Vaginal discharge

What is vaginal discharge?

Vaginal discharge is a mucus or fluid that protects the vagina from bacterial infection. It is totally normal and keeps the vagina clean and moist.

Vaginal discharge may indicate a problem such as thrush or a sexually transmitted infection (STI) if:

• The usually white discharge changes colour.

• The discharge emits a strong or unpleasant odour.

• The discharge changes in consistency.

Vaginal discharge is usually heavier during pregnancy, if you're using the contraceptive pill, or are sexually active, but the amount can vary at any time.

What is considered normal vaginal discharge?

Normal vaginal discharge may change throughout your menstrual cycle. What is normal for you may change if you become pregnant or start using hormonal contraception.

• Colour: Vaginal discharge is normal if it’s clear, milky white or off-white.
  Grey, green, dark yellow, or brown discharge, may indicate an infection or
  other problem.

• Smell: A slight odour might be present, but it shouldn’t be strong or unpleasant. If you notice a fishy or foul smell (with other changes), you may have an infection.

• Texture: It is normal to have discharge that changes from watery and
  sticky to thick and like paste. Normally your hormones cause this change, but infection can also change the consistency. Vaginal discharge that has bits in it, or looks like foam may be due to infection.

• Amount: The amount of discharge people normally produce varies. Factors like pregnancy, using hormonal contraception or producing an egg (ovulation) can affect how much vaginal discharge you have. Sudden changes in the amount could mean something is wrong.

Why does my vaginal discharge smell?

Discharge may smell because of your period, because you've just had sexual intercourse, or another normal smell-producing reason.

An unusually smelly discharge is usually a sign of a treatable problem. This may be a sexually transmitted infection (STI), such as chlamydia or trichomonas, or a condition which isn't caused by sex, such as a retained tampon, irregular bleeding or bacterial vaginosis (BV).

What causes vaginal discharge?

There are many causes of vaginal discharge, most completely normal. However, changes in colour, texture, smell and amount may be due to infection.

Menstruation

After you have produced an egg (14 days before your next period), you may notice that you seem to have a lot more mucus in your vagina. This usually continues until your next period starts.

This is normal and is caused by the hormones in your body. It helps keep your vagina clean and protects it from infection. This type of vaginal discharge is usually clear and has no unpleasant smell.

Patient picks for Vaginal and vulval problems

Women's health

What are the symptoms of bacterial vaginosis?

Bacterial vaginosis is one of the most common vaginal infections. It causes a discharge which is usually watery thin and white or gray-coloured. The discharge often has an unpleasant fishy smell- which points to the diagnosis.

by Dr Doug McKechnie, MRCGP

Women's health

Treating recurring yeast infections

A recurring yeast infection (vaginal thrush) is defined as an episode of thrush four or more times in a year. In some cases, there is a medical reason that you are more prone to thrush infection. Some hormone treatments may also affect your risk of repeated episodes.

by Dr Hayley Willacy, FRCGP

Pregnancy and hormones

Similarly, when you are pregnant, you have a lot of the same hormones in your body as when you are menstruating. Many women notice they have heavy but normal vaginal discharge during pregnancy.

Some contraceptives with hormones in them can make your vaginal discharge heavier too.

In small baby girls, vaginal discharge (and sometimes bleeding) can be caused by the effect of their mother's hormones. This only occurs in newborn babies, as the hormones affect the baby whilst they are in the womb (uterus).

Sex

Some women get small amounts of vaginal discharge for a day or two after sex. If the man 'comes' (ejaculates) inside the vagina, most of his semen will leave the vagina as a vaginal discharge unless he used a condom. There will also be fluid that the glands of the vagina make during sex.

Foreign body

This is anything in the vagina that isn't normally there. Young children sometimes put small toys there and then can't get them out. In women the most common foreign body is a forgotten tampon.

Non-sexually transmitted infections

These are types of vaginal discharge that are caused by vaginal infections. Neither is transmitted during sex.

• Bacterial vaginosis (BV): this is a common cause of vaginal discharge, often with a noticeable fishy smell that may be worse after sex or after a period. BV is NOT a sexually transmitted infection (STI). It is caused by an overgrowth of normal germs (bacteria) in the vagina. Symptoms are often mild and BV may clear without treatment. Other cases can be treated with antibiotics. Some women get repeated or persistent episodes of BV. See the separate leaflet called Bacterial vaginosis for more details.
  

• Thrush (candida): this is caused by a yeast infection. It is the second most common cause of a vaginal discharge, after BV. The vaginal discharge from thrush is usually creamy white and quite thick but is sometimes watery. Some women describe it as looking like cottage cheese. Thrush can cause itch, redness, discomfort or pain around the outside of the vagina. The discharge from thrush does not usually smell. Some women can have some pain or discomfort whilst having sex or whilst passing urine if they have thrush. See the separate leaflet called Vaginal thrush (Yeast infection) for more details.

Sexually transmitted infections

The most common infections causing vaginal discharge are:

• Chlamydia.

• Gonorrhoea.

• Trichomoniasis.

Symptoms of STIs can vary, but the following are the ones to look out for:

• Vaginal discharge.

• Abnormal vaginal bleeding.

• A sore, ulcer, rash, or lump that appears around the vagina, vulva or anus.

• Pelvic pain, either all the time or just when you have sex or when you pass urine. This may be a sign of pelvic inflammatory disease, which occurs when the infection has moved higher up the genital tract.

You are at higher risk of STIs if:

• You have had an STI in the past.

• You have had more than one sexual partner or a new sexual partner in the last year.

• You are under 25 years old.

See the separate leaflet called Sexually transmitted infections (STI, STD) for more details.

