Vaginal Discharge: Symptoms and Treatment

If you have a vagina, then you have vaginal discharge. Discharge is necessary to keep the vagina clean, lubricated, and protected from disease. What comes out is usually perfectly normal, even if it changes consistency, colour, or volume from one week — or even one day — to the next.

But sometimes, changes in our discharge can be a sign of an infection. Here's how to tell if what's going on down there is normal or a symptom of a health condition.

What is vaginal discharge?

"Vaginal discharge is a fluid produced by glands inside the vagina and cervix that serves to carry away dead cells and bacteria, keeping the vagina clean and preventing infection," says Rakhee Patel, M.D., FACOG, an OB-GYN at Pinewood Family Care in New Jersey.

Patel says normal discharge is typically clear or milky white and doesn't smell strong.

Discharge often changes colour and consistency depending on where we are in our menstrual cycle. It's normal for the amount of discharge to increase or decrease.

"Discharge can change because of hormonal influence in patients who are not on birth control," says Fatima Naqvi, M.D., FACOG, an OB-GYN and interim medical director for women's service at Atlantic Health System in New Jersey. "During ovulation, your discharge will be thinner, even see-through. Physiologically, it does make sense because the purpose of ovulation is to release an egg. If an individual is gearing towards pregnancy, you don't want the discharge to be thick or become a barrier to fertilization."

Other factors can also affect normal discharge. "Discharge can vary based on how hydrated you are, what you've eaten, and if you're taking any supplements," says Sara Holt, CNM, MS, a certified nurse midwife at Byenveni Baby in Portland, Oregon.

What causes abnormal vaginal discharge?

Discharge can change throughout the month. Changes in discharge that are accompanied by other symptoms, such as itching or a strong, unpleasant odour, may indicate vaginitis — a catch-all term for infections of the vagina.

Bacterial vaginosis

Bacterial vaginosis (BV) is the most common type of vaginitis. It can be treated with antibiotics. BV occurs when the pH levels of the vagina are upset, leading to an imbalance of "good" and "bad" vaginal bacteria.

The vagina's pH levels can be affected by using douche or other similar cleansing products. Having a new sexual partner or having sex without condoms can also cause changes in the vagina's normal pH levels.

Symptoms of BV include thin gray or white discharge with a fishy odour plus pain, itching, or burning in the vagina.

Yeast infections (candidiasis)

It's normal for yeast to be present in various body parts. But vaginal yeast infections are caused by an overgrowth of Candida fungus. It often causes thick, white discharge that resembles cottage cheese, along with itching and redness, Patel says.

Yeast infections commonly occur after taking antibiotics, which can cause too much yeast to grow. They're treated with antifungal creams or other medications.

Trichomoniasis

Often called "trich" for short, trichomoniasis is a sexually transmitted infection (STI) caused by a parasite.

Discharge with trich can be thick, thin, or even frothy and often yellow-green. It also has a fishy odour and pain during urination, swelling, and itchiness.

Trich must be treated with antibiotics, as it's unlikely to resolve.

Sexually transmitted infections (STIs)

Besides trichomoniasis, other STIs can cause abnormal discharge, including gonorrhea and chlamydia. Both can cause discharge that's yellow or green and cloudy. Both are also treated with antibiotics. Left untreated, these can lead to pelvic inflammatory disease.

Other possible causes

Sometimes, abnormal discharge isn't caused by an infection. Hormonal changes during the menstrual cycle or pregnancy can result in different discharge than we're used to.

Additionally, foreign objects, like sex toys or even tampons left inside the vagina for too long, can cause changes in discharge. Sensitivity to certain fabrics, soaps, detergents, or scented products, like tampons or pads, can also be a cause.

What are the symptoms of abnormal vaginal discharge?

It's normal for discharge to change consistency, colour, and volume. But if discharge changes and is accompanied by other symptoms, this could be a sign of vaginitis.

"What is important to note is an abnormal discharge will cause itching, burning, or pain when urinating, whereas normal discharge is just different consistency," Naqvi says. "It could be white, it could be thin, it could be transparent, but it doesn't have other symptoms."

Unusual color

Normal discharge is typically pale white, off-white, or clear. A discharge tinged with brown or red usually signals menstruation or even implantation of a fertilized egg early in pregnancy. A discharge that's grey, green, yellow, or opaque white can signify something is off.

Odor

Normal discharge has a mild odour. But abnormal discharge may smell fishy or generally strong and unpleasant.

Consistency

The consistency of discharge changes throughout the menstrual cycle and during pregnancy. Abnormal discharge may be thin, thick, chunky, or even frothy.

Itching

Itching in or around the vagina is a prevalent symptom of vaginitis.

Burning

A burning sensation, especially when peeing, is another common sign of an infection.

Irritation

Swelling or a rash can develop on the vulva or other parts of the pelvic region.

When in doubt, schedule an appointment with your doctor, especially if you're experiencing pain, fever, nausea, or vomiting with the discharge. A healthcare provider can determine the exact cause and treat it appropriately.

How do you treat abnormal vaginal discharge?

Treatment options for vaginal infections vary, depending on the diagnosis.

Over-the-counter medications

Some causes of discharge can be treated with over-the-counter medications. Yeast infections, for example, can typically be treated with over-the-counter antifungal creams.

Prescription medications

BV, some STIs, trich, and other infections require antibiotics or other prescription meds.

How do you prevent abnormal vaginal discharge?

There are simple ways to prevent abnormal discharge and the infections that cause it.

Practice good hygiene

While gently washing the vulvar area with gentle soap or even just rinsing with water is fine, you shouldn't actually try to clean the vagina, the experts say. Discharge helps keep the vagina clean.

There's also no need to use douche, wipes, or other vagina cleaning products, as they can upset the natural pH.

Use protection during sexual activity

Sex can cause pH levels to change in the vagina. Using condoms or dental dams can prevent this. So can urinating right after intercourse.

"All bodily fluids don't have the same pH as the vaginal pH," says Tamara Guichard, M.D., gynecologist at Elite Gynecology in New York. "We want our vaginal pH to be below four. After intercourse, saliva, semen, even your urine and blood, all change the pH because they all naturally have a different pH."

Avoid irritating substances

Fragrance can irritate sensitive skin. Skip scented products around the vagina, including detergent and dryer sheets when doing laundry.

Stick to cotton underwear, Holt says. "A thong is not a great way to go, either, because you kind of have a little highway from your rectum to the vagina with the fabric right there," she says.

Holt recommends using pH—neutral lubricants and avoiding ones that are flavored or produce hot or cold sensations.

Maintain a healthy vaginal microbiome

Eat probiotic-rich foods first before jumping to probiotic supplements, Holt says.

"Foods that contain a large amount of lactobacillus, like kefir or yogurt, and fermented foods like sauerkraut, kimchi, or kombucha are great," she says. "Sugary and ultra-processed foods can contribute to the development of yeast vaginitis."

Experts

• Rakhee Patel, M.D., FACOG, an OB-GYN at Pinewood Family Care in New Jersey
• Fatima Naqvi, M.D., FACOG, an OB-GYN and interim medical director for women's service at Atlantic Health System in New Jersey
• Sara Holt, CNM, MS, a certified nurse midwife at Byenveni Baby in Portland, Oregon
• Tamara Guichard, M.D., gynecologist at Elite Gynecology in New York