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 Reviewed by Psychology Today Staff

Building Blocks

How do babies think?

Research on infant thinking suggests that babies are more complex thinkers than was once believed. There is now evidence that, by the end of their first year, children are capable of logical reasoning, testing hypotheses about the world and spending time pondering unexpected discoveries. And, like scientists, babies appear to use process of elimination to come to conclusions.

How do children acquire language?

Young children aspire to repeat the words they hear most often, but context is as important as frequency: Before they use words like the or and, babies focus on words emphasized by their caregivers, those that describe their environment, and their personal interests. Cultural influence also plays a role: In some regions, a child’s first words tend to include more verbs, and in others, terms referring to extended-family relationships come first. In the U.S., where labeling and naming objects is a common part of infant play, babies are more likely to learn words like dog, cat, duck, and kitty. Through large-scale cross-cultural studies, though, a few universal words have been revealed: mommy, daddy, hello, bye, uh-oh, and woof-woof.

What is metacognition?

How much of a child’s intelligence is locked in during early childhood?

How does an involved father benefit cognitive development?

How does conversation strengthen brain development?

Does early exposure to music boost a child’s cognitive development?

How do children acquire prejudices?

Imagination and Play

When do young children learn to distinguish fantasy from reality?

Discriminating fact from fiction can be especially difficult for young children, since their experience of the real world is limited and so much of the media to which they are exposed is based in fantasy or magic. For example, to a child, a picture book about actual astronauts and one about fictional aliens may appear equally real. Yet research shows that, as early as age 3, many children have developed an ability to determine whether content from stories and videos applies to the real world. A parent’s testimony of how the world works is an essential element in this development, along with children’s growing experience of the real world.

Is it a problem if children believe Santa Claus is real?

There has been a good deal of debate over the years about whether stories of Santa Claus, and parental efforts to actively maintain that Santa and other holiday-based characters are real, are harmful to children and their cognitive development. Research shows, though, that virtually all children figure out the truth about Santa Claus by around age 7, even without their parents confessing the truth, and that few children react negatively to the discovery. Children, research further suggests, implicitly understand that fantasy and pretend play is a healthy and fun part of their own development and so they rarely come to resent adults sharing fantasies with them.

How does time playing outside benefit cognitive development?

Do video games hinder cognitive development?

Will too much screen time limit a child’s cognitive development?

Early School Learning

Will starting formal learning as early as possible boost a child’s cognitive development?

It may appear that this is the case, but research shows that the benefit does not last. Formal early learning does produce clear short-term gains for young children, giving many a head start in kindergarten or first grade. But the effect fades quickly: By second or third grade, children who attended formal pre-kindergarten programs are no longer further advanced academically than kids who started their schooling later; in fact, some research suggests that those who started earlier eventually fare worse than others.

What should parents look for in a kindergarten program?

Experts have long debated whether preschool and kindergarten programs should emphasize academic skills or socialization, but a growing body of research supports the latter, for both social and cognitive benefits. Some studies have suggested that while students raised in poverty who attended academic early-childhood programs had initial advantages over peers in elementary school, children who went to play-based kindergartens started earning higher grades by fourth grade. No matter what type of program a family chooses, emphasizing play, socialization, and initiative at home during early childhood delivers clear benefits for children in later years.

How can parents best support a young learner?

Should kids learn to use computers as early as possible?

 Reviewed by Psychology Today Staff

During toddlerhood, one- and two-year-olds display a range of new skills and personality traits, and begin to assert themselves by making their first bids for independence, even as they stay close to their parents or caregivers. They can also be expected to throw tantrums when those bids are denied.

On This Page

• What are the key milestones of toddler development?
• What are signs of developmental concern during toddlerhood?
• How can parents promote empathy in toddlers?
• Can toddlers share?
• How do toddlers manage conflict?
• Can toddlers help around the house?
• Why do toddlers get scared?
• How many words do children need to hear?
• Can a parent detect dyslexia in a toddler?

What are the key milestones of toddler development?

Most children take their first steps during this period, before tackling stairs and starting to run. They begin to undress themselves, to eat with utensils and drink from cups, to throw a ball (or whatever else is handy), and draw straight lines and circles.

According to the Centers for Disease Control and Prevention and the American Academy of Pediatrics, one- and two-year-olds can also be expected to display most of the following social and cognitive skills, although each child develops differently and may achieve some milestones earlier or later than others and still be considered to be experiencing healthy development:

Social Development

• Hand things to others as a form of play.
• Have temper tantrums.
• Display a fear of strangers.
• Show affection to familiar people.
• Engage in pretend play, like feeding a doll.
• Cling to caregivers in new situations.
• Point to show things to others.
• Explore alone, but with parents or caregivers within sight.
• Copy others.
• Show excitement to be around other children.
• Express defiance, such as when told not to do something.
• Play mostly beside other children, but begin to include others in games like chase.

Cognitive Development and Communication Skills

• Point to get attention and show someone what they want.
• Say several single words, including “no,” and, eventually, form sentences of two-to-four words.
• Understand the purpose of common objects like phones, brushes, and spoons.
• Show the ability to point to specific body parts.
• Scribble on their own.
• Follow 1-step verbal requests without any gestures (“sit down”) and, eventually, two-step commands.
• Point to things or pictures when they are named, including in books, and begin to name them themselves.
• Recognize the names of familiar people.
• Repeat words overheard in conversation.
• Find things even when hidden under two or three covers.
• Begin to sort shapes and colors.
• Complete familiar sentences and rhymes.
• Play simple make-believe games.
• Build towers of 4 or more blocks.
• Start to favor a dominant hand.

What are signs of developmental concern during toddlerhood?

If a child in late toddlerhood is not walking steadily, copying others, following simple instructions, or gaining new words, is limited to fewer than 6 words, is not displaying the ability to point to familiar objects and people, does not notice when a caregiver leaves or returns, or loses skills they once had, a parent or caregiver should schedule a developmental screening with their pediatrician.

How can parents promote empathy in toddlers?

Empathy involves understanding what another person may be feeling, and then feeling or imagining a similar emotion. Research suggests that children clearly display empathy by about 18 months of age, often taking action to help an adult who seems to be struggling with a task or comforting a parent or caregiver who seems sad or distressed. For children who may be highly sensitive, taking on others’ emotions may be easy, even if it’s sometimes overwhelming; for other children, research shows, parents who talk about emotions, openly and often, can help them develop higher levels of empathy—along with, of course, modeling empathy at home.

Can toddlers share?

Yes, even if it’s harder when they are tired or overwhelmed. Research shows that, before turning 2, children will share their food with others, even a stranger—and even if they are hungry themselves. Evolutionary psychologists believe that “altruistic food transfer” is a key behavior that separates humans from other primates, one that fosters group cohesion and, in a larger sense, the success of the community and the species.

How do toddlers manage conflict?

Toddlerhood has long also been known as “the terrible twos,” because children often struggle to manage their emotions and behavior at this age. But it is also the stage when kids begin to play with each other, and recent research has shown that, contrary to their reputation, toddlers respect and favor fair play. Watching pretend scenes in which one puppet won a conflict because another puppet got out of its way or otherwise deferred to it, toddlers reported that they liked the winning puppet better. But when the winning puppet ended a conflict by pushing the other puppet out of the way, toddlers did not like the winner more.

Can toddlers help around the house?

They can certainly try, and if they show an interest, parents should let them (within reason). A large body of research shows that virtually all toddlers who watch a parent or caregiver do chores will make gestures to help or copy them. This desire to help out, researchers believe, is nearly universal, but many parents mistakenly do not allow it, often because they believe the toddler may get hurt, may create more work for the adult, or just slow things down. And when parents do ask toddlers to help, they often recruit them with the promise of a reward, quashing their instinct to chip in just to be helpful.

Why do toddlers get scared?

Fear is not innate in humans, many researchers believe (the fear of creatures like spiders and snakes may be an exception), but is instead learned, typically in late infancy and early toddlerhood. For most children, their first fear is of strangers, strange places, or the departure of parents or caregivers. Some fears are conditioned—being “attacked” by an aggressive or overly enthusiastic or affectionate dog, for example. Others fears are learned by example, such as seeing a parent’s fearful reaction to blood.

How many words do children need to hear?

Research has long suggested that significant differences in eventual academic success emerge between children who hear more words in their homes at a young age, and those who don’t. More recent studies find that the differences can be vast: Some adults use as few as 400 words in a 90-minute period with a child, while others use as many as 9,000. But another key difference emerged from these studies: the importance of the diversity of the words a child hears. Children whose parents or caregivers used a wider range of words, including difficult words and even nonsense words, appeared to have an academic advantage later, even if they hadn’t heard the highest volume of words.

Can a parent detect dyslexia in a toddler?

Dyslexia, which involves difficulty with accurate word recognition, as well as poor decoding and spelling, affects 10-15 percent of children. Effective intervention and instruction can help children with dyslexia manage and excel in school, but early detection is greatly beneficial and many signs tend to emerge in toddlerhood. Parents should be aware of struggles with phonological awareness skills—in other words, if a child fails to match letter names to their corresponding sounds, or has trouble blending sounds into larger words, recognizing rhymes, or pronouncing common words.

What are the key milestones of infant development?

Babies make a tremendous amount of progress during their first year, developing the ability to get to a seated position without help, pulling themselves up to stand, taking steps while holding onto furniture, and perhaps taking their first independent steps.

According to the Centers for Disease Control and Prevention and the American Academy of Pediatrics, infants can also be expected to display most of the following social and cognitive skills, although each child develops differently and may achieve some milestones earlier or later than others and still be considered to be experiencing healthy development:

Social Development

• Is shy with strangers
• Cries when parents leave
• Has favorite things and people
• Shows fear in some situations
• Hands adults a book when they want to hear a story
• Repeats sounds or actions to get attention
• Puts out an arm or leg to help with dressing
• Plays games such as “peek-a-boo” and “pat-a-cake”

Cognitive Development and Communication Skills

• Responds to simple spoken requests
• Uses simple gestures, like shaking their head for no, or waving “bye-bye”
• Makes sounds with changes in tone that mimic speech
• Says “mama” and “dada” and exclamations like “uh-oh”
• Tries to repeat words they hear
• Explores things in different ways, like shaking, banging, throwing
• Finds hidden things easily
• Looks at the right picture or thing when it’s named
• Starts to use objects correctly like a cup or hairbrush
• Puts things in a container, takes things out of a container
• Lets things go without help
• Pokes with index finger
• Follows simple directions like “pick up the toy”

Can babies think logically?

Researchers who explore infant thinking now believe that babies are more complex thinkers than was once believed and there is some evidence that, by the end of their first 12 months, they are capable of logical reasoning, testing their hypotheses about the physical world and spending more time pondering unexpected results than expected ones. They also appear to use process of elimination to come to conclusions, not unlike adult detectives and scientists.

How does skin-to-skin contact benefit babies?

Cuddling is an essential piece of the bonding process for parents and babies—especially for premature babies—but research shows that it has powerful effects beyond building a relationship. Touch calms babies by reducing levels of stress hormones like cortisol and lowering their heart rate. Not insignificantly, skin-to-skin contact with their babies calms stressed-out new parents as well. There is also no evidence that holding or carrying babies “too much” will spoil or otherwise inhibit them; in fact, some research suggests that adults who were held and cuddled more as babies were more likely to be well-adjusted later in life.

Are babies moral?

It has long been believed that babies are amoral and must be taught to be helpful or kind to others. But a growing body of research shows that humans may be innately prosocial. Studies of babies as young as seven months old find that they are willing to share food, toys, and other objects, not only with their parents but with strangers as well, and both when requested and spontaneously. Newborns also show empathy, crying in reaction to hearing another baby’s cry in the first days of life. Later, they mimic the gestures and sounds their parents make to comfort them when they see another infant experiencing distress.

Why do babies laugh so much?

