Since reading a thread on the thorn tree about this problem, I thought it may be useful to put some of the things I have discovered down here. Please remember that I am not a doctor. If any of you medics out there want to correct me or add more hints please don't hesitate to E mail me.
Infection of single celled fungus Candida Albicans. Causes Itching and white clotted discharge in the knickers that smells a bit yeasty.
Many, but not all women have a very low level of it which only becomes a problem when vaginal conditions favour the growth of the yeast over the growth of other harmless microbes.
Chafeing on the saddle, warm climates and antibiotics favour thrush as well as the antimalarial Doxycycline (which is an antibiotic.)
1) Get your partner to wear a condom. (Treatment packet instructions tell you to treat your partner too. We found this did not work. My theory is that the semen being alkaline and a rich energy source for sperm favours yeast growth)
2) Do not use soap. Only warm water. I also noticed that swimming in salt water caused flare up (perhaps by killing helpful bacteria). A rinse of the region with fresh water after bathing might help.
3) Some people on the internet prefered to wear only good cycling shorts not panties. I prefer cotten knickers that I can wash quite hot and rinse really well. Cycling shorts make the problem worse for me as they seem to have to much padding that relieves pressure on the bottom bones by transfer of pressure to the frontal regions. Terries ladies liberator saddles have a hole for the vital regions and can help.
4) Take a multi vitamin pill. I was plauged by thrush for 9 months of touring until I took vitamins to supplement the nutrient poor diet we expected crossing Mongolia. Since then there have been no problems despite lots of off road bumping. (Until I started doxycycline anti malarials)
5) In Australia I consulted a Naturopath, who recommended an 'anti candida diet'. Although I did not stick to it rigidly, it did work within a couple of weeks. It would be a difficult diet to sustain whilst touring, but perhaps moving towards it might help.
There is no room here for the details, but essentially the idea is to cut down candida in the gut. Presumably this cuts down cross infection to the vagina from the anus. The naturopath said that it also works systemically. Candida thrives on sugar and the same micronutients as other yeasts, so the diet cuts out all foods with a high glyceamic index. That is; all sweet stuff, even fruit and all diary products (milk contains lactose sugar) as well as all carbohydrates which can be digested quickly to yield sugar sadly this includes the potato. The only staple carb allowed is brown rice. All yeast derived products such as beer and wine, marmite, soya sauce and other things with yeast extract in them are also not on.
The diet also prevents bloating of the gut with wind. I found that giving away the bread, beer, sweets and pasta did help, but I could not do without the potato or milk. I used rice crackers instead of bread.
This is definately better than a 2 week cycle of antifungal tablets and pessaries.
If you have ever had thrush before, or if you are taking Doxycycline antimalarials take some treatment with you. I carry 4 courses of pessaries:
You can buy them easily in France, Italy, Greece,China and Russia that I know of. Ask for Canestin or Clotromazole. The russians even have their own brand of clotromazole writen in Cyrillic on the packet. Pessaries are better than cream. It is better to carry at least one course, as the treatment is much more effective if you use it at the first signs of trouble rather than waiting until you can't sit on the saddle. As well as pessaries, you can get a tablet to take by mouth called Diflucan one. I have not had occasion to need it yet, but I believe it is used if pessaries don't work. It's also pretty light to carry round on the bike!
I believe, but do not know, that there are now even more effective traetments available from doctors in the UK and US. If I was planning this trip again, I would pay the doctor a visit prior to departure.