Thrush in pregnancy

How will I know if I have thrush in pregnancy?

Vaginal infections such as thrush are very common in pregnancy (FPA 2014, NICE 2016).

If you have thrush, you'll most likely notice vaginal discomfort and also changes to your vaginal discharge. It's normal to have more vaginal discharge than usual while you're pregnant, but healthy discharge should look clear or milky in colour, and shouldn't be unusually smelly or itchy.

You may have thrush if:

• You have itching, soreness or redness in or around your vagina.
• You have thick, white discharge that looks similar to cottage cheese. It's usually odourless. But if it does have a smell, it may be yeasty rather than unpleasant (FPA 2014).
• It feels sore when you have sex.
• You feel a stinging sensation or pain when you wee (FPA 2014, NHS 2017, NICE 2016).

How did I get thrush?

Thrush is caused by a microscopic yeast (fungus) called Candida albicans that we all carry on and in our bodies. It's a normal part of our digestive system, and "good" bacteria generally keep it in check. It usually lives harmlessly in the vagina, and you won't know you're carrying it (FPA 2014).

It only becomes a problem when the balance between candida and other micro-organisms in your body becomes disrupted.

You're more likely to get a yeast infection if:

• You're pregnant. Hormonal changes mean you have higher levels of the hormone oestrogen, which helps thrush thrive.
• You've had sex when your vagina was dry or tight.
• You have diabetes or gestational diabetes that isn't well controlled.
• You have a weakened immune system. This could be a result of treatment such as chemotherapy, or an infection such as HIV or AIDS.
  (NHS 2017, NICE 2016)

Although thrush isn't defined as a sexually transmitted disease, it can be triggered by having sex, particularly if you weren't fully aroused or feeling relaxed (NHS 2017, NICE 2016). It's possible, though rare, for it to be passed on during sex (FPA 2014, NICE 2016), so your partner will need treatment if he or she has symptoms, too (FPA 2014, NHS 2017, NICE 2016).

In men, symptoms are usually irritation, burning, itching and redness under the foreskin or on the tip of the penis (FPA 2014). There may also be a discharge under the foreskin. Without treatment, it's possible your partner may pass the infection back to you, even after you've had treatment.

When should I see a doctor about thrush in pregnancy?

If you think you have thrush, tell your doctor or midwife, or visit a sexual health clinic.

Your caregiver may take a look at the area around your vagina to help with the diagnosis. If she's not sure if it's thrush, she may take a vaginal swab and send it to a lab for testing (NHS 2017, NICE 2016).

How will I be treated for thrush in pregnancy?

Your doctor may prescribe antifungal pessaries and creams that are suitable for your stage of pregnancy. You'll need at least a seven-day course to clear the thrush properly (NICE 2016).

If you've been prescribed pessaries, you may prefer to gently put it in place using your hand rather than the applicator provided, as it may be gentler on your cervix (NICE 2016). Pessaries are best inserted at night, so the treatment can be absorbed while you're lying down (NICE 2016).

Thrush can be hard to clear up during pregnancy, so be sure to use the treatment for the full seven days, if that's what you've been prescribed. Go back to your doctor if your symptoms haven't cleared up in a week to two weeks (NICE 2016).

Speak to your doctor before using over-the-counter treatments (NICE 2016). They may not be suitable for use during pregnancy.

Don't take medicines that you have to swallow to treat thrush (FPA 2014, NHS 2018, NICE 2016). Doctors don’t yet know whether these are safe for pregnant women (FPA 2014).

Are there any self-help tips I can try to treat thrush in pregnancy?

To ease the irritation that thrush causes, try the following:

• When washing the area around your vagina (vulva), use an emollient wash, rather than soap (NHS 2017), and wash the area no more than once a day. Ask your pharmacist if you're not sure what to use.
• To protect your skin, use an emollient moisturiser on the skin around your vagina several times a day.
• Take showers instead of baths (NHS 2017).
• Avoid using products that may irritate your skin, such as perfumed wipes or panty liners, vaginal deodorants, douches, or perfumed shower gel, bubble bath or soap (NHS 2017, NICE 2016). Vaginal douching is likely to make things worse, not better (NICE 2016).
• Try probiotics. Eating live yoghurt may help your symptoms improve alongside treatment because the probiotics in yoghurt help "good" bacteria thrive (NICE 2016). Some women use live yoghurt as an ointment for their vaginas, too (FPA 2014).
• Wear cotton or silk underwear that's not too tight-fitting, and avoid wearing tights and stockings (NHS 2017).
• Use lubrication during sex, to make it more comfortable and to relieve any symptoms of pain or tightness (FPA 2014).

To help prevent your thrush spreading and getting worse, always wipe your bottom from front to back after you've been to the toilet (FPA 2014).

Read more about natural remedies for thrush.

Will thrush affect my baby?

No. You may find that thrush comes and goes while you're pregnant (NICE 2016). It may be a nuisance, and take a while to clear up. But your baby is safely sealed inside your uterus (womb) and won't be affected by you having thrush (FPA 2014, NCCWCH 2008).

If you happen to have thrush when your baby is born, he may catch it during the delivery (NHS 2018). But it's nothing to worry about and he'll be given an oral antifungal treatment to clear it up. A baby with thrush will often have white patches in his mouth.

If you're breastfeeding, both you and your baby may need treatment, because thrush can spread to your breasts (Harding 2017, NCCPC 2006).

Babies can also get thrush in their nappy area and in their nail folds (Harding 2017). Again though, it's nothing to worry about and can be easily treated.

Not sure whether your symptoms are thrush or something else? Find out more about vaginal discharge in pregnancy.