Babies love to laugh, and laboratory observations show that they also take it very seriously, focusing intensely on games that lead to laughter, such as peek-a-boo. Developmental psychologists believe that a baby’s laughter may serve a primarily social function; it is an invitation to adults to engage with them and it encourages adults to keep playing even if the basic action is repetitive. For the baby, the key to such games is the adult’s participation.

How does taking their first steps change an infant’s world?

Once a child begins to walk, they can navigate and explore their world in a much more directed and aggressive way. It is also considered to be a major milestone for a parent, whose role as supervisor and protector transforms. A parent’s anxiety may increase at this stage, although they will soon learn that while babies fall often as they take their first steps, they are rarely troubled by stumbles very long. It is the first step on the path toward granting their child independence.

Which words does a child say first?

A child’s first words are heavily influenced by which words their parents use most often, as well as local cultural effects: In some cultures, a child’s first words tend to include more verbs; in others, more terms referring to extended-family relationships; and in the U.S., where labeling and naming objects is a more common aspect of infant game play, babies are more likely to learn words like dog, cat, duck, and kitty. Large-scale cross-cultural studies, however, point to at least six universal first words: mommy, daddy, hello, bye, uh-oh, and woof-woof.

Urethritis is an inflammation of a male’s urethra (the tube you pee through).

Key points

1. Urethritis is usually due to a sexually transmitted infection (STI) such as chlamydia or gonorrhoea.
2. Urethritis can be caught by having vaginal, anal or oral sex without a condom, or sex play.
3. If you use a condom every time you have sex you are much less likely to get urethritis.
4. Testing: You will need a swab test from the urethra and will need to do a urine test.
5. You need to tell anyone you have had sex with with in the last 2 months to get a sexual health check and treatment.
6. You should use condoms or avoid sex for 7 days after you and your partner(s) have been treated so you don’t pass the infection on to someone else.

Causes

Urethritis can be caused by sexually transmitted infections such as chlamydia or gonorrhoea.
It can also be caused by injury, or other conditions causing the same symptoms, such as prostatitis (inflammation of the prostate).

Symptoms

Common symptoms may include:

• discharge leaking from the urethra
• pain or discomfort when urinating
• itching in the urethra.

Treatment

Urethritis is usually treated with tablets. Sometimes you may need an injection.

Learn more

Urethritis patient information 

Image: Canva

What are the causes of trichomoniasis?

Trichomoniasis is caused by a parasite called Trichomonas vaginalis. Trichomoniasis is transmitted through contact with genital fluids from the penis or vagina of someone who has the infection. Ιt can also be passed on by sharing sex toys, eg, vibrators. You don’t need to have many sexual partners to get the infection.

What are the symptoms of trichomoniasis?

About 70% of infected people don’t have any signs or symptoms. When trichomoniasis does cause symptoms, they can range from mild irritation to severe inflammation. Some people get symptoms within 5–28 days of being infected, but others don’t develop symptoms until much later. Symptoms can come and go.

Women

• You may feel pain, burning or itching in your genital area.
• You may also feel pain or discomfort when passing urine (peeing) or having sex.
• You may notice a discharge or fluid leaking from your vagina.
• You may also have a bad odour (smell) in your genital area.
• Many women have no symptoms.

Men

• Μost men don’t have symptoms.
• You can still pass trichomoniasis on even when you don’t have symptoms.
• You may have discharge or fluid leaking from your penis.
• You may also have pain when passing urine (peeing) or during ejaculation (coming).
• You may have pain, swelling or redness around the head of your penis.

How is trichomoniasis diagnosed? 

As the symptoms of trichomoniasis are similar to other STIs, it can be difficult to diagnose. Your doctor will ask you a few questions about your symptoms, and whether you have had any sexual contact with someone with trichomoniasis infection. Your doctor will also examine your genital area.

For women, a swab will be taken from your vagina. For men, your doctor may suggest a urine test or a swab depending on your symptoms. Your doctor may offer treatment straight away without waiting for test results if you have had sex with someone who has trichomoniasis.

If you have trichomoniasis, your doctor may also test for other STIs or do a sexual health check.

How is trichomoniasis treated?

Trichomoniasis can be treated with either a single dose of antibiotics or as a 1-week course. The antibiotic is called metronidazole. The tablets can sometimes make you feel a bit sick, but it helps if you take them with food. Don’t drink alcohol for 24 hours after taking the tablets as it will make you feel really sick.

Without treatment, the infection can last for months or even years.

It is common to get infected with trichomonas again. Make sure all your sexual partners get treated too. Don’t have any unprotected sex (sex without a condom) until a week after you have started antibiotic treatment. Make sure you get checked again if your symptoms come back.

What are the complications of trichomoniasis?

Usually, there are no complications from a trichomonas infection unless it is left untreated.

• It can increase the risk of getting or spreading other STIs, such as HIV and bacterial vaginosis. For example, trichomoniasis can cause genital inflammation, which makes it easier to get infected with the HIV virus, or to pass the HIV virus on to a sex partner.
• Both men and women are at increased risk of infertility.
• Trichomoniasis can cause pelvic inflammatory disease in women.
• It can also cause inflammation of the prostate gland in men (prostatitis).
• Trichomoniasis has been associated with having your too early (preterm), and for your baby to have a low birth weight.

How can I prevent trichomoniasis?

Practising safer sex can protect you from getting, or passing on trichomoniasis and other STIs. The following tips can help prevent STIs:

• Use condoms during vaginal, oral or anal sex with every partner, every time.
• Keep sex toys clean and avoid sharing sex toys with others.
• Have sex with only one partner (who is also only having sex with you).
• Avoid having sex if you or your partner has any symptoms such as sores, ulcers, discharge or any pain around the genital area – get checked by a doctor first.
• Have regular STI checks (every 3 months), especially if you have had any unprotected sex (sex without a condom) or have more than one partner.
• Wash your hands with soap and water before and after sex or sexual play.

Read more about safer sex.

What support is available with trichomoniasis?

