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THRUSH-INDUCED NERVE DAMAGE 

What is thrush-induced nerve damage to the vulva?

Thrush has been the catalyst for many women developing nerve-related vulvodynia (sometimes called vestibulodynia.)​

A severe thrush infection over a prolonged period (over 2 weeks) is theorised to result in an accumulation of mast cells (Bornstein 2025). Mast cells are the sentinels of the body and play a crucial role in the immune system. When they arrive in the already highly innervated vestibule tissue, at the opening of the vagina, they begin an immune response including the release of proinflammatory cytokines which in turn stimulate further nerve growth to fight the infection. 

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Problems arise when the infection is over and the vestibule tissue has grown so many nerve endings that they fire even without an active infection. 

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An alternative theory is that the thrush infection hypersensitises existing vestibule nerves without the need for neuroproliferation. In a process seen similar to post herpatic neuralgia, we see a hypersensitisation of the dorsal root ganglions and increase in pain processing areas in the brain. This in turn reduces the brain to down regulate the pain response and so the onset of chronic pain begins. 

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Generally we see three ways in which vestibulodynia manifests as pain:

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1. Provoked pain

This is when only by touching the vestibule does a burning or sharp feeling arise in the tissue. This can make inserting items like tampons, moon cups and having penetrative sex extremely painful. 

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2. Spontaneous pain (unprovoked)

This is when the burning feeling of a thrush infection simply never ends and the nerves keep firing pain without stimulus. This condition is thought to be a complex chronic pain disorder and linked to central sensitisation (CS). CS occurs when not only the peripheral nerves but those joining up to the spine including dorsal root ganglion all the way up into the brain undergo chemical changes to become hypersensitive. 

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3. Mixed

Many women develop a mixture of both provoked and spontaneous pain linked to the vestibule. 

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The link between chronic yeast infections and vulvodynia is layed out in the Goldstein vulvodynia algorithm – a diagnosis and treatment model proposed by Dr Andrew Goldstein, former President of the International Society for the Study of Women's Sexual Health and Fellow of the American Board of Obstetrics and Gynecology (ABOG), the International Society for the Study of Vulvovaginal Disease (ISSVD), the International Society for Sexual Medicine (ISSM), the Society for Sex Therapy and Research (SSTAR), and the Sexual Medicine Society of North America (SMSNA). Please note this algorithm is not yet validated by ISSVD however shows merit in highlighting recent understandings in the diagnosis of vulva pain syndromes. 

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Goldstein refers to neuropathic vestibulodynia as 'neuroproliferative vestibulodynia' and in relation to a candida 'acquired neuroproliferative vestibulodynia."

What does the nerve damage feel like?

The Goldstein algorithm: