Vaginal Discharge: The Good, The Bad, and The Ugly

October 19, 2010 at 7:39 pm 31 comments

One of my patients’ most common gynecologic complaints is about vaginal discharge. It’s not something most women want to talk about. I mean, if you watch enough commercials for “feminine hygeine products” you start to think that vaginal discharge will make you a social outcast who wears loose, flowy clothing in varying shades of mauve and gray.

But what causes vaginal discharge? When is it normal? What can you treat at home? And when do you need to see a gynecologist? Those are some of the questions I’d like to address in this post.

First of all, vaginal discharge is one of the symptoms of a medical condition gynecologists call “vaginitis.” Literally, it means inflammation of the vagina. (And you thought taking Latin in high school would never come in handy.)

They key to vaginitis is the vaginal flora. Vaginal flora aren’t roses and peonies blooming in your nether-regions. They are microscopic organisms, like bacteria and yeast, who normally live in the vagina and are beneficial. They need a certain level of moisture, acidity, and estrogen in order to function properly. When the balance of normal vaginal flora is upset, vaginitis can result.

Normal vaginal discharge is often clear, white or yellow. It can be thin and watery, creamy or similar to mucus in character. Normal vaginal discharge may lack an odor or may smell musky (as opposed to abnormal discharge, which often smells foul and unpleasant). When the vagina is in a healthy balance, it shouldn’t smell bad, burn/itch or hurt.

The normal balance of vaginal flora may be upset by activities such as douching and tampon use. Both can worsen the symptoms of vaginitis and should be avoided while symptoms persist.

One of the most common causes of vaginitis is a yeast infection. These are caused by a fungus called candida which is normally found in small amounts in the vagina. When candida overgrows, the symptoms of a yeast infection may occur. These include itching and burning of both the vagina (inside) and the vulva (the outside skin near the vagina). Symptoms may be worse after urination or intercourse. Some (but not all) women notice thick white discharge which may be odorless.

Risk factors for developing a yeast infection include pregnancy, diabetes mellitus, recent antibiotic use, human immunodeficiency virus and oral contraceptive use. Treatment is available by prescription or over-the-counter. It usually involves antifungal medication (cream or suppository) inserted in the vagina for 1 to 7 days. Oral treament with a pill may also be offered, but is available by prescription only. Longer courses of treatment may be necessary Sexual partners do not require treatment.

Bacterial vaginosis (BV) is caused by an overgrowth of certain vaginal bacteria, particularly gardnerella. The main symptom of BV is increased discharge can be copious (a large quantity)and may be white, gray or even greenish in color. A strong, fishy vaginal odor is often present. The odor may increase after a mesntrual period or after sexual intercourse. Itching may also occur.

Treatment is by prescription antibiotics. Metronidazole (Flagyl) gel or oral capsules are prescribed for 5 days. Oral metronidazole can not be taken in combination with alcohol or severe nausea/vomiting may occur. Clindamycin suppositories or cream can be used for 3 to 7 days. Longer courses of treatment are sometimes necessary. Sexual partners do not require treatment.

Vaginal discharge may also be a symptom of trichomoniasis. This is a condition caused by the microscopic parasite Trichomonas vaginalis. It is a sexually transmitted disease (STD). Signs of trichomoniasis may include a yellow-gray or green vaginal discharge. The discharge may have a fishy odor, which may lead one to confuse it with bacterial vaginosis. Burning, irritation, redness and swelling of the genitals may occur. Pain may occur during urination.

Trichomoniasis is usually treated with metronidazole (flagyl) by mouth. Women who have trichomoniasis are at an increased risk of infection with other STDs, so they should be screened accordingly. Sexual partners must be treated to avoid re-infection. Sexual intercourse shoudl be avoided until both partners have received treatment.

Vaginal discharge may also be a sign of atrophic vaginitis. This condition can occur when the level of estrogen in the body drops, as usually happens during breastfeeding or menopause. Symptoms include dryness, itching and burning of the vagina. Discharge may be present and pain may occur during sexual intercourse. Treatment is usually aimed at restoring estrogen to the vagina through topical medications. Water-based lubricant can also be helpful, especially during intercourse.

