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A discharge from the vagina may occur normally or may result from inflammation of the vagina (vaginitis), which may be due to an infection. The genital area (vulva)—the area around the opening of the vagina—may also be inflamed. Depending on the cause of the discharge, other symptoms are often also present. They include itching, burning, irritation, redness, and sometimes pain during urination and sexual intercourse.
Normal discharge:
A vaginal discharge can result from normal changes in estrogen levels. When levels are high, estrogen stimulates the cervix to produce secretions (mucus), and a small amount of mucus may be discharged from the vagina. Estrogen levels are high
Typically, a normal discharge has no odor. It is usually milky white or thin and clear. During the childbearing years, the amount and appearance may vary during the menstrual cycle. For example, in the middle of the cycle when the egg is released (at ovulation), the cervix produces more mucus, and the mucus is thinner. Pregnancy, use of birth control pills (oral contraceptives), and sexual arousal also affect the amount and appearance of the discharge. After menopause, estrogen levels decrease, often reducing the amount of normal discharge.
Abnormal discharge:
A vaginal discharge is considered abnormal if it is
Causes
An abnormal vaginal discharge is usually caused by vaginitis, which most often results from irritation by a chemical or from an infection (see Vaginal Infections and Pelvic Inflammatory Disease).
Common causes:
Likely causes of a vaginal discharge depend on age.
During childhood, common causes include
An infection may occur when hygiene is poor. For example, young girls, especially those 2 to 6 years old, may transfer bacteria from the digestive tract to the genital area when they wipe from back to front or do not wash their hands after bowel movements.
If a foreign body is the cause, the discharge may contain small amounts of blood.
During the childbearing years, a discharge is usually caused by a vaginal infection. The most common are
Sometimes a discharge is caused by another infection, including sexually transmitted diseases (such as gonorrhea, a chlamydial infection, or trichomoniasis).
Vaginal infections are usually prevented by the protective bacteria (lactobacilli) that normally live in the vagina. These bacteria keep the acidity of the vagina in the normal range. When acidity in the vagina decreases, the number of protective bacteria decreases, and the number of harmful bacteria increases.
The following make the growth of harmful bacteria more likely (and thus increase the risk of vaginal infections):
After menopause, many women have an abnormal discharge. It occurs because the decrease in estrogen levels causes the vagina to thin and become drier. Moderate to severe thinning and drying is called atrophic vaginitis. A thin, dry vagina is more likely to become irritated and inflamed.
Less common causes:
During childhood, sexual abuse may be the cause. Such abuse can result in injury or a sexually transmitted disease.
During the childbearing years, the cause is sometimes a foreign body (such as a forgotten tampon). But in this age group, a discharge seldom results from inflammation alone (without infection).
In older women, urine or stool may irritate the area around the genitals and anus, resulting in a vaginal discharge. Such irritation may occur when women are incontinent (involuntarily pass stool or urine) or bedbound.
At any age, various products that come in contact with the genital area can irritate it, sometimes causing a discharge. Such products include hygiene sprays, perfumes, menstrual pads, laundry soaps, bleaches, fabric softeners, and sometimes spermicides, vaginal creams or lubricants, vaginal contraceptive rings, diaphragms, and, for women who are allergic to latex, latex condoms. Rarely, women have abnormal openings (fistulas) between the intestine and genital tract, resulting in a discharge from the vagina. This discharge sometimes contains stool. Fistulas may result from damage to the vagina during delivery (mainly in developing countries), Crohn's disease, radiation therapy directed at the pelvis (the lowest part of the torso), injury during pelvic surgery, or tumors in the pelvis. Radiation therapy, pelvic surgery, and tumors can cause a vaginal discharge whether they cause fistulas or not.
Evaluation
Often, doctors can identify the cause of an abnormal discharge based on characteristics of the discharge (such as appearance and odor), the woman's age, other symptoms, and simple tests that provide quick results.
Warning signs:
In women with an abnormal discharge, certain characteristics are cause for concern:
When to see a doctor:
Women or girls with warning signs should see a doctor within a day. However, if the only warning sign is stool in the discharge, a delay of several days is not likely to be harmful.
Women without warning signs should see a doctor within a few days.
