Vaginal discharge

Definition

Vaginal discharge refers to secretions from the vagina. Such discharge can vary in:

• Consistency (thick, pasty, thin)
• Color (clear, cloudy, bloody, white, yellow, green)
• Smell (normal, odorless, bad odor)

Alternative Names

Discharge from the vagina

Considerations

Having some amount of vaginal discharge is normal, especially if you are of childbearing age. Glands in the cervix produce a clear mucus. These secretions may turn white or yellow when exposed to the air. These are normal variations.

The amount of mucus produced by the cervical glands varies throughout the menstrual cycle. This is normal and depends on the amount of estrogen circulating in your body. It is also normal for the walls of the vagina to release some secretions. The amount depends on hormone levels in the body.

Vaginal discharge that suddenly differs in color, odor, or consistency, or significantly increases or decreases in amount, may indicate an underlying problem like an infection.

Causes

The following situations can increase the amount of normal vaginal discharge:

• Emotional stress
• Ovulation (the production and release of an egg from your ovary in the middle of your menstrual cycle)
• Pregnancy
• Sexual excitement

Abnormal vaginal discharge may be due to:

• Atrophic vaginitis (seen in women who have gone through menopause and have low estrogen levels)
• Bacterial vaginosis (BV) -- Bacteria that normally live in the vagina overgrow, causing a grey discharge and fishy odor that worsen after sexual intercourse. BV is usually not sexually transmitted.
• Cervical or vaginal cancer (rarely a cause of excess discharge)
• Chlamydia
• Desquamative vaginitis and lichen planus
• Forgotten tampon or foreign body
• Gonorrhea
• Other infections and sexually transmitted infections (STIs)
• Trichomoniasis
• Vaginal yeast infection

Home Care

To help prevent and treat vaginal discharge:

• Keep your genital area clean and dry.
• Do not douche. While many women feel cleaner if they douche after menstruation or intercourse, it may actually worsen vaginal discharge because it removes healthy bacteria lining the vagina that are there to protect you from infection. It can also lead to infection in the uterus and fallopian tubes, and is never recommended.
• Use an over-the-counter yeast infection treatment cream or vaginal suppository, if you know that you have a yeast infection.
• Eat yogurt with live cultures or take Lactobacillus acidophilus tablets when you are on antibiotics to avoid a yeast infection.
• Use condoms to avoid catching or spreading STIs.
• Avoid using feminine hygiene sprays, fragrances, or powders in the genital area.
• Avoid wearing extremely tight-fitting pants or shorts, which may cause irritation.
• Wear cotton underwear or cotton-crotch pantyhose. Avoid underwear made of silk or nylon, because these materials are not very absorbent and restrict air flow. This can increase sweating in the genital area, which can cause irritation.
• Use pads and not tampons.
• Keep your blood sugar levels under good control if you have diabetes.

If the discharge is caused by a sexually transmitted disease, your sexual partner (or partners) must be treated as well, even if they have no symptoms. Failure of partners to accept treatment can cause the infection to keep coming back and may lead to pelvic inflammatory disease or infertility.

When to Contact a Medical Professional

Call your health care provider right away if you have vaginal discharge and:

• Fever or pain in your pelvis or belly area.
• You had a sexual partner with gonorrhea, chlamydia, or other STI.
• You have increased thirst or appetite, unexplained weight loss, increased urinary frequency, or fatigue -- these may be signs of diabetes.

Also call if:

• A child who has not reached puberty has vaginal discharge.
• You think that your discharge may be related to a medication.
• You are concerned that you may have a STI or you are unsure of possible exposure.
• Your symptoms worsen or last longer than 1 week despite home care measures.
• You have blisters or other lesions on your vagina or vulva (exterior genitalia).
• You have burning with urination or other urinary symptoms -- you may have a urinary tract infection.

What to Expect at Your Office Visit

Your doctor will take a medical history and perform a physical examination including a pelvic exam.

Medical history questions may include:

• When did the change or abnormal vaginal discharge begin?
• Do you have the same amount and type of vaginal discharge throughout the month?
• What does the discharge look like (color and consistency)?
• Is there an odor?
• Do you have pain, itching, or burning?
• Does your sexual partner have a discharge as well?
• Do you have multiple sexual partners or sexual partners that you do not know very well?
• What type of birth control do you use?
• Do you use condoms?
• Is there anything that relieves the discharge?
• Have you tried over-the-counter creams? Have they helped?
• Do you douche?
• Do you have any other symptoms like abdominal pain, vaginal itching, fever, vaginal bleeding, rash, genital warts or lesions, or changes in urination like difficulty, pain, or blood?
• What medications do you take?
• Do you have any allergies?
• Have you recently changed the detergents or soaps that you use?
• Do you frequently wear very tight clothing?
• When was your last Pap smear? Have you ever had an abnormal Pap smear?

Diagnostic tests that may be performed include:

• Cultures of your cervix
• Examination of vaginal discharge under the microscope
• A Pap smear

Treatment depends on the underlying condition. Suppositories or creams may be ordered and antibiotics may be prescribed. Medications taken by mouth may be needed to treat certain fungus or trichomoniasis infections. Your sexual partner may also need treatment.

References

Eckert LO, Lentz GM. Infections of the lower genital tract: vulva, vagina, cervix, toxic shock syndrome, HIV infections. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM, eds. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 22.

Merritt DF. Vulvovaginitis. In: Kliegman RM, Behrman RE, Jenson HB, Stanton BF, eds. Nelson Textbook of Pediatrics. 19th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 543.

Schrager SB, Paladine HL, Cadwallader K. Gynecology. In: Rakel RE, ed. Textbook of Family Medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2011:chap 25.

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