In summary, vaginitis and discharge are common conditions which may require special diagnostic tests and/or treatment by a gynecologist. If you are experiencing bothersome symptoms, especially if over-the-counter treatments have failed, it is time to talk to your doctor.

Entry filed under: Gynecology. Tags: bacterial vaginosis, BV, candida, discharge, fishy odor, gardnerella, STD, trichomonas, trichomoniasis, vaginal discharge, vaginal odor, yeast infection.

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31 Comments

1. Lin | April 13, 2011 at 4:39 pm

I have a yellowish-near to green but not green discharge. My period is coming and I had unprotected sex just a few days ago. It hurt while peeing but not anymore and it doesnt itch. I didnt go to the doctor but Im worried. =( I left my pad in the toilet few days back and after about half an hour, I saw ants on it. Can u please tell me whats wrong. =(
- 2. drnicoll | April 24, 2011 at 5:40 pm
  
  Hi Lina,
  It’s not possible to diagnose you via email and it sounds like you are in urgent need of gynecologic care. Please see your care provider as soon as possible. If you don’t already have a gynecologist, you can find one in the directory provided by your health insurance carrier. Best of luck.
  -Dr. N
- 3. drnicoll | June 26, 2011 at 11:40 pm
  
  Hi Lin,
  This is not a question for an online blog. You need to see a doctor. Please call your provider and make an appointment as soon as possible. If you don’t have a provider, you can go to a local clinic or emergency room.
  Best of Luck,
  Dr. N
4. nks | September 13, 2011 at 1:14 am

i have recurring bv been to the doctor a couple of times for it but seems like nothing helps
- 5. drnicoll | September 13, 2011 at 6:56 pm
  
  Hi Supergurl,
  It may be tempting to self-diagnose (or seek help online), but that doesn’t lead to the best care or outcomes. If you are still having symptoms, you should contact your doctor. If you think you are not receiving appropriate care, seek a second opinion by making an appointment with another provider.
  Best,
  Dr. N
6. Mrs. G | December 14, 2011 at 3:40 am

Prior to menstruation on CD 26 (Normal 28D Cycle), I had dry brown discharge only when wiping. I am now on CD 30 and no menses yet and the same discharge when wiping. I am exhibiting some signs of pregnancy (sore breasts, low back pain, nausea, fatigue) and had a negative HPT on CD 28 with first morning urine. Should I be concerned about this discharge? Is it possible to still be pregnant and not enough HCG for a HPT to detect?
- 7. drnicoll | December 18, 2011 at 9:02 pm
  
  Hi Mrs. G,
  As I have stated in other posts and in my “About Me” section, I don’t dispense individual gynecologic diagnosis or treatment recommendations on this site. I strongly encourage you to contact your healthcare provider (your gynecologist or primary care provider) to discuss your symptoms and address these important questions.
  Wishing you the best of luck,
  Dr. N
8. Rieko | January 13, 2012 at 3:10 am

Dear Dr N,

Thank you for your information. It answers my doubts on different reasons why women have discharge. This helps me to understand my condition better, where a lot of my gynecologist will not spend the time explaining in depth during consultation. I hope you can also write on topics such as Streptococcus Group B and yeasts, fungus. So that we can learn more about ourselves.
9. KATIE | March 29, 2012 at 10:41 pm

i am young but been haven sex for year i hAVE ALLWAYS HAD A YELLOISH -WHITE IDSCHARGE AND FEEL NWET ALL THE TIME IS THAT NORMAL
- 10. drnicoll | April 16, 2012 at 5:52 pm
  
  I do not give out medical advice on my site. Please call your women’s health provider (gynecologist) or your primary care doctor to evaluate this issue. If you are under 18, be advised that you may be protected by confidentiality laws in your area and may not need a parent or guardian’s consent for treatment for sexual-health issues. Your provider’s office and give you further information on this subject. If you don’t have a provider, a local Planned Parenthood is a good choice. They offer general gynecologic care (not just pregnancy related care).
  Best of luck,
  Dr. N
11. vaginal infection symptoms | April 24, 2012 at 11:26 pm

