I had my first yeast infection at the age of 17. I’d been to a summer music festival in my kicky “boho” jeans and home-made Beastie Boys tank, sweat a lot in the pit, and awoke the next morning to find a discharge the consistency of cottage cheese tumbling from within my vagina.
My reaction was a mixture of mild concern (“I guess that’s the ‘cottage cheese discharge’ I’ve read about in Everywoman, huh …”) and, perhaps more alarmingly, a sense of abject fascination at the Cronenbergian nature of the human body (“…COOL!!”).
My mother’s reaction was altogether a more reasonable one, which was to whisk me off to the chemist to pick up what was then the best defense: six days’ worth of Clotrimazole antifungal vaginal pessaries (weird squishy single-dose egg-shaped things/creams/applicators/wipes/tablets). I would spend the next week with the telltale “sand in the pants” sensation that anyone who has run a course of six-day pessaries will be intimately familiar with.
That was in 2001, and it was my first step on a tortuous journey towards self-acceptance: acceptance, that is, of the fact I am one of those members of the population doomed to a lifetime shared with a colony of angry yeasts.
Within a few years I had lost track of the number of times I’d had thrush — or, at least, symptoms that seemed to suggest recurrent thrush. After all, the phrase “chronic thrush: is thrown about in the same way we might say we have “the flu” when it’s really just a bad cold, or “gastro” after a brief spell with the shits and a sole, cathartic spew at 2a.m.. Complicating matters further is the fact that self-diagnosed “chronic thrush” can actually be something else (bacterial vaginosis, for example).
In reality, actual chronic thrush — less colloquially, Recurrent Vulvovaginal Candidiasis, or RVVC for those of us who like to pretend we’re in a cool club — is, generally, “four or more culture-proven vulvo-vaginal candidiasis episodes per year.” Definitive stats about RVVC are hard to come by —perhaps because it’s not generally thought of as debilitating. (More than one doctor I visited suggested that chronic pain and discharge, vaginally, wasn’t going to prevent me from going about my life. AU CONTRAIRE, DOCTOR!) This paper from 2001 — that magical year in my history of thrush — suggests that “an estimated 75 percent of all women will develop a yeast infection during their lifetime; 90 percent of these infections are caused by Candida albicans. Further estimates indicate that 5 percent of women with vulvovaginal candidiasis may develop RVVC.”
Alas, as I was not in the business of reading medical studies, I did not know this. And it turned out that all this time, the hint that RVVC existed was buried in the consumer advice leaflet that I had, having used the full spectrum of thrush treatments umpteen times by this point, thrown out each time I tore open a new box of pessaries. The leaflet read: “See your doctor if you have had 3 or more infections in the last 6 months.” So, last December, fourteen years after that yeasty festival, I visited my local sexual health clinic. Gripped by unbearable pain (imagine, perhaps, what the aftermath of having had sex with a sanding-block might feel like) and convinced I must have a sexually transmitted infection, I flopped down on the chair in tears. “Is it herpes?” I moaned.
Instead, I was capably informed, I had RVVC. What nobody told me — nor, I’m guessing, you — is that when candidiasis becomes chronic, the symptoms change. Gone was the cottage cheese discharge and itching, and in their place was a dermatitis-like response that featured, as my doctor kindly if terrifyingly explained, “Hundreds of tiny cuts on the vaginal walls.”
This would explain why the apple cider vinegar douche I had tried a week earlier at the suggestion of a friend, desperate for relief, felt like I had used acid to put out a fire that had sparked in my vagina. The enlightenment continued: the doctor told me that many of the home remedies recommended for thrush were, in fact, causative. You see, one thing you’ll learn if you’ve had thrush more than once is that everybody has their favorite home remedy, and they’ll all insist it will “cure” you: borax suppositories, apple cider vinegar, garlic cloves inserted with a tampon applicator, peroxide mixed with acidophilus powder, etc. Forget “extreme sports,” extreme thrush treatment is real and it’s out there.
I’ve tried the garlic clove suppository and, fun fact, did you know that housing your garlic supply in your vagina gives you garlic breath? As soon as I found that out I considered wrapping strips of Extra around my tampons. I’ve peeled a spear of aloe vera and gotten intimate with it. I’ve tried my best to insert natural Greek yogurt into my vagina, which is, I can assure you, quite a lot of “fun.” And of course there was that apple cider vinegar douche. I don’t recommend any of them.
Listen, I’m as hippie as the next person: I have a collection of crystals I have been known to chat to, I’ve saged a room, I know which essential oils will make my headache go away and which will zap a pimple. It’s true that a bit of plain yogurt or a bath with tea-tree oil in it might do away with a single, passing case of thrush. But in the case of my medically-recognised, 5 percent to 8 eight-of-the-population-only vagina of fire, I have been more than happy to step up to the big-pharma trough. And it turns out the “cure” is simple (and rather less messy): to keep my symptoms in check, I take a 200mg Fluconazole oral tablet twice a week, and mix a silicon base antifungal cream (the silicone base is less irritating than the preservatives in standard Clotrimazole creams) with a steroidal ointment for any external flare-ups. I have been doing that for the past seven months and aside from the occasional hint of an itch, my RVVC is under control.
It turns out my yeasts are particularly tenacious. My doctor advised me that while some RVVC sufferers have to take multiple (and higher) doses of the oral treatment, many recover with a weekly single dose at over-the-counter strengths. A study published in 2002 reflects this, with the ‘first response’ treatment for RVVC — 150mg Fluconazole taken orally, weekly, which was my initial prescription — with 90.8 percent of patients given the Fluconazole being cured of flare-ups after six months of treatment.
(It goes without saying that this is not a recommendation for self-diagnosis or self-treatment. As the 2001 RVVC paper notes very clearly, one study found that, of women who thought they had RVVC and were evaluated by specialists, “only 28 percent were diagnosed with RVVC. They were, therefore, using these medications inappropriately and, in at least the 15 percent of women in the study who had irritant dermatitis, their self-treatment played a role in the perpetuation of their symptoms.” In other words, self-diagnosis and treatment can worsen your symptoms. REMEMBER, REMEMBER THE BURNING VAGINA OF NOVEMBER!!)
There are other more amusing aspects to my self-care routine now. Under doctor’s orders, I am not allowed to wear pants around the house. Some of the old wives’ tales hold true: pantyhose, tight jeans and leggings are a bad idea, as is sitting around in a wet swimsuit. Insufficient lubrication during sex is guaranteed to summon the fires of RVVC. Mercifully, there is no truth to the “eating sugar and yeasts increases your vaginal yeast colony” school of thought. In fact, my doctor advised me that if eating a donut is what stands between me and feeling miserable, I should eat the donut, as “feeling miserable” is quite literally likely to bring about a thrush flare-up. And the best news of all is that I never, ever, have to use a 6-day sand-in-the-pants vaginal pessary treatment every again. Because as the Beastie Boys put it, “THESE PUSSY CRUMBS ARE MAKIN’ ME ITCH.”
[Image of woman's underwear via Shutterstock]