If you think you have trichomoniasis or any other sexual health concerns, you can see or talk to your GP. Alternatively, there are other options where you can get help.

Sexual health clinics
Family Planning clinics

Learn more

Trichomoniasis patient information NZ Sexual Health Society
Trichomoniasis Family Planning, NZ
Trichomoniasis (Trich) Just The Facts, NZ
Trichomoniasis NHS, UK

References

1. Trichomoniasis management summary NZ Sexual Health Society, 2017
2. Trichomoniasis patient information NZ Sexual Health Society
3. Trichomoniasis Family Planning, NZ
4. Trichomoniasis (Trich) Just The Facts, NZ
5. Trichomoniasis infection HealthInfo Canterbury, NZ
6. Trichomoniasis Patient Info, UK
7. Trichomoniasis Centres for Disease Control, US

Reviewed by

	Dr Phoebe Hunt is currently working as a registrar in sexual health at ADHB. Her interests are in women’s health, sexual health and lifestyle medicine. Phoebe is planning on starting GP training next year.

Resources

Support

Phone Healthline for free on 0800 611 116 any time of the day or night for advice on any health issue, no matter how small. In an emergency, phone 111 for an ambulance.

Sexual Health Clinics NZ – find a clinic near you  Phone 0800 739432
Auckland Sexual Health Service – find a clinic near you Phone 0800 739 432
Family Planning Phone 0800 372 546

Contact your GP if you have any concerns. To find a GP near you, go to Healthpoint NZ

Brochures

 A compact guide to sexual health

Ministry of Health, NZ, 2012

 A “how-to guide” for a sexual health check-up

BPAC, NZ, 2013

 Trichomoniasis

NZ Sexual Health Society, 2012

Related topics

Sexual health overviewOverview of contraception methods | Rongoā ārai hapūtangaSafer sex – how can I prevent STIs?Safer sex and STI topics

Vaginal thrush (mateīhi) is a common yeast infection that affects most women at some stage. Common symptoms include vaginal itching, discharge and pain.

On this page, you can find the following information:

• What causes vaginal thrush?
• Are some women more at risk of vaginal thrush?
• What are the symptoms of vaginal thrush?
• Can I self-diagnose vaginal thrush?
• Should I see a pharmacist or my doctor about treatment for vaginal thrush?
• What is the treatment for vaginal thrush?
• I’m pregnant, is thrush going to harm my baby?
• Can I have sex when I have vaginal thrush?
• Will my sexual partner need treatment?
• How can vaginal thrush be prevented?

Key points 

1. Vaginal thrush is caused by an overgrowth of, or an allergic reaction to, a yeast called Candida albicans.
2. Vaginal thrush usually clears up within a week of treatment with antifungal medication. This is available at your pharmacy or on prescription from your doctor.
3. For some women, vaginal thrush is more difficult to treat and tends to occur quite frequently, despite treatment. Read more about recurrent vaginal thrush.

Image: 123rf

What causes vaginal thrush?

Vaginal thrush is caused by an overgrowth of, or an allergic reaction to, a yeast called Candida albicans. It is normal to have Candida in your vagina and most of the time it does not cause any problems. However, sometimes certain factors disrupt the natural balance, causing the Candida to multiply. Up to 3 out of 4 women will have at least one bout of thrush in their lives.

Vaginal thrush is sometimes called candidiasis or vaginal yeast infection or vaginal candidiasis.

Are some women more at risk of vaginal thrush?

Vaginal thrush can affect women and girls of all ages, but it is rare before puberty or after menopause. Your risk of getting vaginal thrush increases if you:

• are pregnant
• have a history of sexually transmitted infections (STIs)
• have recently been on a course of antibiotics or steroids
• have diabetes and your blood glucose is not under control
• use a type of hormonal birth control that has higher doses of oestrogen
• have a weakened immune system, such as from chemotherapy
• have a skin condition such as eczema or dermatitis
• have sex when you are not fully aroused, as vaginal dryness during sex can trigger thrush
• wear tight fitting clothes
• use vaginal deodorants, sprays, gels and wipes, perfumed bubble baths, douches or other products that change the natural acidity of your vagina.​

In some women, vaginal thrush tends to occur quite frequently. If you experience 4 or more vaginal thrush infections per year, this is called recurrent vaginal thrush. Read more about recurrent vaginal thrush.

What are the symptoms of vaginal thrush?

Symptoms of vaginal thrush include:

• itching or irritation around your vagina and vulva
• burning or stinging when urinating (weeing)
• vaginal discharge – this can be thick and white or thin and watery, without any smell
• pain during sex.

Some people have no symptoms and thrush may be picked up when having a test for something else.

Can I self-diagnose vaginal thrush?

Because it’s so common and symptoms are well known, many women self-diagnose and self-treat thrush with over-the-counter products. 

The signs and symptoms of vaginal thrush are a lot like symptoms of sexually transmitted infections (STIs) and bacterial vaginosis. These conditions can increase your risk of getting other STIs and can lead to problems getting pregnant. So if you are not completely sure if you have thrush, see your doctor.

Should I see a pharmacist or my doctor about treatment for vaginal thrush?

If you’ve had vaginal thrush diagnosed in the past and you know the symptoms, you can buy antifungal treatment from a pharmacist.

Sometimes symptoms of vaginal thrush may be due to another condition. See your doctor if you have symptoms of vaginal thrush and you:

• are having symptoms of thrush for the first time
• are under 16 years or over 60 years old
• are pregnant
• have treated yourself with a thrush treatment from the pharmacy, but your symptoms have not gone away
• have a history of, or are concerned about, sexually transmitted infections
• have any of the following vaginal symptoms:
  • discoloured or strong smelling discharge
  • lower abdominal pain or vaginal bleeding that is not your period
  • ulcers or blisters next to your vagina
  • vaginal thrush symptoms that have not settled despite appropriate treatment
  • vaginal thrush symptoms more than four times in a year
  • vaginal thrush symptoms plus other symptoms such as fever, tiredness or nausea.

What is the treatment for vaginal thrush?