Spot on with this write-up, I honestly feel this website needs much more attention. I’ll probably be back again to read more, thanks for the advice!
12. vaginal infection symptoms | April 24, 2012 at 11:27 pm

Right here is the perfect website for anybody who would like to understand this topic. You realize a whole lot its almost tough to argue with you (not that I personally will need to…HaHa). You definitely put a new spin on a subject that’s been discussed for years. Wonderful stuff, just great!
13. vaginal infection symptoms | April 24, 2012 at 11:34 pm

Having read this I thought it was extremely enlightening. I appreciate you finding the time and effort to put this information together. I once again find myself spending way too much time both reading and leaving comments. But so what, it was still worthwhile!
14. martha | April 26, 2012 at 10:28 am

Hi Doctor. I was pregnant last year September, n I went to d hospital d gynaecologist said I mght hv an ectopic prenancy then, they did laparatomy. I don’t know if they took one of my tubes out or not, n since then iv been trying to conceive again and I don’t become pregnant since after the operatio. I am now worried and don’t know what to do as me and my husband hv bn tryng till now I don’t know what to do.
- 15. drnicoll | May 10, 2012 at 2:01 am
  
  Hi Martha,
  Patients have legal rights to their medical records. A hospital or doctor’s office can provide copies of any requested materials. They may, however, charge a fee. If you don’t know what surgery you had, you can find out. And then you can have a frank discussion with your doctor about the implications a particular surgery he or she might have performed, why that operation was chosen, and what effect it might have on future fertility. If you don’t feel comfortable talking to your current doctor, it may be time to find a new one.
  Best of luck,
  Dr N
16. Miley | May 8, 2012 at 4:55 pm

Hi I have been having discharges frequently sometimes it smells and sometimes it doesn’t. Lately it’s been going through my pants is this a sign of yeast infection or is it because I’m gonna start my menstrual cycle pretty soon?
- 17. drnicoll | May 10, 2012 at 1:56 am
  
  Hi Miley,
  I do not dispense individual medical advice on my blog. Please contact your gynecologist or other women’s healthcare provider to discuss your concerns.
  Best of luck,
  Dr N
18. Latasha | May 18, 2012 at 7:56 pm

Hi I have a question I just found out I have trichymonius. I tried to take the metronidazole that the doctor prescribed me with. Is there anything else I can take. Can the doctor give me a shot to cure this sti
- 19. drnicoll | May 23, 2012 at 9:36 pm
  
  Hi Latasha,
  If you have questions about your diagnosis or the prescribed treatment, the best thing to do is to call or make an appointment to speak with your doctor. He or she can explain your diagnosis and address why one treatment might be chosen over another. In general, however, Metronidazole is the standard treatment for trichomonas. It is usually administered orally (as a pill taken by mouth). Trichomonas is not usually treated with an injection (i.e. a shot).
  Best of luck!
  -Dr N
20. Holli | June 1, 2012 at 4:30 pm

Have you heard of a new test for BV called VS-SENSE, as a practitioner I am interested if you feel the test is valuable?
- 21. drnicoll | June 5, 2012 at 11:03 pm
  
  Hi Holli,
  It’s always nice to hear from a colleague.
  I have heard of VS-SENSE. It is essentially a piece of pH sensitive material on the end of an applicator. This is more expensive than the test many gynecologists perform in the office with a cotton swab and a strip of pH paper, but I imagine it is much more convenient for women to use in their own home.
  As for the utility of the test itself, I find checking vaginal pH useful in differentiating between BV/trichomonas and yeast infections. However, I usually perform a confirmatory test with a DNA probe when the diagnosis is in question.
  I think the VS SENSE is a good tool if used appropriately. By that, I mean that users should be prepared to see their provider for a prescription if the test is positive (as this may indicate either BV or trichomonas, but further testing must be used to differentiate between the two). Neither BV nor trichomonas can or should be treated with over-the-counter remedies.
  But if the test is negative, indicating that vaginal irritation is likely to represent a yeast infection, I think the use of over-the-counter vaginal anti-fungals is appropriate for most patients.
  Pregnant women, patients with risk factors for complicated or recurrent infections (immunocompromised or diabetic patients), and those who do not experience relief from over-the-conter preparations should see their provider (instead of performing at-home testing) so as to avoid undertreatment or misdiagnosis.
  I hope this was helpful!
  -Dr. N
22. samantha | June 11, 2012 at 11:28 pm

