Clotrimazole for vaginal thrush. Clotrimazole cream
Clotrimazole is an antifungal medicine.Side-effects are unlikely but may include mild skin irritation or itching.If your symptoms do not improve within seven days, speak with your doctor.Do not use more than two courses of clotrimazole within six months without speaking with a doctor for further advice.
Many women have an occasional bout of, It is due to an infection with a yeast fungus called Candida spp. Most cases of thrush are caused by the yeast called Candida albicans but other types of Candida spp. can also cause thrush. Common symptoms of vaginal thrush are itching, soreness, and redness around the outside of the vagina and a thick, creamy white, odourless vaginal discharge.
- Clotrimazole works by killing the yeast fungus causing the infection.
- Clotrimazole is usually applied in two ways to treat thrush.
- A pessary or internal (intravaginal) cream is inserted high into the vagina to treat the infection.
- Then a cream (usually containing 2% clotrimazole) is applied around the outside of the vagina to relieve the itching and soreness.
Many of the products available are ‘combi’ packs – these contain either a pessary or internal cream, and also a cream for external use. Clotrimazole is available on prescription and you can also buy it at a pharmacy, without a prescription, if you have previously been diagnosed by your doctor as having vaginal thrush.
If you are pregnant. This is because you should only use medicines on the recommendation of a doctor while you are expecting a baby. Also, you may need to use clotrimazole for a longer period of time during pregnancy than is usually recommended.If you are under 16 or over 60 years of age.If you have had more than two episodes of thrush in six months.If you have a foul-smelling or blood-stained vaginal discharge, or if you have blisters or sores in the vaginal area.If you are in pain, feel sick, or have diarrhoea or a fever.If you have previously had a sexually transmitted infection, or if you have had a partner with a sexually transmitted infection.If you have ever had an allergic reaction to a medicine.If you are using or taking any other medicines. This includes medicines which are available to buy without a prescription, as well as herbal and complementary medicines.
Before starting this treatment, read the manufacturer’s printed information leaflet from inside the pack. It will give you more information about how to use the clotrimazole preparation you have been given.If you are using clotrimazole cream, apply the cream to the area around the outside of your vagina and back passage two or three times daily. Rub it in gently. Continue to use the cream until the itching and soreness due to the infection are gone.If you are using clotrimazole intravaginal cream (for example, Canesten 10% VC® or Canesten® Internal Cream), insert one applicatorful high into your vagina at bedtime. A single dose is usually sufficient to treat the infection. If you are having your period, ask your doctor when you should use the cream.If you are using a clotrimazole pessary, use the applicator to insert the pessary high up into your vagina at bedtime. Depending upon the strength of the pessary, a single dose is usually sufficient to treat the infection. If you are having your period, ask your doctor when you should use the pessary. If you are pregnant, do not use the applicator which is provided to insert the pessary, unless your doctor has recommended you to do so. Instead, use a finger to insert the pessary as high as possible.
Use clotrimazole exactly as your doctor tells you to, or as directed on the pack. Remember to complete the course of treatment as this will help to prevent the infection from coming back. If your symptoms do not improve within seven days, see your doctor for further advice.A pessary will dissolve overnight in the moisture in the vagina. If you have problems with vaginal dryness you may notice some undissolved pieces of pessary the following morning.Clotrimazole can damage the latex in condoms and diaphragms so do not rely on these forms of contraception. Use an alternative method of contraception (or do not have sex) for at least five days after using clotrimazole. Please also keep in mind that having vaginal sex while you have thrush could infect your partner.If after seven days your symptoms recur, you can buy a repeat course of clotrimazole from a pharmacy. If you have more than two occurrences of thrush during six months, you should speak with a doctor for further advice. An alternative treatment could be more suitable for you.
Clotrimazole is unlikely to cause any serious side-effects. It can occasionally cause some irritation when it is used at first. If you experience any other symptoms, speak with your doctor or pharmacist for further advice.
Keep all medicines out of the reach and sight of children.Store in a cool, dry place, away from direct heat and light.
|If you suspect that someone has swallowed some of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty. This medicine is for you. Never give it to other people even if their condition appears to be the same as yours. Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you. If you have any questions about this medicine ask your pharmacist.
