Vaginal discharge is any fluid or material that leaves a female’s body through the vagina. Some vaginal discharge is normal for all women, especially those in their reproductive years (ages 15 to 44). When the amount, quality or consistency of vaginal discharge changes, it may be a sign of disease or other irritation.

The fluids, chemicals and organisms of the vagina have a natural balance. When in balance, they help to clean the vagina and protect it from outside organisms. Any change to that natural balance can affect the characteristics of vaginal discharge. Changes may originate from both internal factors (e.g., hormonal changes, stress) or from external factors (e.g., infection, poor hygiene).

Normal vaginal discharge is clear or white with no bad odor. It has regular fluctuations that result from hormonal changes occurring throughout the menstrual cycle. The normally clear and thin fluid becomes a bit thicker and heavier at the time of ovulation. Sexual excitement increases vaginal discharge. It also changes during pregnancy, at menopause and when a woman uses birth control pills.

Change in the color, odor or consistency of vaginal discharge may indicate an infection. Yeast infections, where the volume of regular vaginal yeast increases, cause a thick, white discharge that resembles cottage cheese. Other vaginal infections (sometimes grouped as vaginitis) like trichomoniasis and bacterial vaginosis can cause other changes to vaginal discharge, such as changes in amount, color and odor. Sexually transmitted diseases may also be associated with unusual vaginal discharge, but frequently have no symptoms.

In addition, altered vaginal discharge may be the result of personal behaviors or habits that can affect the vaginal environment. These include douching and wearing tight clothing that restricts air flow to the vagina.

Symptoms that may accompany vaginal discharge include painful urination, itching, pelvic pain or rash. Sudden change in vaginal discharge should be reported to a physician, preferably a gynecologist (GYN). If there is infection, it can be treated and the vaginal discharge should return to normal levels

Girls may begin to notice some vaginal discharge up to a year before their first menstrual period. Those not yet nearing puberty who experience vaginal discharge should see a physician immediately, because discharge is rare in healthy prepubescent girls.

The vagina is a natural pathway that leads from the uterus to the outside of a female’s body. Fluids from glands in the cervix (opening that leads to the uterus) lubricate the vagina. The Bartholin glands found near the opening of the vagina also produce fluids. All these fluids help keep the vagina clean and help keep infection out of the body. They also provide lubrication for sexual intercourse.

The vagina contains a balanced, slightly acidic combination of certain bacteria, mucus, yeast and other organisms. This combination is called the vaginal flora. Change in any component of the vaginal flora affects the natural balance and may affect vaginal discharge. The environment outside a woman’s body may also affect the vagina. The vagina needs some air circulation to keep its flora moist and in balance.

Vaginal discharge is normally clear to milky white in color and has no bad odor. For women in their reproductive years, vaginal discharge varies according to the hormones in their menstrual cycle. During menstruation, the vagina serves as a pathway for menstrual blood to leave the body. Two weeks after menstruation, at ovulation, hormonal changes make vaginal discharge thicker and more slippery. Sexual excitement also increases vaginal discharge, as can other hormonal changes.

For a healthy woman, the body produces a vaginal discharge that cleans, protects and lubricates. Some variations are normal. Sudden changes in vaginal discharge may indicate a reaction to medication or the environment, which may not require medical attention. Other changes in discharge may signal disease or other conditions that require medical or hygienic attention.

Vaginal discharge is normal for young girls shortly before their first menstrual period (menarche). Any vaginal discharge in a younger girl may be a sign of a medical condition or sexual abuse and requires immediate medical attention.

Although vaginal discharge is a regular factor for a woman’s health, abnormal vaginal discharge may signal many conditions, either related to diseases in the reproductive organs or to factors outside the body. Sometimes, abnormal discharge occurs in conjunction with other symptoms. Any unusual discharge that occurs with these symptoms should be reported to a physician, preferably a gynecologist (GYN). 

Other symptoms that may be experienced with vaginal discharge include:

• Itching
• Rash
• Pelvic pain
• Unusual odor
• Pain or burning during urination (dysuria) or bowel movements (dyschezia)
• Fever
• Warts or lesions
• Non-menstrual vaginal bleeding

A healthy woman normally has some vaginal discharge. Changes to that discharge may be caused by numerous health conditions or diseases, such as:

• Yeast infection. A form of vaginitis caused by an excess of the naturally occurring fungus Candida albicans. A white, cottage cheese-like vaginal discharge is the most common symptom. Certain antibiotics prescribed for infections sometimes kill the normal vaginal bacteria. This changes the balance of the vaginal flora, causing an excess of yeast. A number of other factors can also change the balance of flora, resulting in a yeast infection.
  
  
• Bacterial vaginosis (BV). A form of vaginitis caused by the Gardnerella bacteria, which is normally present in the vagina in smaller quantities. When the balance of vaginal flora changes, levels of Gardnerella bacteria may increase. BV causes a gray vaginal discharge with a fishy odor, most noticeable after sex, along with painful urination and itching.
  
  
• Pregnancy. Due to the hormonal changes that take place during pregnancy, pregnant women have increased levels of discharge that are thinner and milky white in color. They are also more susceptible to yeast infections.
  
  
• Childbirth. After giving birth, women experience vaginal discharge as their reproductive organs return to normal. Women bleed for several days after birth. Then a white or pink vaginal discharge called lochia can continue for weeks.
  