Rare causes of vaginal discharge

• Cervical polyps: sometimes polyps on the neck of the womb (cervix) can cause a vaginal discharge. A polyp is a small fleshy lump. They can usually be seen when your doctor or nurse examines you. They are easily removed (this may need to be done in hospital) and are very rarely cancerous.

• Ectopy: sometimes the covering of the neck of the womb changes and becomes more fragile. This is called ectopy (or ectropion) and it can lead to more vaginal discharge. It is not serious and often doesn't need any treatment. See the separate leaflet called Common problems of the cervix for more details.

• Cancer: some cancers such as cancer of the womb and cervical cancer can also cause a vaginal discharge. There are usually other symptoms and it would be very unusual to have discharge as the main symptom of these cancers.

• Skin conditions: some skin conditions such as dermatitis and lichen planus can also cause a vaginal discharge. They also have other symptoms with them. The most common is itch. Your doctor may examine you to reassure you about these rarer causes.

What should I do if I have vaginal discharge?

If your vaginal discharge is normal, you don't need to do anything - your body is working as it should.

You should see a doctor if you are experiencing abnormal vaginal discharge, or vaginal discharge you have had for some time changes. Here are the features that suggest you need medical advice:

• A change in the colour of the vaginal discharge - for example, yellow, green grey, pink or blood-stained.

• A funny odour like fish or rotten meat.

• Producing more vaginal discharge than usual.

• A change in the consistency of your discharge - for instance, becoming thick or lumpy.

• Other symptoms such as soreness, itching or burning around the opening of the vagina, pain when you empty your bladder, pelvic pain, and spots of blood between periods or after sex.

Vaginal discharge treatments

The treatment of the vaginal discharge will depend on the cause:

Chlamydia:

• The usual treatment is doxycycline 100 mg twice daily for 7 days (NOT if pregnant or breastfeeding).

• If doxycycline is not suitable then azithromycin 1g orally as a single dose for 1 day, followed by 500 mg orally once daily for 2 days is prescribed.

Gonorrhoea:

• Options include ceftriaxone 1 g intramuscular injection as a single dose, or ciprofloxacin 500 mg as a single dose.

• Alternatives include gentamicin 240 mg injection as a single dose plus azithromycin 2 g orally or cefixime 400 mg orally as a single dose, plus azithromycin 2 g orally. These are usually only given if an injection is contraindicated or refused by the person.

Trichomonas:

• Metronidazole 400–500 mg orally twice a day for 5–7 days, or metronidazole 2 g as a single oral dose (NOT if pregnant or breastfeeding).

Non-sexually transmitted infections

• Bacterial vaginosis (BV): you may be prescribed antibiotics called metronidazole or clindamycin in the form of pessaries, gel or cream (inserted into the vagina) or tablets taken by mouth. See the separate leaflet called Bacterial vaginosis for treatment details.

• Thrush (candida) - this is usually treated with pessaries or creams containing clotrimazole, econazole, miconazole or fenticonazole. See the separate leaflet called Vaginal thrush (Yeast infection) for treatment details. Sometimes tablets taken by mouth are offered. You may be asked to buy treatment for thrush over the counter rather than having it prescribed.

Sexually transmitted infections

STIs which cause a vaginal discharge include:

• Trichomonas.

• Genital chlamydia.

• Gonorrhoea.

• Genital herpes.

For additional information, including treatment, on these and other STIs, see the separate leaflet called Sexually transmitted infections (STI, STD).

Foreign body

This can usually be removed by the doctor at the time you are being examined.

If you have a large object which would cause discomfort when it is removed, you may need sedation or a light anaesthetic during removal. You would need to be admitted to hospital for a few hours for this. You might need an antibiotic afterwards to prevent infection.

Treating rarer causes of vaginal discharge

• Cervical polyp: this can be removed by your GP or a specialist.

• Cervical ectropion: under local anaesthetic, this can be treated by burning with a cautery (cauterisation).

See the separate leaflet called Common problems of the cervix.

How do doctors diagnose the cause of abnormal vaginal discharge?

The doctor may ask how long you have had the vaginal discharge and whether you have noticed any of the changes listed above. Because a vaginal discharge may be a symptom of an STI, they may ask about birth control and if you use condoms. Condom use can protect against STIs.

Talking through your symptoms

The doctor may have a good idea of what is wrong just by talking to you, particularly if you have never been sexually active and have not had a recent vaginal surgical procedure. If they are confident from your symptoms that you have bacterial vaginosis or thrush, they may be able to offer treatment without examining you or doing any tests.

Physical examination

Otherwise they may ask to examine your genital area. You are entitled to ask for a chaperone whilst you are being examined - even if it is a female doctor. They will ask you to remove your clothing from the waist down. If you wear a loose skirt, you may only need to remove your underwear. You will be asked to lie on your back on the examination couch. They may examine you with two fingers inside your vagina. This can tell them whether your womb, ovaries or Fallopian tubes are tender.

Sometimes the doctor may also use an instrument called a speculum. This goes into your vagina. This gently opens the vagina and allows the cervix to be seen (at the top of the vagina). They will be able to see any discharge and take a sample of the discharge with a swab. This can be sent to the laboratory to tell them if any infection has caused the discharge. They will also be able to see any sore areas or polyps on the neck of the womb.

STI tests

If you have been sexually active the doctor may offer you a full STI screen which involves blood tests as well as swabs. Your sexual partner(s) may also need to be tested.

When the doctor has all the results, they will discuss with you whether you need any more investigations such as an ultrasound scan, or whether you need to see a specialist - a gynaecologist.

Sometimes, reassurance may be enough.