There is only one active ingredient available OTC for the topical treatment of thrush, clotrimazole. It is found in all topical thrush treatments and can be applied directly to the affected area to relieve symptoms. There are two options for topical treatment, creams for internal or external use and pessaries.

Pessaries
There are two types of pessary; the first is bullet shaped and made out of solid vegetable oil and the second is made from soft gel and shaped like a tear drop. As the pessary dissolves the active ingredient is slowly released. There is no difference between the effectiveness of the two different forms of pessary. The type chosen will often come down to the customer's preference with a lot of women choosing the soft gel option due to its comfort and ease of use.

Pessaries are designed to be inserted into the vagina either by using a finger or the applicator provided. It is important to insert the pessary as high into the vagina as possible as they require moisture to fully dissolve. This is particularly important advice for women who suffer from vaginal dryness otherwise they may notice undissolved pieces of pessary crumbling out of the vagina. Customers should be reassured that a white chalky residue is quite normal.

It is recommended that pessaries are used before going to bed as the pessary will be retained within the vagina longer when the patient is lying down and there can also be some leakage. It is recommended that pessaries are not used during menstruation as they could be washed out by the blood flow.

OTC pessaries include Canesten 500mg Vaginal Pessary and Canesten Thrush Soft Gel Pessary. These are both single dose regimes that customers will find more convenient. Some customers may request other strengths of pessary including Canesten 100mg or Canesten 200mg Pessary. The lower strength products have different dosage recommendations and longer treatment periods; refer to the individual patient information leaflets or product packaging for details. Customers should be advised to abstain from sexual intercourse whilst undergoing treatment as this can lead to transmission of the infection to their partner. These products are not licensed for treatment of children less than 16 years old or for customers over 60.

Here are some tips on how to insert a pessary which you can provide to customers who may not have used them before or are concerned about how to use them:

• Always wash hands before touching the pessary.
• Ensure all packaging is removed from the pessary and applicator before use including any plastic or foil wrapped around the pessary.
• When using an applicator ensure the pessary is pushed into the opening at the end of the applicator.
• Sit or lie down with knees bent and legs apart.
• Insert the pessary as far as is comfortable into the vagina either using a finger or the applicator.
• If using an applicator, depress the plunger to release the pessary then remove the applicator from the vagina.
• Wash hands after inserting the pessary.