An Open Letter to the NHS
- philippabaines
- 2 days ago
- 4 min read
To Whom It May Concern,
The NHS Thrush page currently omits clinically significant information that is essential for safeguarding women’s health and could save the NHS valuable resources.
I see your thrush page is due for review 2026 and so the included information is well-timed and implementable.
There is a well-documented association between vulvovaginal candidiasis (thrush) and vulval nerve damage leading to vulvodynia, a chronic and often life-altering pain condition (sometimes called vestibulodynia, affecting the nerve-dense vulval vestibule). This relationship is consistently acknowledged across UK specialist bodies:
“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.”
“Secondary vulvodynia may follow inflammation in the vulva, such as that caused by thrush or the overuse of topical and vaginal anti-thrush treatments.”
ISSWSH in use since 2014
Goldstein Vulvodynia algorithm – ‘Aquired neuroproliferative vestibulodynia: …chronic yeast infections’
“Aetiology: Likely to be multifactorial; a history of vulvovaginal candidiasis, usually recurrent, is the most commonly reported feature.”
“Aetiology: Likely to be multifactorial; a history of vulvovaginal candidiasis, usually recurrent, is the most commonly reported feature.”
Since 2014, further 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 consequences of vulvodynia are severe. Like other chronic pain syndromes, it is associated with a 2–3 fold increased risk of suicide (Gerhant 2017; Cheatle et al., 2023), causes profound reductions in quality of life, and is widely recognised as ‘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.
For this reason, I strongly recommend that the following sentence be added to the NHS Thrush page:
"There is an association 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." (Vulval Clinic listing)
The benefits of including this information 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 gynocologists 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 above synthesis is informed both by the published evidence and by lived experience, detailed here, you’ll see in the comments how many other women developed it also from a severe bout of thrush:
And discussed further here:
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:
https://www.nhs.uk/medicines/clotrimazole-for-thrush/common-questions-about-clotrimazole-for-thrush/
Including this information aligns with NHS priorities on prevention, patient safety, and substantial cost reduction. Its absence represents a 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.
Yours sincerely,
Philippa
References
Bornstein et al.(2024)
Inflammation-induced mast cell-derived nerve growth factor: a key player in chronic
vulvar pain? BRAIN 2025: 148; 331–346
Cheatle et al (2023)
Suicidal thoughts and behaviors in patients with chronic pain, with and without co-occurring opioid use disorder. Pain Med. 2023 Apr 4;24(8):941–948.
Krishna, Dr M. (2026)
Vulval Pain (Vulvodynia)
Gerhant et al (2017)
Vulvodynia and depression – a case study. Psychiatr. Pol. 2017; 51(5): 937–952
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