What is the cause of vulvovaginal candidiasis?
About 20% of non-pregnant women aged 15 to 55 harbour Candida albicans in the vagina. Most have no symptoms and it is harmless to them. Overgrowth of Candida albicans causes a heavy white curd-like vaginal discharge, a burning sensation in the vagina and vulva and/or an itchy rash on the vulva and surrounding skin. Oestrogen causes the lining of the vagina to mature and to contain glycogen, a substrate on which Candida albicans thrives. Lack of oestrogen in younger and older women makes vulvovaginal candidiasis much less common. Overgrowth of Candida albicans occurs most commonly with: • Pregnancy • Higher dose combined oral contraceptive pill and oestrogen-based hormone replacement therapy • A course of broad spectrum antibiotics such as tetracycline or amoxiclav • Diabetes mellitus • Iron deficiency anaemia • Immunological deficiency e.g., HIV infection • On top of another skin condition, often psoriasis, lichen planus or lichen sclerosus.
