent bouts of thrush and are certain of the diagnosis, there are many over-the-counter treatments available that you can buy from your local chemist without a prescription. What treatments are available? Anti-fungal medications are used to target the yeast infection. The group of drugs commonly used are known as the azoles and include imidazole, miconazole , clotrimazole and fluconazole. Over-the-counter treatments in the form of creams, pessaries, tablets, and suppositories are very effective. Treatment type is dictated by patient preference. Treatment duration varies according to the type of medication used. Fluconazole is available as a single dose tablet. Side effects are mild and include headache, rash and nausea. The oral azoles are not recommended for pregnant women. Dramatic relief after the first 24-48 hours should follow all treatment. However, be sure to follow the recommended instructions for your medication. If you are required to complete a week-long course and do not finish it, the infection will return. Topical corticosteroid cream should be avoided because it frequently exacerbates the burning sensation. Some studies have reported success in a limited number of women with recurrent infections who ate live or active yoghurt containing lactobacillus to treat the infection. However, in general there is a lack of positive studies in this area. If you are one of the small percentage of women who suffer from antibiotic induced candidiasis, your doctor may prescribe prophylactic anti-fungal therapy along with the antibiotics.