Clotrimazole for vaginal thrush. Clotrimazole cream
- 0.1 Do pessaries dissolve completely?
- 1 How far up do you put a pessary?
- 2 What happens if pessary is left in?
- 3 How do I know if pessary is working?
- 4 How do I remove my pessary myself?
- 5 Do progesterone pessaries leak out?
- 6 Can a pessary come out?
Do pessaries dissolve completely?
How to use pessaries – Pessaries are made to go into your vagina only. Do not swallow them. Pessaries need moisture in the vagina to dissolve completely. If they do not dissolve, pieces of the pessary may crumble and fall out of the vagina. You may notice this if you have vaginal dryness.
- Wash your hands before you start.
- Remove the applicator from the packet.
- Pull the plunger (the thinner end of the applicator) out as far as it will go.
- Take the pessary out of the blister pack.
- Gently squeeze the holder (the wider end of the applicator) to open it.
- Push the pessary into the application following the instructions that come in the medicine packet.
- Lie on your back, bend your knees then let your knees fall to each side.
- Gently put the applicator into your vagina and push it in as far as you can comfortably.
- Holding the applicator in place, slowly press the plunger in until it stops moving.
- Remove the applicator.
- Throw the applicator away safely, out of the reach of children. Do not flush it down the toilet.
- Wash your hands thoroughly when you’ve finished.If you have a 100mg pessary, you can insert 2 pessaries at a time.
Do not use tampons or other vaginal products while you’re using the pessary. Do not use pessaries during your period – wait until your period has finished.
What happens if pessary does not dissolve?
A second treatment may be carried out if necessary. Canesten pessaries need moisture in the vagina in order to dissolve completely, otherwise undissolved pieces of the pessary might crumble out of the vagina. Pieces of undissolved pessary may be noticed by women who experience vaginal dryness.
Can you pee after using a pessary?
Will the vaginal pessary interfere with my going to the toilet? – The pessary should make it easier for you to pass urine and empty your bladder more effectively. If you have any difficulties passing urine please contact the Urogynaecology Department.
- You may experience more leakage soon after the insertion of pessary.
- This symptom usually settles in a week or two.
- You should contact Urogynaecology Department if you continue to experience leakage.
- Generally, it does not affect your bowel movement.
- Initially you may experience pressure which settles in few days.
It is better to ensure that you are not constipated by drinking plenty of fluids and taking a high fibre diet.
How far up do you put a pessary?
Insert the folded pessary into the vagina (long ways) as far back as you can. It will open up into its normal shape when you let go on the ring. Use your index finger to make sure the rim is behind the pubic bone. If you are left handed, place your right foot up on a chair, low stool, or toilet.
What happens if pessary is left in?
Depending on the type of pessary prescribed, you should be able to leave it in for as long as four to six months. However, other types, such as cube pessary, must be removed every night. This depends on the kind of pessary you are prescribed. Most vaginal pessaries can be left in for as long as four to six months or unless told otherwise by your healthcare provider.
- In comparison, a type of pessary used for women with advanced degrees of vaginal prolapse, called cube pessary, should be removed every night.
- This type of pessary works by exerting suction pressure over vaginal walls and may cause vaginal ulceration if left in for too long.
- You can remove your ring pessary for cleaning purposes once a week or even nightly and put it back inside the vagina.
You also need to follow up with your healthcare provider every few weeks initially. During each visit, the doctor will check your pessary’s placement and clean it. The doctor will also inspect the vaginal walls for any signs of bruising or injuries. If the type of pessary does not allow for removal while at home, you will need follow-up visits every two to three months.
How do I know if pessary is working?
How labour is induced – If you’re being induced, you’ll go into the hospital maternity unit. Contractions can be started by inserting a tablet (pessary) or gel into your vagina. Induction of labour may take a while, particularly if the cervix (the neck of the uterus) needs to be softened with pessaries or gels.
You will usually stay in the hospital maternity unit while you wait for it to work. If you’ve had no contractions after 6 hours, you may be offered another tablet or gel. If you have a controlled-release pessary inserted into your vagina, it can take 24 hours to work. If you are not having contractions after 24 hours, you may be offered another dose.