I am 14 years old my vagina itches off and on and sometimes theres a white discharge it also smells down there sometimes and i dont have my period yet.
Can you help me?
- 23. drnicoll | June 12, 2012 at 6:34 pm
  
  Hi Samantha,
  I do not dispense individual medical advice on my blog. Please talk to a trusted adult and call your doctor ASAP.
  
  I say this because young teens often need help getting medical treatment, so they often receive better care if they get their parents or another responsible adult (an aunt, a trusted teacher, the school nurse?) involved.
  
  Gynecologic symptoms can signal important health problems and are a reason to call your doctor ASAP. An adult can help do this. Your pediatrician is a good place to start, but places like Planned Parenthood or an urgent care center also take care of teens.
  
  Best of luck!
  Dr. N
24. R. | July 3, 2012 at 2:57 pm

hi. I am having symptoms of increase of vaginal discharge. It is very watery and yellow. i have to wear a sanitary towel that i have to change a few times a day. Sometimes its got blood in it as well. It has a very musky kind of smell. It started after i had finished a course of antibiotics for a urinary tract infection. I also have just started (in month 2) going on the contraceptive injection. Can you please tell me what it could be?
- 25. drnicoll | July 3, 2012 at 4:11 pm
  
  Hi R.,
  I do not give individual medical advice on my blog. Please contact your heathcare provider and schedule a visit. A thorough history, physical exam and possibly laboratory testing is the only way to distinguish between a healthy discharge and an unhealthy one which may require medication.
  Best of luck,
  Dr. N
26. stranger | July 13, 2012 at 9:05 am

i have waterly discharge for 2 or 3 days in a month and have a little lower stomach pain during discharge and also pain during urination.sometimes it smells and sometimes it not. i feel

very weak and my weight is also very less .please help me what should i do????
- 27. drnicoll | July 20, 2012 at 2:50 pm
  
  Dear Stranger,
  I do not dispense individual medical advice on my blog. Symptoms such as abnormal discharge, abdominal or urinary pain, urinary odor, weakness, or unexplained weight loss should immediately be brought to the attention of a doctor (or other medical provider). A delay in seeking medical attention can lead to worsening symptoms and possible negative health outcomes.
  Best of luck,
  Dr. N
28. Simone | July 20, 2012 at 1:47 am

N. Hi I wen t to my doctors recently and I asked about having discharge and she said that’s its normal to have white discharge everyday and she didn’t test me because I was on my period and I didn’t tell her that I was having a fishy odor that’s sometimes comes back after taking a shower I know you don’t diagnose but do you have any idea what its sounds like?
- 29. drnicoll | July 20, 2012 at 2:47 pm
  
  Hi Simone,
  It’s good you saw your doctor recently. You should call her to discuss any medical concerns.
  A fishy odor may be a sign of bacterial vaginosis, but only your doctor can be sure (by taking a history and possibly doing an exam or tests).
  Good luck!
  -Dr. N
30. Lydia sanchez | July 20, 2012 at 4:16 pm

I have yellow to greenish discharge for 2 days now and burning feeling when urinating and feels my vagina is swollen even if I don’t urinate is has pain, no itchy feeling but it has slightly odor but not that bad.please help me.what is that i am experiencing.
- 31. drnicoll | July 23, 2012 at 6:55 pm
  
  Dear Lydia,
  I do not dispense individual medical advice on my blog. Symptoms such as abnormal discharge, burning on urination, swelling or pressure in the vagina, and abnormal vaginal odor should immediately be brought to the attention of a doctor or other medical provider. A delay in seeking medical attention can lead to worsening symptoms and possible negative health outcomes.
  In short, please call your doctor.
  Best of luck,
  Dr. N