Here are all the ways it’s possible to get thrush after sex

Woman in underwear sitting on the bed

You’re wearing your favourite tight-fitting, synthetic bodysuit but are mentally preparing to take it off soon: you’ve just brought home that hottie you’ve been lusting over and it’s clear you’re both itching to have sex.

Your first time together is wonderful and exciting, and you each perform and receive a variety of different sex acts: hand play, oral sex, and penetration, and are careful to use both protection and lube. You go to sleep that night feeling like you’re floating on air, and yet, you notice that you have genital thrush a few days later. How did this happen?

Thrush is not a sexually-transmitted disease, but can be triggered by sex in some instances. This happens when conditions created by sex also increase the risk of thrush developing, for example, irritation caused by vaginal dryness.1

Skip to: | Sex toys | Lube | Tight, synthetic clothing | Douching | Oral sex | I’m a woman who has sex with women. Am I more at thrush of thrush?

How does sex trigger thrush?

To develop into thrush, a fungus called Candida, which is naturally present on our skin, needs to multiply and overgrow. Many different factors can encourage this, including wearing tight and synthetic underwear or using perfumed soaps to clean our vulva.2

“The factors that could trigger an overgrowth are different for everyone,” says GUM consultant, trainee GP, and member of the Decolonising Contraception collective Dornu Lebari. “We don’t have much hard evidence about how sex can trigger thrush, but there are things that we do that increase the risk of it. A sexual act that creates a condition favourable to thrush could increase that risk.”

“The women in which thrush is triggered are likely to have higher amounts of Candida present and to have micro-traumas”

But it’s how prone an individual woman might be to thrush, rather than the sex she has, that mostly predicts whether she’ll get it, explains Dr Caroline Cooper, spokesperson for the Faculty of Sexual and Reproductive Health (FSRH). “The women in which thrush is triggered are likely to have higher amounts of Candida present and to have micro-traumas,” she says, referring to tiny cuts, tears, or irritations on the vulva. Candida is normally present on our skin in low numbers, but about 20% of women are thought to have higher amounts.

If your vagina is dry or tight during sex, there is an increased risk of small tears being made on the vulva and vagina during penetration, which can prompt Candida to overgrow.3 These tears enable the Candida to invade tissue and cause infection.

Hand play and anal sex

These sex acts are likely to pose the most risk of thrush through the friction that they cause — particularly if you’re experiencing some vaginal dryness, says Dr Caroline. “It’s the friction that you’re getting during sex, which may be pleasurable, but can cause a little bit of trauma. This can occasionally include tears around the entrance of the vagina.”

Some sources say that introducing foreign bacteria into the vagina — say, from unclean fingers or from the rectum — can cause thrush, but evidence on this is lacking. However, it could introduce the risk of other infections, so it’s important to wash hands before hand play and to clean your toy, or your partners’ penis or strap-on, after anal play.

Sex toys

In a similar vein, a sex toy would be most likely to trigger thrush if it caused some irritation or micro-tears on our vulva, due to friction or any tightness we might have. “It could happen if there were any sort of roughness, for example, if you had a sex toy that was big, or if you had a vaginal area that was tight,” says Dr Caroline.

“There are a lot of theories about sex toys and sharing sex toys, because there is evidence linked to other STIs. This is where the advice comes from to wash your sex toys between usages and between partners”

While it’s important to wash your sex toys before and after use, and use between partners, it’s unlikely that an unwashed sex toy would bring on thrush. “Candida lives on moist areas, so it’s less likely to live on a sex toy,” says Dr Caroline. “If there was bacteria on it, and this was introduced into your vagina, then it would be more likely to trigger bacterial vaginosis.”

“There are a lot of theories about sex toys and sharing sex toys, because there is evidence linked to other STIs,” adds Dornu. “This is where the advice comes from, to wash your sex toys between usages and between partners, and to use a condom with the toy if you’re not sure. This is a standard mantra.”

Lube

Glycerin in a common ingredient in many types of lube that not only can act as a food source for Candida, but has been shown to kill dominant bacterial species within the vaginal microbiome that help to maintain an acidic pH.4 The vagina is naturally slightly acidic, and if it becomes more alkaline, this can encourage Candida to multiply. Be sure to read the label thoroughly when shopping for new lube.

Tight, synthetic clothing

Urologist, andrologist, and sexual medicine expert Dr Maria Fernanda Peraza Godoy, known as Dr Mafe, considers tight, synthetic clothing to be a behavioural risk factor for thrush. “Poorly ventilated clothing and/or synthetic underwear could increase perineal temperature and humidity, which could cause hypersensitivity or allergic reactions,” she says.

“We know that tight underwear is a factor. Aeration is important, which can be difficult with synthetic fabrics”

While guidelines do note an association between tight, non-breathable clothing and thrush, evidence here is limited.5 Both Dr Caroline and Dornu agree however that tight, synthetic underwear can be a risk factor for thrush.

“We know that tight underwear is a factor. Aeration is important, which can be difficult with synthetic fabrics,” says Dornu.