Sometimes a hormone drip is needed to speed up the labour. Once labour starts, it should proceed normally, but it can sometimes take 24 to 48 hours to get you into labour.
Can you push pessary too far up?
If the pessary is uncomfortable, you may take it out. You cannot push it in too far.
Can you insert a pessary wrong?
What is a pessary? A pessary is a prosthetic device that can be inserted into the vagina to support its internal structure. It’s often used in the case of urinary incontinence and a vaginal or pelvic organ prolapse. A prolapse occurs when the vagina or another organ in the pelvis slips out of its usual place.
The support a pessary provides can help a woman avoid pelvic surgery. This device can also be used as a vessel for administering medication slowly. A pessary needs to be fitted by a medical professional as they can cause vaginal damage and fail to improve symptoms if fitted incorrectly. A collapsed pessary is inserted into the vagina and put in place just under the cervix.
Depending on the type of pessary used, it may be inflated using a bulb. There are two main types of pessary: support and space-filling. They come in many different shapes and sizes to fit a woman’s individual anatomy. They are all usually made from medical-grade silicone, which makes them durable and resistant to absorption.
- The most commonly used support pessary is the ring pessary with support.
- This is because it fits a large majority of women and can be used at all stages of pelvic organ prolapse.
- The most commonly used space-filling pessary is the Gellhorn pessary.
- This has a broad base with a stem that comes in different lengths so that it will also be able to fit most women.
A pessary will be inserted by a medical professional, usually a gynecologist, in an initial fitting. They may need to try different styles and sizes to find the one that’s right for you. Once you both feel the fitting is correct, they will give you training as to how to insert and clean the pessary by yourself.
You’ll return to the clinic a week later to check the device’s fit. The gynaecologist will remove the pessary so that they can examine the vagina for signs of irritation. They will then clean and replace it so long as all is well. Usually, you’ll have further follow-up appointments two weeks and six months later, but some women may need to return more frequently.
You’ll also be offered an annual examination of your vaginal wall. Most women find they are able to successfully use a pessary for two years or more without requiring surgery for their condition. There are sometimes mild side effects from pessary use, such as vaginal irritation, foul-smelling discharge, and urinary tract infections,
However, because the pessary is removable, any side effects experienced can usually be corrected quickly. It’s possible to have intercourse with a ring pessary in place, though most women prefer removing it for sexual activity. If you are comfortable removing and reinserting your own pessary, you may remove the pessary once or twice a week.
Once removed, clean it with mild soap and warm water and then rinse before replacing it. You doctor may prescribe a vaginal estrogen cream to apply inside your vagina while the pessary is out to prevent irritation. Pessaries can fall out if you strain.
- If you can, try not to bear down during bowel movements.
- If the pessary does fall out, you can reinsert it after you clean it.
- Many women find insertion easier when they are standing up with one foot resting on a stool.
- It’s important to use plenty of water-based lubricant for insertion.
- If you aren’t comfortable removing and reinserting your own pessary, your doctor will set up follow-up visits for you to come and it done in the office.
Frequency of visits can range from monthly to every three months, depending on your needs. A pessary can occasionally cause some complications:
Foul-smelling discharge. This could be a sign of a condition called bacterial vaginosis, which is an imbalance in the natural bacteria found in your vagina.Irritation and even damage inside the vagina.Bleeding.Passing a small amount of urine during exercise or when you sneeze and cough. This is called stress incontinence,Difficulty having sexual intercourse.Urinary tract infections. Initial signs of this may be difficulty urinating, feeling unwell, or a high temperature.
It’s important that you see your doctor if you develop any signs of these complications, as they are usually very treatable. A pessary could be a good option for women with a pelvic organ prolapse, be it mild or severe. Many women like the idea of avoiding surgery, and most get used to a pessary very quickly.
How do I remove my pessary myself?
Tips & Tricks: Vaginal Pessary Insertion & Removal Techniques Before a vaginal pessary is offered, it is important to confirm that the patient does not have any known contraindications to its use, including known genital tract malignancy, unexplained vaginal bleeding, or severe vaginal atrophy.
- It is also important to confirm the patient is able to comply with follow up (Thakar 2013).