If women recognize the symptoms of a yeast infection (see Vaginal Infections and Pelvic Inflammatory Disease: Vaginal Yeast Infection (Candidiasis)), are confident that what they have is a yeast infection, and have no other symptoms, they probably do not need to see a doctor every time they have a discharge. A discharge caused by a yeast infection is usually distinctive. It is thick, white, and often clumpy, resembling cottage cheese. However, sometimes yeast infections cause mainly itching and burning with only a small amount of discharge.
What the doctor does:
Doctors first ask the woman questions about her symptoms and medical history. Doctors then do a physical examination. What they find during the history and physical examination often suggests a cause of the pain and the tests that may need to be done (see Symptoms of Gynecologic Disorders: Some Causes and Features of a Vaginal Discharge ).
Doctors ask about the discharge:
Other questions include whether women use hygiene sprays or other products that may irritate the genital area and whether women have any conditions that can increase the risk of having a vaginal discharge.
The physical examination focuses on the pelvic examination (see Diagnosis of Gynecologic Disorders: Gynecologic ExaminationDiagnosis of Gynecologic Disorders/Gynecologic Evaluation/Gynecologic Examination).
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Some Causes and Features of a Vaginal Discharge |
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Cause
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Common Features*
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Tests
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During childhood
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A foreign object (often toilet paper) in the vagina
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A discharge, usually with a foul odor and often containing small amounts of blood
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A doctor's examination, sometimes done after the girl is sedated or given a general anesthetic
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Infections such as
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Yeast (candidiasis)
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Pinworm
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Streptococcal
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Staphylococcal
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Itching, redness, and swelling
Often pain during urination
With pinworm infection, itching that worsens at night
With streptococcal or staphylococcal infection, redness and swelling in the genital area
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Examination under a microscope and analysis of a sample of the discharge to check for microorganisms that can cause vaginal infections
Examination of the genital area and anus to check for pinworms
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Sexual abuse
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Soreness in the genital area
Sometimes discharge that has a foul odor or contains blood
Often vague symptoms (such as fatigue or abdominal pain) or changes in behavior (such as starting to have temper tantrums or to withdraw)
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Examination under a microscope and analysis of a sample of the discharge
Tests to detect sexually transmitted diseases using a sample of secretions taken from the cervix
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During the childbearing years
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Bacterial vaginosis
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A thin, white or gray cloudy discharge with a fishy odor
Itching and irritation
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Examination under a microscope and analysis of a sample of the discharge
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Yeast infections
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Irritation, itching, redness, and swelling in the genital area
A thick, white, clumpy discharge that resembles cottage cheese
Sometimes worsening of symptoms after intercourse and before menstrual periods
Sometimes recent use of antibiotics or a history of diabetes
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Examination under a microscope and analysis of a sample of the discharge
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Trichomoniasis (a protozoan infection)
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A usually profuse, yellow-green, frothy discharge with a fishy odor
Itching, redness, swelling, and soreness in the genital area
Sometimes pain during sexual intercourse and urination
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Examination under a microscope and analysis of a sample of the discharge
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Pelvic inflammatory disease
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Aching pelvic pain that becomes increasingly severe and may be felt on one or both sides
A discharge that sometimes has a foul odor and, as infection worsens, can become puslike and yellow-green
Sometimes pain during sexual intercourse or urination, fever or chills, nausea, or vomiting
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Tests to detect sexually transmitted diseases using a sample of secretions taken from the cervix
Sometimes ultrasonography of the pelvis
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A foreign object (often a forgotten tampon) in the vagina
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An often profuse discharge with an extremely foul odor
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A doctor's examination
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After menopause
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Thinning of the lining of the vagina (atrophic vaginitis)
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A scant discharge
Pain during sexual intercourse
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A doctor's examination
Examination under a microscope and analysis of a sample of the discharge
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Irritation caused by urine or stool
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General redness in the area around the genitals and anus
Conditions that increase the risk of such irritation, such as being incontinent or bedbound
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A doctor's examination
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Cancer of the vagina, cervix, or lining of the uterus (endometrium)
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A watery or bloody discharge
Often no other symptoms until the cancer is advanced
Pain that develops gradually and sometimes becomes chronic
Sometimes weight loss
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A Papanicolaou (Pap) test
A biopsy
Imaging tests such as ultrasonography, MRI, or CT
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At any age
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Chemical irritation (such as that due to soaps, bubble baths, hygiene sprays, or vaginal creams and ointments)
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Redness and soreness of the genitals
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A doctor's examination
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An abnormal opening (fistula) between the intestine and genital tract, which may result from
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An injury during childbirth
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Surgery
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Inflammatory bowel disease
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Cancer of the digestive tract or reproductive organs
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A discharge with a foul odor
Presence of stool in the vagina or in the vaginal discharge
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A doctor's examination
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Inflammation due to
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Recent treatment of a disorder affecting the pelvis
A discharge that contains pus
Pain during urination and sexual intercourse
Sometimes irritation, itching, redness, burning pain, and mild bleeding
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A doctor's examination
Usually examination under a microscope and analysis of a sample of the discharge
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*Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present.