  
• Irritation. Products such as spermicides can irritate the vagina and cause discharge in some women.
  
  
• Diabetes. Variations in glucose (blood sugar) levels make women with diabetes more susceptible to yeast infections.
  
  
• Trichomoniasis. A form of vaginitis caused by the Trichomonas protozoa, usually spread through sexual contact. It may cause a greenish-yellow or gray, frothy vaginal discharge with a fishy odor.
  
  
• Sexually transmitted diseases (STDs). These may include gonorrhea, chlamydia and genital herpes. Women frequently have no symptoms at the time of STD infection, but when symptoms do occur, they may include unusual vaginal discharge. Changes can include the amount or type of discharge.

• Pelvic inflammatory disease (PID). Infection of the upper reproductive organs (often caused by gonorrhea or chlamydia). PID may not have symptoms, but when symptoms do occur, they may include unusual vaginal discharge.
  
  
• Atrophic vaginitis. A condition that may occur after menopause where decreased estrogen levels make the vagina drier and more susceptible to bleeding and infections.
  
  
• Reproductive cancers. Cancers of the uterus, cervix and other reproductive organs can sometimes cause unusual vaginal discharge.
  

Medications may also affect vaginal discharge, especially those containing hormones. The changes may not be cause for concern, and awareness of a medication’s effects can help women monitor their health during use. Medications that may change vaginal discharge include:

• Antibiotics. These medications can reduce the normally occurring vaginal bacteria. This shifts the balance of vaginal yeast and may cause the thick, white, cottage cheese-like discharge associated with a yeast infection.
  
  
• Birth control pills. Oral contraceptives contain the hormone estrogen, which normally may cause fluctuations in vaginal discharge. Birth control pills may also increase the likelihood of a yeast infection.

Conditions outside a woman’s body and her personal habits may affect vaginal discharge. Some of these factors include:

• Douching. This can change the balance of vaginal flora and allow introduction of other bacteria. Douches may also force vaginal bacteria into the uterus, which can cause an infection.
  
  
• Tight clothing. Wearing tight clothing for prolonged periods of time can create a warmer, moister vaginal environment that encourages bacterial growth and affects vaginal discharge.
  
  
• Perfumed products. Scented tampons, soaps, sprays, detergents or toilet paper may cause irritation or an allergic reaction and affect vaginal discharge.
  
  
• Poor hygiene. Improper or insufficient hygiene can introduce rectal or other outside bacteria into the vagina, especially if a woman does not wipe in a direction away from the vagina after using the toilet.
  
  
• Emotional factors (e.g., stress, sexual excitement). They can increase vaginal discharge.

Most vaginal discharge is normal and does not require treatment. If a woman is uncomfortable with her normal levels of vaginal discharge, she may use absorbent panty liners. However, continual use of panty liners is not recommended for vaginal health because of decreased air flow to the area.

Treatment for abnormal vaginal discharge usually involves treating the underlying condition, rather than the symptom. Physicians may prescribe medications for infections, including pills or topical creams. Medications usually improve the condition within a few days. Treatment for bacterial infection may include antibiotics. Some women find that supplementing the diet with yogurt or pills containing active lactobacillus acidophilus cultures is helpful in maintaining a healthy balance of vaginal flora during treatment.

Birth control pills may be changed to a different hormone combination to modify vaginal discharge. Hormone replacement therapy (HRT) for menopausal women may alleviate vaginal dryness by increasing vaginal discharge through the action of the hormones.

Discharge that is accompanied with any pelvic pain should receive immediate medical attention. Such discharge may indicate infection with a sexually transmitted disease (STD).

Women can promote vaginal health with changes in some personal habits:

• Safe sex. Women should practice safe sex to minimize the potential for acquiring STDs. This includes using latex or nonlatex types of condoms during sex, limiting the number of sexual partners and regular testing for STDs.
  
  
• Clothing. Loose clothing and cotton underwear allow more air circulation to the vagina.
  
  
• Toilet hygiene. After urination or a bowel movement, a woman should wipe from front to back to keep outside bacteria away from the vagina.
  
  
• Douches. It is recommended that women avoid the frequent use of douches unless it is medically indicated. Douching changes the balance of the vaginal flora and may force bacteria in the vagina up into the uterus. Either of these actions may cause infection.
  
  
• Personal products. Women can avoid use of any perfumed soap or deodorant products in or near the vagina. Perfumes or other additives in these products may cause irritation or an allergic reaction.
  
  
• Diabetes management. Maintaining control over glucose (blood sugar) levels will help to avoid recurring yeast infections.

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor or healthcare professional the following questions about vaginal discharge:

1. What constitutes normal vaginal discharge?
   
   
2. Why has my vaginal discharge changed?
   
   
3. What does this change indicate?
   
   
4. Is there anything I can do to reduce my vaginal discharge?
   
   
5. What steps can I take to improve my vaginal discharge?
   
   
6. When should I be concerned about a change in vaginal discharge?
   
   
7. Is my vaginal discharge caused by a serious condition?
   
   
8. Can any of my current medications affect my vaginal discharge?
   
   
9. What lifestyle factors or personal habits may be affecting my vaginal discharge?
   
   
10. How can I prevent yeast infections from recurring?