women thrush

What if it’s not thrush?

Have you been experiencing vaginal symptoms and the usual thrush treatments don’t seem to be working? Well, perhaps, it’s not thrush!

Thrush is an overgrowth of Candida yeast species in the vagina. It is one of the most common vaginal conditions and is relatively low risk, however, highly distressing. To read more about thrush, check out this blog by my wonderful colleague Margaret.

When it isn’t thrush it is most likely dysbiosis of another kind occurring in the vagina. Dysbiosis refers to an imbalance in the ideal make up of microbial species within a certain area. Throughout the entire human body, having diversity is key to health. We want lots of different strains in our gut and on our skin to provide us with the benefits of each individual species. However …

The vagina is the only microbiome in the body where diversity is not a good thing!

Inside the vagina, it is ideal to have a Lactobacilli dominant microbiome. There are multiple different strains of these Lactobacillus species and they are different to the ones that we find in the gut.

Dysbiosis occurs when low levels of Lactobacilli are found in the vagina, leaving room for other bacterial species to overgrow. The reason we want Lactobacilli species is because of the protective effects they have on the vagina such as keeping the pH acidic (below 4.5) and secreting D-Lactate.

The reason we want an acidic pH in the vagina is because certain undesirable microbes cannot survive in this environment, including certain sexually transmitted infections and Human Papiloma Virus (HPV). HPV is the main contributor to cervical cell dysplasia and is what our pap smear/cervical screen’s are looking for.

D-Lactate is a chemical that Lactobacilli secrete which provides a protective anti-inflammatory environment for the cells of the vagina. It also helps to trap viral pathogens in vaginal mucous, enhances cell repair and improves our local immune response.

Having low levels of Lactobacilli means that we do not get the wonderful benefits of these species. To improve the Lactobacilli levels of the vagina we suggest:

  1. Using a vaginal Lactobacilli specific probiotic to help boost levels. This can be taken both orally and vaginally (Lactobacillus Rhamnosus GR-1 and Lactobacillus Fermentum RC-14).
  2. Followed by providing prebiotics to feed these bacteria. This is best used vaginally (Lactulose and Green Tea).

Bacterial Vaginosis (BV)

BV is characterised by a high alkaline pH in the vagina (over 4.5) and undesirable high levels of certain bacteria such as Gardnerella Vaginalis and Mycoplasma. BV is the most common cause of vaginal signs and symptoms, some of which include:

  • Smelly discharge
  • Off-white discharge
  • Burning
  • Itching
  • Increase in symptoms after intercourse
  • Recurring miscarriage or infertility

What can be distressing about this last point is that around half of all women with BV are asymptomatic, meaning they have no idea they have it. One of the easiest ways to find out if you have BV is to do a pH strip test or a vaginal microbiome test. Both of these can be done from home.

Some of the treatment options for BV include:

  • Specific probiotic strains both orally and vaginally (Lactobacilli rhamnosus and Lactobacilli ruteri).
  • Lactulose used vaginally as a douche or spray.
  • Slow absorbed Vitamin C used vaginally.
  • Antimicrobial herbs used orally and vaginally.

Group B Streptococcus

This is one of the bacterial species most women will be tested for at their week 35 pregnancy check up. Antibiotics are routinely given for this due to some evidence suggesting that an infection of this bacteria can impact both pregnant women and neonates.

Not only pregnant women can have this infection, however, because many people will be asymptomatic, it will often go undetected until tested in pregnancy. As a precaution, women can begin probiotic treatment from week 28 to reduce their chances of finding high levels of Group B Strep and potentially negate the need for antibiotic treatment. If you have been experiencing undesirable vaginal symptoms, are not responding to typical thrush treatments or have been experiencing fertility challenges, I’m happy to help explore testing and treatment options.


Emma Drady, Naturopath BhSc

Emma is a degree qualified naturopath with a focus on women’s hormonal health throughout the lifespan.

Learn more about Emma here

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