Thrush and cystitis are common, and both respond well to treatment. Toxic shock is much rarer: in the US, it's about 1 case per 100,000 women a year. But anyone who uses tampons or a menstrual cup should know its signs.
Is it thrush or cystitis?
Thrush mostly itches: itching and soreness around the vulva, and white discharge like cottage cheese that usually doesn't smell. It can sting during sex or when you pee. It's caused by candida, a yeast that usually lives in the body quietly and overgrows when the balance shifts: after antibiotics, in pregnancy, or when the skin is irritated.
Cystitis, a bladder infection, mostly burns: it hurts to pee, you keep needing to go but only a little comes out, and your lower belly aches. It's usually gut bacteria getting into the urethra, the tube you pee through. In women it's short, so the bacteria don't have far to travel.
What helps right now?
With thrush, wash the outside with warm water instead of soap or scented gels, and pat the skin properly dry. Wear loose cotton underwear, and put off sex if it's uncomfortable. With treatment, thrush usually clears up in 7–14 days.
With cystitis, drink enough to keep your pee pale, rest, and skip coffee, alcohol and fruit juice for a while. Paracetamol taken as directed can ease the pain.
Mild cystitis sometimes clears up on its own, so a doctor may suggest waiting 48 hours before antibiotics. With them, symptoms usually go in 1–2 days.
What is toxic shock, and how do I avoid it?
Toxic shock is caused by poisons that some bacteria release. It can happen with tampons and menstrual cups, and also from an infected cut or burn.
Change your tampon every 4–8 hours and never keep one in for more than 8. Use the lowest absorbency that works for you: if a tampon easily lasts the full 8 hours, it's probably too absorbent. Wash your hands before and after, and only use tampons during your period.
If you sleep longer than 8 hours, a pad or period pants are a better choice for the night. Keep a cup in no longer than the instructions for your model allow.
Common questions
I fell asleep with a tampon in for more than 8 hours. What now?
Take it out as soon as you wake up. Extra hours don't mean you'll get toxic shock. They just give bacteria more time. If you can't get it out, see a doctor, who can remove it for you.
Does cranberry really help with cystitis?
Cranberry doesn't treat cystitis that has already started. If it keeps coming back, cranberry products may help prevent it. Check with a doctor first if you're pregnant, and avoid cranberry if you take warfarin.
Can I treat thrush without a doctor?
If you've had thrush before and recognise the symptoms, a pharmacist can help. Don't use antifungal treatment more than twice in 6 months without advice from a pharmacist or doctor.
Does my partner need treatment?
For thrush, no, unless your partner has symptoms. It isn't counted as a sexually transmitted infection, although sex can trigger it. Also, thrush creams can damage condoms.
In short
- Keep a tampon in for 8 hours at most, and use a pad at night
- Pee soon after sex
- Wash the outside with warm water, no scented gels
Source: NHS: Toxic shock syndrome
Educational content; it does not replace professional medical advice.