An Open Letter to the NHS

This is an open letter to the NHS,

No woman should have to live with 24/7 burning genitals. 24/7 burning genitals with no known cure. 

Pain so bad you cannot work a full-time job, have to give up your dreams of having a family and have daily regrets being born a woman. And yet here I find myself sitting on an ice pack giving you this message. 

All because the system doesn’t take thrush seriously. 

There is a well-documented association between thrush and vulval nerve damage leading to vulvodynia, a chronic and often life-altering pain condition. 

This is what happened to me - my 10th, drug resistant thrush infection lasted 2 months and has done irreversible nerve damage to my vulva. 

I am asking for two sentences be added to the NHS thrush page. Two sentences that could have saved my life – 

"There is a causal link between thrush and vulval nerve damage, a chronic pain condition called vulvodynia. Women prone to thrush should take all reasonable measures to bring their rate down and consult a vulval clinic if they have any concerns." 

A link to all of the UK's Vulval Clinics can be found on the BSSVD website.

The above amend would cost the NHS next to nothing and yet would have had the power to save my life. 

The relationship between thrush and nerve damage is consistently acknowledged across UK specialist bodies, to back my request. 

• Vulval Pain Society:

“Some women have a sudden onset of symptoms following a specific event: 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.”

• British Association of Dermatologists:

“Secondary vulvodynia may follow inflammation in the vulva, such as that caused by thrush or the overuse of topical and vaginal anti-thrush treatments.”

• British Association for Sexual Health and HIV (guidance last updated 2014):

“Aetiology: Likely to be multifactorial; a history of vulvovaginal candidiasis, usually recurrent, is the most commonly reported feature.” 

• British Society for the Study of Vulvovaginal Disease (BSSVD):

“Aetiology: Likely to be multifactorial; a history of vulvovaginal candidiasis, usually recurrent, is the most commonly reported feature.”

Since 2014, research has strengthened the causal understanding of this link. The National Vulvodynia Association has supported recent work by Bornstein et al. (2025), identifying vulvodynia as a mast-cell–driven condition involving neuroproliferation, hypersensitisation of existing nerves, and central sensitisation following infection. This establishes a biological and evidence-based mechanism by which inflammatory insults such as thrush can lead to permanent nerve pathology.

The benefits of including this information on the NHS thrush webpage are substantial and measurable:

• Women will take recurrent and or repeated thrush seriously and make informed lifestyle and medical decisions to reduce recurrence.

• Increased thrush following coil insertion or other interventions will be recognised as clinically relevant, rather than dismissed.

• Women will be directed to vulval clinics—the only services where clinicians receive systematic training in vulvodynia—reducing diagnostic delay and inappropriate treatment. Swabs cannot detect nerve damage, and many patients are currently discharged after referral to a gynaecologist who have a knowledge gap when it comes to the vulva despite ongoing symptoms and pathology. Early diagnosis and interventions maximise chances of nerves healing and in some instances, full recovery can be made - as long as there’s no further insult to the nerves by further thrush outbreaks. 

• NHS costs will be significantly reduced. Vulvodynia patients often require lifelong regular GP visits, psychological services, pelvic physiotherapy, vulval clinics, pain management, long-term neuropathic medication, and in severe cases, invasive interventions such as spinal cord stimulators (£20,000+ per patient just for fitting with 1 in 3 needing further surgical interventions due to complications I.e lead migration). A clear preventive warning on a high-traffic NHS page could avert a substantial proportion of these cases.

The consequences of vulvodynia are horrific. Like other chronic pain syndromes, it is associated with a 2–3 fold increased risk of suicide (Cheatle et al., 2023), causes profound reductions in quality of life, and is widely recognised as exceptionally difficult to treat (Krishna, 2025). Curative treatments are not imminent and remain many decades away. A Candida vaccine whilst in development, is also decades away but could significantly mitigate the risks of vulval nerve damage.

Given these realities, prevention and early risk reduction are the only meaningful interventions currently available.

You should also advise against drinking alcohol whilst taking anti-thrush medication as it increases the chances the treatment will fail and therefore a severe, nerve-damaging infection resulting in vulvodynia.

Including this information would go far on prevention, patient safety, and substantial cost reduction. Its absence represents a colossal missed opportunity to prevent a devastating, lifelong condition.

I urge you to act on this evidence so that fewer women are harmed, and fewer NHS resources are consumed by a condition that could, in many cases, be prevented.

All this has been emailed to the NHS web resources at the start of January and thus far I’ve heard nothing back and I’m not prepared to let this continue indefinitely because of unsafe levels of bureaucratic delays. 

Take thrush seriously. 

Yours,

Philippa

BA, Oxon

References:

Bornstein et al.(2025) 

 Inflammation-induced mast cell-derived nerve growth factor: a key player in chronic

 vulvar pain? BRAIN 2025: 148; 331–346

(https://www.nva.org/wp-content/uploads/2025/01/awae228.pdf) 

British Association of Dermatologists. Vulvodynia and Vestibulodynia. Available at:

https://www.bad.org.uk/pils/vulvodynia-and-vestibulodynia (Accessed 23 January 2026)

British Association for Sexual Health and HIV. Vulval Conditions 2014.  Localised Provoked Vestibulodynia. Available at: https://www.bashh.org/resources/32/vulval_conditions_2014/ (Accessed 23 January 2026)

British Society for the Study of Vulval Disease. (2014) UK National Guideline on the

Management of Vulval Conditions. Available at: https://bssvd.org/wp-content/uploads/2018/06/BASH-UK-national-guideline-for-the-management-of-vulval-conditions-2014.pdf (Accessed 23 January 2026)

Cheatle et al (2023)

Suicidal thoughts and behaviours in patients with chronic pain, with and without co-occurring opioid use disorder. Pain Med. 2023 Apr 4;24(8):941–948.

(https://pmc.ncbi.nlm.nih.gov/articles/PMC10391589/)

Krishna, Dr M. (2026)

Vulval Pain (Vulvodynia), Pain Spa. Available at:

https://www.painspa.co.uk/condition/vulval-pain-vulvodynia/ (Accessed 23 January 2026)

Gerhant et al (2017)

Vulvodynia and depression – a case study. Psychiatry. Pol. 2017; 51(5): 937–952

https://www.psychiatriapolska.pl/pdf-67371-81408?filename=81408.pdf

Vulval Pain Society. Vestibulodynia (Formerly vestibulitis). Available at:

https://vulvalpainsociety.org.uk/about-vulval-pain/vulval-pain-conditions/vestibulodynia-formerly-vulval-vestibulitis/ (Accessed 23 January 2026)