Antifungal medicine is the best treatment for vaginal thrush. It comes in the form of vaginal creams, pessaries (tablets you insert into your vagina) or capsules that are taken by mouth (fluconazole). The choice of treatment and the dose will depend on different factors such as:

• whether your symptoms are mild or severe
• how often you get vaginal thrush
• whether you are pregnant.

Read more about the treatment of vaginal thrush using medicines.

The following measures have not been shown to help:

• Special low-sugar, low-yeast or high-yoghurt diets
• Putting yoghurt into the vagina
• probiotics

I’m pregnant, is thrush going to harm my baby?

Thrush does not damage the vagina and it does not spread to damage the womb (uterus). Having thrush while you are pregnant won’t harm your unborn baby but if you have thrush when you are giving birth, it may be passed on to your baby. If this happens you will be given advice on how to treat it. Untreated thrush can cause problems so make sure you see a doctor if you think you have thrush to find out how best to treat it during pregnancy.

Can I have sex when I have vaginal thrush?

You can still have sex when you have vaginal thrush. However, it can be uncomfortable and you may experience a burning sensation during or after sex. Use plenty of lubricant to protect your skin. Thrush can also pass to the mouth during oral sex. Read more about oral thrush here.

Use barrier forms of contraception (eg, condoms) to avoid passing thrush to your partner.

Some vaginal creams can weaken condoms, so apply the treatments after you have had sex if you are using condoms, or use alternative forms of contraception.

Will my sexual partner need treatment? 

It is possible to pass thrush to your partner during vaginal, oral or anal sex.

• If your sexual partner is a man, the risk of infection is low. He should see a doctor if he gets an itchy red rash on his penis. Read more about thrush in men.
• If your sexual partner is a woman, she may be at risk. She should be tested and treated if she has any symptoms.

How can vaginal thrush be prevented?

The best way to prevent vaginal thrush is to identify what triggers it. If you get recurrent vaginal thrush and are unsure what is causing it, discuss your symptoms with your doctor. They can investigate the underlying causes and suggest ways you can manage it. Read more about recurrent vaginal thrush.

Things you can do to ease discomfort and prevent vaginal thrush returning:

• Dry the affected area properly after washing.
• Wear loose cotton underwear and avoid tight clothing.
• Always wipe from the front (vagina) to the back (anus) after toileting.
• Use only water-based lubricants.
• Use soap substitutes such as water-based emollients.
• Consider changing your laundry detergent.
• Ensure your blood glucose level is kept under control if you have diabetes.

Avoid the following: 

• Avoid using soap to wash your genital area.
• Avoid irritants such as deodorants, talcum powder, bubble bath solutions, deodorised panty shields or vaginal douches.
• Avoid spermicidal condoms.
• Avoid fabric softeners.

Learn more

Thrush (candida) HealthInfo, NZ
Understanding your vaginal swab results  HealthInfo, NZ
Vulvovaginal candidiasis DermNet, NZ
Thrush in men and women NHS Choices, UK
Vaginal candidiasis CDC, US
Thrush in pregnancy NHS, UK

References

1. Vulvovaginal health in premenopausal women BPAC, NZ
2. Vaginal and vulval infections NZ Formulary, NZ
3. Thrush NHS, UK, 2021

Reviewed by

Dr Jeremy Tuohy is an Obstetrician and Gynaecologist with a special interest in Maternal and Fetal Medicine. Jeremy has been a lecturer at the University of Otago, Clinical leader of Ultrasound and Maternal and Fetal Medicine at Capital and Coast DHB, and has practiced as a private obstetrician. He is currently completing his PhD in Obstetric Medicine at the Liggins Institute, University of Auckland.

Syphilis is a sexually transmitted infection (STI) caused by a bug that gets into your body through tiny breaks in your skin, mainly in your genital area or mouth.

On this page, you can find the following information:

• How do you get syphilis?
• What are the symptoms of syphilis?
• How is syphilis diagnosed?
• Does syphilis affect pregnancy?
• Do I need to tell sexual partners if I have been diagnosed with syphilis?
• How is syphilis treated?
• Should I avoid sex when I have syphilis?
• How is syphilis prevented?
• Where do I go for a check-up?

Key points about syphilis

1. Many people don’t get any symptoms and would not know they had syphilis without having a blood test.
2. You get syphilis by having sexual contact, including oral sex with another person with syphilis.
3. Condoms help prevent syphilis. Having had syphilis once does not protect you from catching it again. 
4. Treatment is normally with injections of an antibiotic called penicillin.
5. If left untreated, the syphilis bacteria eventually causes damage to your internal organs. People without symptoms can still develop these problems later on if not treated.

How do you get syphilis?

Syphilis is very infectious and is usually caught by having close sexual contact with an infected person. This may include vaginal, anal or oral sex or just close skin-to-skin contact. The chances of catching syphilis are lower if you use condoms during sex.

Syphilis can also be spread from mother to baby during pregnancy if the mother is infected. It can cause miscarriage, stillbirth or infection in the baby if the mother is not treated.

Syphilis is highly infectious in the earlier stages, so it’s important to diagnose and treat it as soon as possible to prevent its spread.

What are the symptoms of syphilis?

About 50% of people don’t get any symptoms and would not know they have it without having a blood test. People without symptoms can still get problems later on if they are not treated and can still pass the infection on to their sexual contacts. 

For those who do get symptoms, syphilis is divided into 3 stages: primary, secondary and tertiary.

• Primary and secondary syphilis are also known as infectious syphilis.
• Tertiary syphilis is known as non-infectious or late-latent syphilis. 

Primary syphilis

The first sign of syphilis is a sore, usually on your genitals but it may also appear on other parts of your body where there has been sexual contact. The sore may be hidden in your cervix, mouth or anus and because it is usually painless it may go unnoticed.

The sore usually appears 3–4 weeks after infection, but sometimes it takes longer. It disappears without you doing anything within a few weeks. 

• Even though the sore heals, you still have the syphilis infection and can pass it onto others.
• Any genital sore must be examined by a doctor, even if it starts to heal and is small and painless. 

