Vaginal yeast infections (thrush): What can help?

Photo of a woman at a doctor's appointment

Vaginal infections are often caused by an overgrowth of yeast (a type of fungus). Also known as thrush, yeast infections in the vagina usually go away after a short course of treatment with antifungal medication. It is not clear whether home remedies help.

Many women are familiar with the symptoms of vaginal yeast infections: unpleasant itching and burning, as well as whitish cottage-cheese-like vaginal discharge. Vaginal yeast infections are treated with antifungal drugs (antimycotics). The symptoms usually go away after a short course of treatment with these medications when used locally in and around the vagina.

It is sometimes a good idea to take oral medication (swallowed in the form of tablets) or to use the treatment for longer.

How are antifungal drugs normally used?

Antifungal drugs kill or reduce the growth of fungi (including yeast). The following medications are often used to treat vaginal yeast infections:

  • clotrimazole
  • nystatin
  • ciclopirox
  • fluconazole

Fluconazole is only available as a tablet, and you need a prescription to get it. Most of the creams and vaginal suppositories are available from pharmacies without a prescription. In Germany and other countries you have to pay for them yourself, though.

Simple infections clear up after a few days of locally applied treatment (vaginal suppositories or creams). Depending on the drug used, the treatment takes one, three or six days. It is best to insert suppositories and creams deep into the vagina before going to sleep. To help you do this, most packages have an applicator and instructions in them. Vaginal suppositories sometimes come with a small tube of antifungal cream that you can apply to affected areas of the external (outer) genitals.

There is also a different treatment where you take (swallow) just one tablet. Doctors may recommend using that if you have your period, for instance. Research has shown that medications like fluconazole tablets work somewhat better than creams or vaginal suppositories do. But all of the treatments are equally good at relieving symptoms such as itching or burning.

If you keep getting vaginal yeast infections, your sex partner may have one in their genital area too – with similar symptoms, such as redness and itching at the tip of their penis or in their vagina. Then you might keep infecting each other. To prevent this kind of “ping pong effect,” it can be a good idea for your partner to see a doctor too and use antifungal medication if necessary.

What are the risks associated with antifungal drugs?

Antifungal drugs that are applied to the skin or mucous membranes are generally well tolerated. The possible side effects include further irritation of the affected areas, burning and itching.

When using mechanical contraceptive devices, it's important to read the package insert carefully. Some antifungal drugs are oily. This can make contraceptives like condoms more porous, allowing sperm to pass through them.

If antifungal drugs are taken in the form of tablets that you swallow, they can lead to other side effects such as headaches, dizziness, nausea and diarrhea. There are also a lot of medications that shouldn't be used together with antifungal drugs because they may influence each other’s effect. These include certain medicines, blood-pressure-lowering drugs and medications for psychological problems. You can find out about these “drug-drug interactions” in the package insert that comes with the antifungal drug.

Antifungal drugs that you swallow (oral antifungals) haven’t been approved for use in women who are pregnant or breastfeeding. But those that are used locally in the vagina (creams and suppositories) can be used by this group of women.

When is a longer-term treatment considered?

If you have a complicated vaginal yeast , it’s a good idea to talk to your doctor. He or she may recommend using a treatment over a longer period of time. A vaginal yeast is considered to be “complicated” if it causes more severe symptoms such as widespread, painful swelling in the vagina and on the outer genitals – or if the recurs more than four times per year. Yeast infections are also considered to be complicated if they’re caused by a weakened , for instance due to an HIV .

When treating complicated vaginal yeast infections, an initial treatment is typically followed by maintenance treatment. In the initial phase of treatment,

  • creams or suppositories are used for 1 to 2 weeks, or
  • instead, one oral tablet is taken every three days for about a week.

This is usually followed by maintenance treatment, where you take one antifungal tablet per week over a period of six months. If you can't take tablets – for instance, due to a pregnancy or interactions with other drugs – you can continue treatment with locally applied antifungal cream or suppositories.

Are there effective alternatives to antifungals?

The membranes lining a healthy vagina contain a lot of lactic acid . These are a normal part of the vaginal flora – the natural balance of microorganisms (germs) there. Small amounts of yeast are also normal. If this natural balance is upset, harmful or yeast can thrive and lead to an .

There are vaginal suppositories or capsules that contain live lactic acid (probiotics). These products are designed to protect and restore the natural balance in the vagina. They may help to fight a yeast when used in addition to antifungal drugs. But it’s not clear whether they can effectively fight a yeast when used on their own.

Some women use home remedies to treat vaginal yeast infections. For instance, they may eat garlic or natural yogurt. Others insert garlic cloves into their vagina, or use tampons soaked in things like tea tree oil or natural yogurt. But there’s hardly any research on whether these kinds of home remedies can help to get rid of vaginal yeast infections or prevent them. They can cause things like allergies or irritate the mucous membranes, though. Vaginal douches or female intimate hygiene products may irritate the skin, making the symptoms worse.

Centers for Disease Control and Prevention (CDC). Sexually Transmitted Disease Treatment Guideline: Vulvovaginal Candidiasis. 2021.

Denison HJ, Worswick J, Bond CM et al. Oral versus intra-vaginal imidazole and triazole anti-fungal treatment of uncomplicated vulvovaginal candidiasis (thrush). Cochrane Database Syst Rev 2020; (8): CD002845.

Martin Lopez JE. Candidiasis (vulvovaginal). BMJ Clin Evid 2015: pii: 0815.

Rosa MI, Silva BR, Pires PS et al. Weekly fluconazole therapy for recurrent vulvovaginal candidiasis: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol 2013; 167(2): 132-136.

Sherrard J, Wilson J, Donders G et al. 2018 European (IUSTI/WHO) International Union against sexually transmitted infections (IUSTI) World Health Organisation (WHO) guideline on the management of vaginal discharge. Int J STD AIDS 2018; 29(13): 1258-1272.

Weyerstahl T, Stauber M. Duale Reihe Gynäkologie und Geburtshilfe. Stuttgart: Thieme; 2013.

Xie HY, Feng D, Wei DM et al. Probiotics for vulvovaginal candidiasis in non-pregnant women. Cochrane Database Syst Rev 2017; (11): CD010496.

IQWiG health information is written with the aim of helping people understand the advantages and disadvantages of the main treatment options and health care services.

Because IQWiG is a German institute, some of the information provided here is specific to the German health care system. The suitability of any of the described options in an individual case can be determined by talking to a doctor. informedhealth.org can provide support for talks with doctors and other medical professionals, but cannot replace them. We do not offer individual consultations.

Our information is based on the results of good-quality studies. It is written by a team of health care professionals, scientists and editors, and reviewed by external experts. You can find a detailed description of how our health information is produced and updated in our methods.

Comment on this page

What would you like to share with us?

We welcome any feedback and ideas. We will review, but not publish, your ratings and comments. Your information will of course be treated confidentially. Fields marked with an asterisk (*) are required fields.

Please note that we do not provide individual advice on matters of health. You can read about where to find help and support in Germany in our information “How can I find self-help groups and information centers?

Updated on April 4, 2022
Next planned update: 2025

Publisher:

Institute for Quality and Efficiency in Health Care (IQWiG, Germany)

How we keep you informed

Follow us on Twitter or subscribe to our newsletter or newsfeed. You can find all of our films online on YouTube.