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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.)​
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This is highlighted by the British Association for Dermatologists:
"Secondary [acquired] vulvodynia may follow inflammation in the vulva, such as that caused by thrush or the overuse of topical and vaginal anti-thrush treatments."
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The UK's Vulva Pain Society, led by renowned vulva pain expert Dr David Nunns also lists it as a precipitating event.
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"A commonly recognised event is a severe attack of thrush followed by anti-thrush treatment. Once the attack of thrush settles following treatment, soreness and burning may persist as vestibulodynia."
The National Vulvodynia Association of America highlights in their 2000 newsletter the link between an acute yeast infection and the onset of vulvodynia:
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"In a study by Sarma and colleagues (1999), women with VVS were five times more likely to have had a physician-diagnosed yeast infection than women who did not have VVS.'
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Research on mice models has found that giving females repeated thrush infections leads to chronic pain of their vulva (Farmer et al 2012).
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Mr Chris Jenner of Harley Street's Vulvar Pain Clinic and author of Viva La Vulva quotes Landale's (2022) work:
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"​There is evidence that recurring Candida or vaginal yeast infections can result in vulvodynia. Vaginal yeast infection symptoms may be mild or moderate, but they do nonetheless, have a significant impact on women’s health."
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In "When Sex Hurts" one of the leading books on vulvodynia written by notable researchers in the field: Dr Andrew Goldstein and Irwin Goldstein, there is an entire chapter explaining the link between candida and the development of vestibulodynia. To quote:
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"We can't tell you how many women tell us that their vulvar pain began after a yeast infection or a series of them."
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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-herpetic neuralgia, we see a hypersensitisation of the dorsal root ganglia and an increase in pain-processing areas in the brain. This in turn, reduces the brain's ability to downregulate the pain response and so the onset of chronic pain begins.
What does the nerve damage feel like?​​
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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 Goldstein algorithm:​​
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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 candida 'acquired neuroproliferative vestibulodynia." This describes an overgrowth of nerves in the vestibule as explained above.
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An alternative treatment algorithm provided by consultants with a speciality in neurology rather than gynaecology is shown below:
Note the above treatment algorithms are not validated by NICE and every consultant will treat vulvodynia in different ways. You are best advised to seek a relationship with a consultant you trust to be competent and in your gut feels compassionate. Do not settle for a Doctor who does not fulfil these two prerequisites.
I think I have nerve damage, what do I do?
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If you suspect you have developed nerve damage related vulvodynia, do not panic. When caught early, the nerves can often heal of their own accord. This can take time – up to 2 years. In those two years it is exceptionally important to not get any further thrush infections – consult with an experienced vulva doctor and take measures to minimise your risk.
Note that gynaecologists are not taught about vulvodynia in medical school and are unlikely to be able to understand the seriousness of the situation. You need to see a vulva clinic or vulva dermatologist, see Finding a Doctor.
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I've got provoked vestibulodynia, what are the next steps?
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For provoked pain acquired from thrush, time may allow the nerves to settle. There are medication, physiotherapy, counselling and biofeedback treatments. A final line with some research reporting 80% efficacy (Goldstein et al 2006) is an operation to remove the nerve-damaged skin called a vestibulectomy. Very few vulva consultants know how to perform this procedure in the UK; none perform 'full vestibulectomies' which is defined as 1-11 O'clock of the vestibule tissue and performed by experts in the United States. UK consultants all perform partial vestibulectomies and can only remove 9-3 O'Clock.
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See this map for indications of where you can find a surgeon.
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Reputable names include:
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Deborah Boyle, Royal Free London
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Jenni Byrom, Birmingham Women's
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Clare Bailey, Vulva Clinic Oxford
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In France, pelvic neurosurgeon Eric Bautrant is able to perform a full vestibulectomy. His clinic is based in Aix en Provence and requires a French speaker to book an appointment. He does telehealth appointments and speaks good English.
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Please note, we do not endorse any particular consultant – please see Finding a Doctor for tools to decide which is the right match for you.
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Can I get a vestibulectomy for unprovoked pain?​
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It is not advisable to have surgery for unprovoked pain as no peer-reviewed evidence shows it benefits patients and there is a risk of further nerve damage. In fact, Bornstein found that a vestibulectomy was 6 times more likely to fail if the patient was suffering from spontaneous unprovoked pain. Bornstein theorised this is likely due to central sensitisation and the pain being remembered in the spine and no longer isolated to just the peripheral nerves.
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What do I do if I have constant pain?​
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If you suffer from constant pain (spontaneous) ask for a referral to a pain management clinic with spinal cord stimulator capabilities; this will save you time in the long run as they'll be able to try various treatments before resorting to more invasive methods.
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UK Pain Management Centres with Spinal Cord Stimulator capabilities include:
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UCLH Pelvic Pain Team, London​
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The Walton Centre, Liverpool​
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Leeds Teaching Hospitals – Pain and Interventional Neuromodulation Service, Leeds​
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North Bristol NHS Trust – Pain Clinic, Bristol​
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Oxford University Hospitals – Neuromodulation Pain Service, Oxford
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Intrathecal pain pumps are also indicated as a last resort for chronic vulval pain by the National Vulvodynia Association; do not lose hope until you have tried all treatment modalities.
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Intrathecal pain pumps are harder to come by as they require a lifetime of commitment between patient and consultant. The initial set-up cost is very high and then every 3-6 months you'll be required to go for top-ups of medication delivered via needle into the pump itself. Transferring top-up care between Doctors can be a challenge. Like all procedures, there are risks and complications that need to be weighed up against the benefits of having the pump fitted.
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Seek support on our Support Group page.
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