Secondary syphilis

Sometimes a rash appears quite suddenly about 6 weeks after infection. It may appear on your body, face, arms and often on the palms and soles of your feet.

The type of rash and how large it is varies from person to person and even on different parts of the body of the same person. It may be very obvious but it may be so mild that you don’t notice it. It rash lasts up to 4–6 weeks and often disappears as suddenly as it appeared. 

There may also be one or more of the following symptoms: 

• mouth ulcers
• headache
• swollen glands
• fever
• hair loss
• general tiredness
• flat warty growths in your genital or anal area.

A person in the primary or secondary stage of syphilis is very infectious because the sores and rashes are full of syphilis bacteria. There is a very high chance of infecting a sexual partner.

If syphilis is not treated in the primary or secondary stages, the symptoms will disappear but you can remain infectious for up to 2 years. 

At this stage, infection is only picked up on blood tests.

Tertiary syphilis

If not treated, a small number of people will get late stage syphilis (or tertiary syphilis), which can cause damage to your heart, brain, nerves, blood vessels, liver, bones and joints many years later.

Treatment is still effective and can prevent further damage, but will not repair any damage that has already taken place. Tertiary syphilis is not infectious and can be avoided by treatment at an earlier stage.

How is syphilis diagnosed?

Syphilis is usually diagnosed by blood tests for antibodies to the syphilis bacterium. It can take up to 3 months to develop antibodies, so the tests may be negative early on. If you have a genital sore or body rash, the doctor may also take samples from the sores to be sent for laboratory analysis. 

Does syphilis affect pregnancy?

Syphilis can be spread from mother to baby during pregnancy if the mother is infected. This can result in stillbirth, miscarriage or an infected baby. An infected baby may be born without symptoms but could develop them within a few weeks and could become very ill. Proper treatment of the mother during pregnancy will prevent the baby being born with syphilis.  

It is recommended that every woman have a blood test for syphilis during pregnancy and this is done as part of routine antenatal blood tests early in pregnancy. It is important to continue to test for syphilis later in pregnancy if there is a risk of infection during pregnancy.  

Do I need to tell sexual partners if I have been diagnosed with syphilis?

If you have been diagnosed with syphilis, all your sexual partners from the past few months must be advised to see their doctor or local sexual health clinic. You doctor will let you know how many months this needs to be. 

• If you had sex with them while the rash or sore was present they will usually need treatment.
• You should not have sex until your rash or sore clears up because you remain infectious for some time after treatment. This is the only way to control the disease and protect the health of sexual partners.
• Anyone who has had sex with an infected person in the past must be tested and treated if necessary.
• Some people feel embarrassed, scared or angry when they or their partner has a sexually transmitted infection (STI). This is common and okay. Don’t let these feelings stop you from getting medical help or telling your partner. Anyone who is sexually active can get an STI.
• Talk to partners as soon as possible. If left untreated, syphilis can cause complications and be spread to other partners. Tell current partners or past sexual contacts to see their doctor or sexual health clinic because they may have an STI.
• If you need help contacting your sexual partner(s), talk to the doctor or nurse at the sexual health clinic for advice. 

How is syphilis treated?

You will need injections of an antibiotic called benzathine penicillin. If you are allergic to penicillin other antibiotics will be used.

• In most cases penicillin injections are used but under certain circumstances the medication may be taken by mouth (eg, tetracycline or erythromycin tablets).
• Take the treatment exactly as prescribed and do not miss any doses, as this will reduce its effect.
• The length of treatment varies according to the stage of infection and type of antibiotic used.
• Proper treatment of women during pregnancy will prevent the baby being born with syphilis.
• After treatment with penicillin injections some people (particularly in early syphilis) have a flu-like illness for 24 hours. This includes fevers, aches and pains, and generally feeling unwell. This will go away and doesn’t require any special treatment, except possibly over-the-counter medication (such as paracetamol) for fever and pain, and resting.

After treatment, follow-up blood tests are essential for at least 1 year to ensure the treatment has been successful. If it seems likely that the infection has occurred recently, sexual partners are also usually treated because the blood tests may not become positive for several weeks. Having syphilis once does not protect you from getting it again. 

Should I avoid sex when I have syphilis?

You should not have sex until your rash or sore clears up because you remain infectious for some time after treatment. How long will vary from one person to another, so ask your doctor or nurse about this. This is the only way to control the disease and protect the health of sexual partners.

How is syphilis prevented?

Syphilis can’t always be prevented but if you’re sexually active you can reduce your risk by practising safer sex.

• Use a male condom or female condom during vaginal, oral and anal sex.
• Use a dental dam (a square of plastic) during oral sex.
• Avoid sharing sex toys – if you do share them, wash them and cover them with a condom before each use.

These measures can also reduce your risk of catching other STIs. Because many people don’t have symptoms, having regular sexual health check-ups is important.

Where do I go for a check-up?

Sexual health clinics have specialists who are experienced in diagnosing and treating syphilis. Treatment is free and confidential and the people there can help with testing your sexual partners. 

Learn more

Syphilis Ministry of Health, NZ
Syphilis Just the Facts, NZ
Syphilis patient information The NZ Sexual Health Society
Syphilis Healthy Sex, NZ

References

1. Syphilis management summary NZ Sexual Health Society, 2017
2. Syphilis and pregnant women and congenital syphilis Goodfellow Podcast, NZ
3. Syphilis in NZ Goodfellow Podcast, NZ

Sexual assault is any sexual contact without consent. It includes rape, attempted rape and any other kind of forced sexual act (kissing, touching, oral sex, taking pictures). It can affect people of all genders, ages, cultures and backgrounds.

Key points

1. Women are much more likely than men to be sexually assaulted, but it also happens to men.
2. Often, the person who commits the assault is someone you know.
3. Sexual assault is never your fault.
4. It is your choice whether you want to report it to the police.
5. Unfortunately, sexual assault is quite common and most crimes are not reported
6. Recovering from a sexual assault can take time, but there is help for you even if it happened a long time ago.