Douching

Douching is a practice of washing out the vagina with water or other fluids, including bleach and vinegar,6 to ‘clean’ it out. This is not necessary and can cause harm, and is linked to an increased risk of thrush, bacterial vaginosis, pelvic inflammatory disease, and other STIs.7

This is because douching can remove our normal vaginal flora, which can allow pathogens to overgrow. If douching with a pressurised stream of fluid, this can actually work to help transport bacteria from the lower genital tract into the uterus, Fallopian tubes, or abdominal cavity.8

Many women practice douching due to false beliefs that it can help prevent infection or that it’s good for their hygiene. This can translate into douching before or after sex to ‘cleanse’ the vagina. There are many complex reasons why beliefs like this persist, not in the least due to social pressures from physicians, partners, and the media.9

Oral sex

Some studies have found an association between receptive cunnilingus and the incidence of thrush.10 A 2000 study of 455 university-age women found that exposure to saliva during cunnilingus was linked to an increased risk of thrush, while exposure to saliva during masturbation actually had a protective effect.11 The authors suggest that this may be due to components in our saliva being able to recognise our own antigens, versus someone else’s saliva, which may react differently with our vaginal antigens and organisms. However, the evidence is not strong enough to prove a causative link between cunnilingus and thrush.

Studies would need to prove that certain sexual acts play a role in causing thrush, rather then indicate a correlation between them

“Oral sex doesn’t carry a risk on its own. It can cause a little bit of irritation around the very delicate parts of the vulva,” says Dr. Caroline. “There is no evidence that it’s due to bacteria from the mouth or anything like that.”

I’m a woman who has sex with women. Am I more at risk of thrush?

Although official guidelines state that women who have sex with women (WSW) may be at greater risk of thrush,12 Dr. Mafe, Dr Caroline, and Dornu all emphasise that the evidence we have for this is limited.

“There is a suggestion that it’s more prevalent in WSW, but this needs to be backed up with numbers,” says Dornu.

Research findings are conflicting and sometimes contradictory. In one study, thrush was found to be significantly associated with a higher number of female partners in the previous year, but not with specific sexual practices or numbers of male partners — suggesting that it is possible for Candida to be sexually transmitted between women.13 However, A 2014 study of 196 bisexual and lesbian women found no evidence that Candida can be sexually transmitted, and instead that sex with both women and men, and the number of male sexual partners, were significant predictors of thrush.14

Thrush being theoretically more prevalent within a group, however, would be related to sexual practices, habits, and host risk factors, which are all individual and difficult to control for within research. Studies would also need to prove that certain sexual acts play a role in causing thrush, rather then indicate a correlation between them.

“It’s not about sexual orientation,” says Dr Mafe. “More studies are needed to clarify the role of sexual practices.”

Featured image is of a lightly dark-skinned woman kneeling on her bed. She is wearing soft grey underwear and is visible in the frame from her feet to her lower back. The bed sheets are a soft white colour

Decolonising Contraception is a multidisciplinary collective formed by Black and people of colour working in sexual and reproductive health. Their work seeks to raise awareness and unpick the influence of colonialism on their practice

Page last updated May 2020

Monica Karpinski

Founder & Editor, The Femedic

Monica is the Founder and Editor of The Femedic. Against a journalism background and after years of leading content marketing projects in the healthcare space, it became clear that health information out there for women simply wasn’t good enough. No-one had bothered to look deeper into the ways women were searching for information, or consider the depth of what they actually needed to know. Instead of waiting for the perfect publication to approach her, she created The Femedic.

Monica has been named one of The Drum’s 50 under 30 for influential women in digital 2018 and was shortlisted for Female Entrepreneur of the Year in the 2018 British Business awards. She speaks and writes widely on gender and health inequality.

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References

  1. NICE, Candida – female genital, Clinical Knowledge Summaries, National Institute for Health and Care Excellence, May 2017 [online] (accessed 22 May 2020)
  2. Ibid
  3. Gonçalves, B., et al., Vulvovaginal candidiasis: epidemiology, microbiology and risk factorsCritical reviews in microbiology, 2016, vol 42, issue 6, pp 905-927
  4. Ibid
  5. BASHH, Guideline for the management of vulvovaginal candidiasis, Clinical Effectiveness Group (CEG), British Association for Sexual Health and HIV, August 2019 [online] (accessed 22 May 2020)
  6. Martino, J.L., and Vermund, S.H., Vaginal douching: evidence for risks or benefits to women’s health, Epidemiological Reviews, 2002, vol 24, no 2, pp 109-124
  7. Ibid
  8. Ibid
  9. Ibid
  10. Reed, B.D., et al., Sexual behaviours and other risk factors for Candida Vulvovaginitis, Journal of Women’s Health and Gender-Based Medicine, 2000, vol 9, no 6, pp 645-655
  11. Ibid
  12. NICE, Candida – female genital, Clinical Knowledge Summaries, National Institute for Health and Care Excellence, May 2017 [online] (accessed 22 May 2020)
  13. Bailey, J.V., et al., Vulvovaginal Candidiasis in women who have sex with women, Sexually Transmitted Diseases, June 2008, vol 35, no 6, pp 533-536
  14. Muzny, C.A., et al., Lack of evidence for sexual transmission of genital Candida species among women who have sex with women: a mixed methods study, Sexually Transmitted Infections, March 2014, vol 90, no 2, pp 165-170