- This is also the ideal time to explore if the patient currently is or wishes to be sexually active to aid selection of the most appropriate pessary.
- If the patient will be self-managing the pessary, an assessment of manual strength and dexterity is crucial (Thakar 2014).
The patient should be informed that pessary fitting is a process of trial and error and may require several attempts at sizing before the best fit is found. A correctly fitted pessary should not be noticeable to the patient while relieving their symptoms, should remain in place, and should not interfere with urination or defecation.
Pessary sizing involves performing a vaginal examination to assess the length and width of the vagina using the index and middle finger to first estimate the distance between the posterior fornix and pubic symphysis and horizontally at the level of the cervix or vaginal vault to determine the vaginal width (Thakar 2014).
The measurements taken can then be used to size the correct pessary, starting with the smallest size and increasing if necessary. Ensure any manufacturers’ advice regarding care of the pessary is read as some pessaries require washing prior to use. To aid insertion, many pessaries are foldable.
The ring pessaries can be folded in two or folded into a figure 8 to reduce the diameter. If difficulty is experienced bending the pessary, running it under warm water can make it easier to manipulate and using an oestrogen-based cream in post-menopausal women can further aid insertion and reduce abrasions.
The pessary is inserted into the vagina in a vertical position and once inside the vagina released to assume a horizontal position. A correctly sized pessary should allow a finger to be passed easily around the circumference of the pessary. Following pessary insertion, the patient should be asked to walk around and pass urine in the department; pessaries that are expelled on walking are usually too small and those obstructing urination are too large.
Before discharge, the patient should be instructed on how to correctly remove the pessary if they experience discomfort and should be aware to expect an increase in vaginal discharge, especially if an oestrogen cream is being used concomitantly. A contact number for the unit should be provided in the event of pain, expulsion, or signs of infection.
Pessary removal is often simpler than insertion. Removal can be achieved by hooking a single finger under the rim of the pessary in a ring pessary and gently pulling down towards the rectum while keeping the pessary folded. When difficulty is experienced removing a pessary, ask the patient to bear down, then use a Cusco speculum to identify the pessary and a sponge holding forceps to grasp the stem of the pessary.
- Pessaries rely on a suction seal being created to stay in place, therefore breaking this seal can allow removal.
- Inserting a finger under the rim of the pessary or squirting warm water into the stem of the pessary with a syringe can also achieve this.
- REFERENCES Thakar R.
- Pessaries for treatment of pelvic organ prolapse and incontinence.
Rogers R, Sung WV, Thakar R, Iglesia C (Eds). Female Pelvic Medicine and Reconstructive Surgery: Clinical Practice and Surgical Atlas. Williams Gynecology, McGraw- Hill Education Ltd, 2013:339-52. Thakar, R, Glob. libr. women’s med,, (ISSN: 1756-2228) 2014; DOI 10.3843/GLOWM.10479.
Why would a pessary fall out?
Interpretation – In our study of women aged 55 years and older, higher age was negatively associated with unsuccessful pessary fitting in the final multivariate logistic regression model, which means that in our study, which was explorative, the risk of unsuccessful pessary fitting decreased with advancing age. Evidence of the association is conflicting: some studies did not find an association between age and the likelihood of unsuccessful pessary fitting (e.g. Clemons et al., Markle et al., Mutone et al., Nguyen and Jones ), whereas others found age 65 years or younger to be a predictor of unsuccessful pessary fitting, Older women are more likely to choose pessary treatment over reconstructive surgery and older age has been shown to be a good predictor of the continuation of pessary use in successfully fitted patients, This may indicate that the acceptance and appreciation of pessary treatment for prolapse is higher in older women. Health care providers could therefore try pessary treatment in women of all ages, but especially in older women. In our study, a higher BMI was associated with unsuccessful fitting. This has been found before, An explanation for this might be that increased pressure on the pelvic area in women with a high BMI impedes pessary fitting. However, some studies report a lack of association of BMI with unsuccessful pessary fitting, Thus, this association needs further exploration. Women with underactive or inactive pelvic floor muscles, compared with those with normal pelvic floor function, had a higher likelihood of unsuccessful fitting. It is conceivable that underactive pelvic floor muscles provide insufficient support to the pessary, which in turn results in the pessary falling out. This finding is different from the results of the two other studies that