What is consent?

Consent is required when two people agree to take part in sexual activity. Without consent from both people, sexual activity is illegal. In New Zealand, you must be over 16 years of age to consent to sexual activity. 

Consent is an enthusiastic yes, not just the absence of saying no. Consent is often established with talking and body language. Consent cannot be given if you are asleep, unconscious, too drunk or high on drugs.

Consent is a continuous process – just because you said yes initially, it doesn’t mean you can’t change your mind. And just because you have had sex with this person in the past, this doesn’t guarantee consent to sex in the future. Consent must be given freely without pressure or coercion from the other person.

Read more about consent.

What should I do after a sexual assault?

Remember, if you have been sexually assaulted, it’s not your fault. The responsibility for sexual assault lies with the person who did it. It doesn’t matter whether you had been drinking, were out late at night, what kind of clothes you were wearing or if you had agreed to go out on a date with them.

It’s normal to feel upset, scared, angry, numb or shut down, and you might also feel disbelief, humiliation, disgust, guilt, regret, self-blame and want to keep it a secret. Talking about it with someone can help you work through these feelings.

Get help from your doctor

It’s a good idea to see your doctor so they can treat any injuries and protect you against unwanted pregnancy and sexually transmitted infections. They may also refer you to a specialised doctor to collect forensic evidence in case you decide to report the assault to the police. 

You are in charge of your body, and you can say no to any part of the examination. They may prescribe medication to stop an unwanted pregnancy or sexually transmitted infection. You may need to go to a follow-up appointment with your doctor to see if the medications have worked and to talk about what support you need.

Decide whether to report the assault to the police

It’s your choice whether or not to report your sexual assault to the police. If you decide to, you can take someone with you as a support person. The police can also help to arrange a medical assessment and make sure you have all the support you need.

If you are over 16 years old, you can see a doctor without having to report your assault – many are not reported and it’s up to you whether you do or not.

Get some support

Tell someone you trust – a friend, family/whānau member, teacher or church leader. Let them be there for you. You might not know what you need at times, but at least you have someone you can talk to when you need to.

Talk to a professional

It can also help to talk about what has happened with a counsellor or psychotherapist. They are used to helping people through these kind of experiences. You can do this straight away or many years later. There is free support available for you funded by ACC. Read about ACC’s sexual assault support. 

As well as any injuries and distress at the time, over time you might start to experience PTSD, depression, anxiety or thoughts about suicide. If this happens, it’s important to get help as soon as you notice yourself feeling this way.

Look after yourself

Take good care of yourself while you are recovering by:

• getting plenty of sleep
• eating nourishing food
• doing gentle exercise
• spending time with close friends
• doing relaxing activities, such as baths, walks, good books and soothing music
• avoiding alcohol and drugs.

Where can I get support?

Contact one of these specialised organisations for support:

Safe to talk 24/7 free and confidential helpline. Phone 0800 044334 or text 4334.
ACC sensitive claims Funded counselling options.
NZ Police Advice about what you can do after an assault.
Rape Crisis A non-profit, community agency that supports survivors of sexual violence to progress towards healing. Phone 0800 88 33 00.
Rape Prevention Education Free support and counselling to survivors of rape and sexual abuse.
Sexual Abuse Help Foundation Support for survivors in Wellington and Auckland for people of all ages and genders. 24/7 free crisis support line: Auckland 09 623 1700 Wellington 04 801 6655.
Sexual Abuse Prevention Network Education and advice with the goal of ending sexual abuse.
The Harbour An online information hub for survivors, those who have harmed and family/whānau and friends.
Victims’ information A website developed by the Ministry of Justice to help support victim-survivors of sexual violence through the court process and to help them make informed choices about the actions they take after they’ve experienced sexual violence.
Wellington HELP Free support for anyone who has been affected by sexual violence in the Wellington region.

Learn more

Consent BodySafe, NZ
Support services for sexual abuse in Auckland HELP Auckland, NZ
Sexual assault statistics Rape Prevention Education, NZ
Legal definitions around sexual abuse Rape Prevention Education, NZ
Advice for victims NZ Police
Your options SAATS Link, NZ
Getting specialist medical help after sexual assault SAATS Link, NZ
Sexual abuse Oranga Tamariki, NZ

References

1. Fergusson DM, McLeod GFH, Horwood LJ. Childhood sexual abuse and adult developmental outcomes – findings from a 30-year longitudinal study in NZ Child Abuse & Neglect. 2013 Sept; 37(4): 664–674.
2. Post-traumatic stress disorder management National Institute for Health Care and Excellence, UK, 2005
3. Sexual violence research and data Ministry of Justice, NZ
4. Latest crime survey reveals surprising high levels of unreported sexual violence Ministry of Justice, NZ, 2020

Reviewed by

	Dr Phoebe Hunt is currently working as a registrar in sexual health at ADHB. Her interests are in women’s health, sexual health and lifestyle medicine. Phoebe is planning on starting GP training next year.

For most people, your teenage and young adult years are when you start to express your sexuality. There’s a lot that goes along with that change, so it’s really useful to know who can help with what.

Key points

1. Sex can be great! It’s one of the pleasures of life that open up as you mature into adulthood. However, being sexually active comes with responsibilities and a need to look after your sexual health. And sometimes sex isn’t great, so you need to know how to protect yourself and what to do if something not great happens to you.
2. Young people in New Zealand have a high rate of unplanned pregnancies and STIs. If you don’t want this for yourself, you need to know about how to look after your sexual health.
3. The first thing to know is that you only have to have the kind of sex you want when you are ready. Learning how to be sexual just with your own body is a great place to start as it can help you find out what you like and what you don’t.
4. Take your time to explore your sexuality and what kind of sexual experiences feel right for you. There’s a lot more to sex than penetrative sex. And if you don’t want to have any sex, that’s fine too.
5. You also need to know about how to manage relationships, safer sex, contraception, pornography, sexually transmissible infections (STIs) including HIV, and what to do if something goes wrong. That’s a lot!
6. Here are some places that will give you the information and support you need so you can enjoy good sexual health and get support if you need it.

