Vulvovaginal Candidiasis (VVC)
Vulvovaginal Candidiasis (VVC) is the medical term used for vaginal thrush or vaginal yeast infections. This condition is caused by an overgrowth of yeast, often a candida strain such as candida albicans in the vagina and on the vulval tissues.
Current estimates indicate that 75% of all women will develop VVC in their life-time, with around 5-10% of women experiencing recurrent VVC (a chronic subtype of VVC).1
VVC causes symptoms in most women, including:
- White discharge (often described as ‘cottage cheese’ like)
- Itching
- Pain and a burning sensation
- An unusual odour (often described as sweet or ‘yeasty’)
- Feeling of vaginal dryness
- Dyspareunia (painful sex)
Women may experience cyclical symptoms of yeast, suffering before ovulation and before their period more than other times, due to fluctuating levels of oestrogen.
Risk factors for vaginal yeast infections include:
- Antibiotic use (these medications reduce the good bacteria that are protective against yeast overgrowth)
- Lifestyle practices that disrupt the protective microbiome of the vagina may cause yeast overgrowth (e.g. tight clothing, chemicals in personal products)
- A weakened immune system (as a result of an illness or immune suppressant medications)
- Poorly controlled diabetes
- Pregnancy (due to changing hormones)
- Hormone imbalances
High levels of oestrogen can cause yeast to proliferate. Oral contraceptive pills and hormone replacement therapy (HRT) can trigger thrush, or conditions associated with oestrogen dominance such as endometriosis and Polycystic Ovary Syndrome (PCOS).
Yeasts become more pathogenic and hard to eliminate the longer they are allowed to thrive. This is due to various factors including the ability for yeast to form protective biofilms, their ability to form long filamentous hyphae able to invade and damage mucosal epithelial cells, treatment not always being appropriate and the rise of anti-fungal medication resistance.2,3
A healthcare professional will be able to diagnose VVC. It can be commonly mistaken for other vaginal imbalances, so its important a culture or microbiome test confirms yeast overgrowth, especially in recurrent cases, to facilitate correct treatment. Medical treatment involves an anti-fungal medication from the azoles group of drugs, available as oral tablets, vaginal creams or pessaries.
In cases of recurrent VVC, its important to understand the drivers for ongoing symptoms. Probiotics can be useful as part of a multifaceted approach, to increase the protective bacteria, which help reduce the growth of opportunistic yeast infections.
References
- Rathod SD, Buffler PA. Highly-cited estimates of the cumulative incidence and recurrence of vulvovaginal candidiasis are inadequately documented. BMC Womens Health. 2014;14(1):43.
- Rodríguez-Cerdeira C, Martínez-Herrera E, Carnero-Gregorio M, et al. Pathogenesis and Clinical Relevance of Candida Biofilms in Vulvovaginal Candidiasis. Front Microbiol. 2020;11:544480.
- Cleveland Clinic. Antifungal resistance. Cleveland Clinic. https://my.clevelandclinic.org/health/articles/21557-antifungal-resistance. Accessed Mar 12, 2025.