looked at the role of pelvic floor muscle strength in pessary fitting and in which no association was found, A possible explanation for these conflicting results might be the differences in the definition and measurement of underactive pelvic floor muscles. We did not find an association between the severity of pelvic organ prolapse and the likelihood of an unsuccessful pessary fit. We did not find an association between the most prolapsed compartment (anterior wall, posterior wall, or uterus/vault) and unsuccessful pessary fitting either. Although this is in accordance with previous studies, our study may have lacked the power to detect an association because of the low number of patients with the posterior wall as the leading edge of the prolapse ( n = 11). So far, there is controversy regarding the effectiveness of a pessary for posterior wall prolapse as a pessary uses the pelvic floor as a support base and its supportive effect was therefore thought to be presumably anteriorly. To date, there is insufficient evidence to state that a posterior wall prolapse is a risk factor for unsuccessful pessary fitting. The effect of a wide GH or a short vagina on pessary fitting could not be studied because of a lack of patients with these conditions in our sample. In primary care, women with a prolapse often have a normal hiatus width and vaginal length. Patients referred for secondary or tertiary care settings may more frequently show a hiatus > 5 cm or a vaginal length < 6 cm. The discriminatory performance of our final multivariate regression model was moderate and the calibration seemed to be good. Information about the discrimination and calibration is relevant to estimate the performance of a prediction model. This study was performed to generate hypotheses about predictive factors for unsuccessful pessary fitting in general practice rather than to arrive at a prediction model to be used in clinical practice. Information about the independent risk factors for unsuccessful pessary fitting is therefore of greater interest than the performance of the final multivariate logistic regression model. Future research should address the observed risk factors and seek to confirm these associations, preferably in a larger population. Until then, the association between the identified predictors and fitting failure is insufficiently strong to advise against pessary use in women with those predictors.
Does a pessary melt?
The pessary will melt at body temperature and may leak from your vagina. Wear sanitary towel to prevent the pessary from staining your clothes. If you have history of drug allergy, consult your doctor or pharmacist before using the medication. The pessary is recommended to be inserted at bedtime.
Do progesterone pessaries leak out?
Gel/Jelly, Suppository, Tablet –
Your doctor will tell you how much medicine to use. Do not use more than directed. Use this medicine only in your vagina. Do not swallow it. Read and follow the patient instructions that come with this medicine. Talk to your doctor or pharmacist if you have any questions. Wash your hands with soap and water before and after using this medicine. Vaginal gel:
This medicine comes in a prefilled, disposable applicator. Use each applicator only once, and then throw it away.This medicine may leak out of your vagina during the day. You may wear a sanitary pad to protect your clothing, but do not use a tampon. You might see small, white drops of gel up to several days after you insert the medicine.
This medicine comes with a disposable applicator. Place the tablet in the applicator and then insert the applicator into your vagina. Use each applicator only once, and then throw it away.
Missed dose: Take a dose as soon as you remember. If it is almost time for your next dose, wait until then and take a regular dose. Do not take extra medicine to make up for a missed dose. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light.
Can a pessary come out?
Avoid getting constipated – Supporting the area between the anus and the opening of the vagina (figure 5)) when opening your bowels gives confidence to push without pushing the pessary out. Wrap toilet paper or a sanitary pad around your hand and press and support the area just in front of the anus and around the opening of the vagina.
Occasionally a pessary may come out completely and you may need to wash and reinsert it or replace with a new one. If this happens often contact your clinician as you might need a bigger size of pessary. It is normal for the pessary to move sometimes. This may cause discomfort. If this happens, try moving the pessary back into position.
It is a good idea to have a spare pessary available. If any of the following symptoms occur, you should contact the clinic or your GP
Smelly or offensive discharge. An increase in discharge is very common but it should not be smelly. If you notice smelly discharge, contact your clinic or GP. You can change pessaries more often to help with discharge. Bleeding from the vagina. If this happens, take the pessary out if you are able to and contact your clinic or GP. Soreness, discomfort or pain. If this happens, take the pessary out if you are able to and contact your clinic or GP.