General information, support and advice

The Real Sex Talk Online discussions, articles and videos about sex, gender identity, relationships, consent and more.
Just the Facts This website tells you how to look after your sexual body, keep yourself safe from sexually transmitted infections (STIs) and what to do if you catch one.
BodySafe Works with young people to promote respectful relationships and prevent sexual violence.
Family Planning This New Zealand-based website provides up to date information on many sexual health-related topics and answers common questions about contraception.
The Light Project A website to start the conversation and help equip New Zealand youth, their whānau and communities to navigate the new porn landscape.  
Youthline Youthline provides a free, confidential and non-judgemental telephone counselling service and other resources for young people, including about your sexuality, gender identity, sexual health, relationship issues and anything else you want to talk about.
Sexual Health Clinics For sexual health check-ups, including if you think you may have an STI.
Sexwise A sexual health programme for secondary school students. It is a theatre in education programme, consisting of a theatre performance and an interactive workshop.
Healthline Call Healthline free on 0800 611 116 for health advice and information. A trained nurse can give you advice on what to do about any sexual health issue.
Abortion Services in New Zealand A website providing impartial information on the abortion services available throughout New Zealand and how to access them.
New Zealand Herpes Foundation A website providing information and support for people with, or wanting to know more about, herpes simplex.
HPV New Zealand A website providing information and support for people with, or wanting to know more about, genital or oropharyngeal HPV (human papillomavirus).
New Zealand AIDS Foundation A website to answer all of your questions about HIV in New Zealand. Their services include prevention, testing, counselling and support for people living with HIV.

Organisations for LGBTQI+ and sexual identity

Rainbow Youth Rainbow Youth is an Auckland-based organisation that provides information, advocacy and education for queer young people, their friends and whānau.
Ending HIV offers a combination of tools to gay and bi guys to prevent HIV transmissions. It responds to the rising rates of HIV by empowering men with information and inspiring them to take action.
OUTline OUTLine NZ is a national telephone counselling and information support service for the gay, lesbian, transgender, takataapui and bisexual people of New Zealand.
Gender Minorities Aotearoa Gender Minorities Aotearoa is a cross-cultural and transgender-led national organisation. It assists transgender, intersex and takataapui people in having choices about their lives and their bodies, and in getting the things they need for wellbeing. 

Organisations for sexual abuse and abusive situations

Safe to Talk For free, confidential information and support for people affected by sexual harm (sexual violence, rape, sexual assault, sexual abuse) This helpline is staffed by specialists trained in sexual harm support.
Sexual Abuse Prevention Network The Sexual Abuse Prevention Network works with schools, workplaces and community groups to educate and create open dialogues about sexual harm and healthy relationships. 
SAATS-Link A website to find your nearest sexual assault medical service.
TOAH NNEST Te Ohaakii a Hine National Network Ending Sexual Violence Together (TOAH NNEST) is a network of specialist sexual violence response and prevention services across New Zealand.
Women’s Refuge A website providing support and information to help young people identify, escape and shelter from abuse.
Males Survivors of Sexual Abuse An organisation providing support and information to male survivors of sexual abuse.
SHINE Committed to making homes violent free. Provides help and support for men who are violent and want to change their behaviour.

Organisations with a cultural focus

Te Whāriki Takapou A Māori health promotion organisation specialising in kaupapa Maori sexuality education for rangatahi Māori and whānau.
Village Collective Empowering Pasifika youth through sexual and reproductive health education.
Shakti International A website providing culturally competent support services for women, children and families of Asian, African and Middle Eastern origin.

Learn more

The following links provide further information about sexual health for young people. Be aware that websites from other countries may have information that differs from New Zealand recommendations.

Safer sex Family Planning, NZ
Sex Youthline, NZ
Porn use self check The Light Project, NZ
HPV vaccination Just the Facts, NZ

• o has lice in their beard.

You can also get pubic lice when you are in contact with towels, bedding or clothing of someone who is infected with pubic lice, but that is much less common. 

What are the symptoms of pubic lice?

Common symptoms of pubic lice include:

• itching in and around your pubic hair area, which is worse at night
• faint blue spots in your genital area
• skin irritation and redness caused by scratching
• dark brown specks of old blood in your underwear
• lice and eggs may be seen in your pubic hair
• red eyes (if your eyelashes are infected).

Some people have no symptoms but they can still spread the parasite to other people. 

How are pubic lice diagnosed?

Your doctor will need to look at the affected area for the signs listed above to diagnose pubic lice. There is no specific test available to diagnose pubic lice. 

If you have pubic lice, your doctor will also check for other STIs and do a sexual health check. Read more about sexually transmitted infections (STIs).

How are pubic lice treated?

Pubic lice are usually treated at home by applying creams, lotion or shampoo containing permethrin to the affected area.

These treatments are available to buy over the counter in pharmacies. In general, the treatment will need to be applied to the affected area and washed off after 12 hours. Then, a second treatment is needed after 7 days, to kill the remaining lice from eggs that may have survived the first treatment round. Your doctor or pharmacist can advise you on how to use these medicines correctly.

If the lice are not killed by this regimen, talk to your doctor or pharmacist to get an alternative treatment. 

If your eyelashes are affected, see or talk to your doctor to find out what other medicines can be used. Don’t apply medicines with permethrin close to your eye area or to your eyelashes. 

How can I prevent getting pubic lice again?

Wash your clothing, towels and bedding in hot water at the same time as you are having the treatment. Make sure all your sexual partners get treated too, even if they have no symptoms.

Also, wait to have sex again until you finish the second treatment (7 days after the first treatment). Unfortunately, condoms don’t protect you from getting pubic lice (although they can protect you from getting other STIs).

What support can I get with pubic lice?

If you think you have pubic lice or any other sexual health concerns, you can see or talk to your GP. Otherwise you can see a pharmacist (as long as your eye area is not affected). Other places you can get help are:

Sexual health clinics
Family Planning clinics