Thrush and Pregnancy

I keep on getting thrush now that I am pregnant!

Vaginal thrush (also called Candida or Monilia) is a common infection due to an overgrowth of Candida albicans yeast. This yeast lives naturally in the bowel and in some women in the vagina.

Some women have thrush in their vagina and have no symptoms and so no awareness. It is mostly harmless, but symptoms can develop if yeast numbers increase. About 75 per cent of women will have vaginal thrush in their lifetime. Thrush only needs to be treated if you are symptomatic.

Thrush can also occur in other parts of the body, such as the mouth and on the nipples.

Symptoms include:

  • Vaginal discomfort described as itching or burning
  • A thick, white discharge with a ‘cottage cheese’ appearance and yeasty smell
  • Redness or swelling of the vagina or vulva
  • Stinging or burning while urinating or during sex
  • Splits in the genital skin.

The diagnosis can be confirmed by me or you local doctor with a vaginal examination. This will usually include a swab taken for microbiology studies

Thrush is more common in pregnancy because of higher oestrogen levels in pregnancy. I have had some women who know they are pregnant because they suddenly get vaginal thrush.

Other triggers relevant when not pregnant and some when pregnant are antibiotic use (altering the normal bacterial flora in the vagina), oral contraceptive use (not in pregnancy), diabetes, menstrual cycle changes (not in pregnancy), diabetes, iron deficiency and immune system disorders, associated vulval skin conditions. Sometimes, the reason for Candida overgrowth is not known..

What can be done about it?

Vaginal antifungal creams and pessaries are now available over the counter in pharmacies. This makes them easy to purchase and implies their safety for use in pregnancy. Treatment aims to reduce the number of yeasts so they no longer cause symptoms.

Some pharmacists will give misinformation and say apply to the outside vulvae only in pregnancy. They are worried that vaginal application could result in bleeding and in some way they will be help responsible. But considering the major infection site is in the vagina, treating the vulval alone will not work. You need to also treat the vagina including high in the vagina. There is no logical reason why vaginal treatment of thrush will cause you to miscarry and to my knowledge this has never been reported.Canestan1 (1)

My favourite vaginal thrush treatment is Canestan Once Pessary + Cream.  It is a single high dose Canestan pessary that you insert high in the vagina and cream that you apply to the outside two to three times per day.

Recurrent thrush is a challenge

Because of the high pregnancy oestrogen level being the trigger it is very hard to prevent thrush from recurring. Some pregnant women have to treated treat themselves many times in pregnancy but with the assurance that it should come to an end after delivery.

Extra steps that may help if you recurrent thrush 

  • Wipe your bottom from front to back after going to the toilet. This will prevent the spread
  • Avoid using soap to wash the genital area. Soap substitutes can be used.
  • Avoid perfumed products.
  • Avoid using antiseptics, douches or perfumed sprays in the genital area.
  • Avoid using perfumed toilet papers.
  • Avoid synthetic (eg nylon) underwear and tight-fitting pants such as jeans. I have had patients who resort to no underwear and wearing a skirt to get relief.
  • Get your husband /partner to be treated in case he is reinfecting you with sex.
  • Consider changing your clothes-washing detergent and don’t use fabric softeners.

When baby comes

You should recover but thrush in your vagina or on your nipples can be spread to your baby’s mouth. So be very careful wash your hands well before handing baby and if the thrush is on your nipples treat your nipples and areola.

 

Posted by Dr Gary Sykes on -

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