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CT = computed tomography; MRI = magnetic resonance imaging.
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Testing:
Simple tests, which can be done in or near the examination room, can provide quick results that often enable doctors to identify the cause. Additional tests are done to confirm or, if needed, to identify the cause.
Unless the cause is obvious (such as a foreign body or an allergic reaction), doctors use a cotton swab to take a sample of the discharge from the vagina or cervix (see Diagnosis of Gynecologic Disorders: Screening for Sexually Transmitted Diseases). They examine the sample under a microscope to check for yeast infections, bacterial vaginosis, and Trichomonas vaginitis. They usually also send a sample to the laboratory to test for gonorrhea and chlamydial infections (which are sexually transmitted).
Treatment
The underlying condition is corrected or treated if possible. For example, bacterial vaginosis is treated with antibiotics.
Some general measures can help relieve symptoms, although they do not eliminate an infection.
General measures:
The genital area should be kept as clean as possible. Washing every day with a mild, unscented soap (such as glycerin soap) and rinsing and drying thoroughly are recommended. Changing underwear and bathing or showering once a day may help relieve symptoms. Improved hygiene is particularly useful if the cause is being incontinent or bedbound. Young girls should be taught good hygiene—to wipe from front to back, to wash their hands after bowel movements and urinating, and to avoid fingering the genital area.
If a product (such as a cream, powder, soap, or brand of condom) consistently causes irritation, it should not be used. Women are advised not to use feminine hygiene sprays and not to douche. These products do not eliminate the discharge and may make it worse. Douching may increase the risk of pelvic inflammatory disease (see Vaginal Infections and Pelvic Inflammatory Disease: Pelvic Inflammatory Disease (PID)).
Placing ice packs on the genital area or sitting in a warm sitz bath (with or without baking soda) may reduce soreness and itching. A sitz bath is taken in the sitting position with water covering only the genital and rectal area. Flushing the genital area with lukewarm water squeezed from a water bottle may also provide relief.
Drugs:
If symptoms are moderate or severe or do not respond to general measures, drugs may be needed. For example, a corticosteroid cream (such as hydrocortisone) or sometimes antihistamines taken by mouth can relieve itching.
Essentials for Older Women
After menopause, estrogen levels decrease markedly. As a result, the amount of normal discharge usually decreases. However, because the lining of the vagina thins and becomes drier (called atrophic vaginitis), the vagina is more likely to become irritated, often resulting in an abnormal discharge from the vagina. This discharge may be watery and thin or thick and yellowish.
Thinning also makes certain vaginal infections more likely to develop. The thin, dry vaginal tissues are more easily damaged, allowing usually harmless bacteria from the skin to enter tissues under the skin and cause infection there. Such infections are usually not serious but can cause discomfort.
Older women are more likely to have treatments that can reduce estrogen levels and thus make the vagina more likely to become irritated. Such treatments include removal of both ovaries, radiation therapy directed at the pelvis, and certain chemotherapy drugs.
Problems that make good hygiene difficult, such as being incontinent or bedbound, are more common among older women. Poor hygiene can result in chronic inflammation of the genital area due to irritation by urine or stool.
Vaginal infections, such as bacterial vaginosis, yeast infections, and Trichomonas vaginitis are uncommon after menopause but may occur in women with risk factors for these infections. Risk factors for yeast infections include diabetes and incontinence. Risk factors for bacterial vaginosis and Trichomonas vaginitis include new or several sex partners.
If older women are sexually active, condoms should be used to reduce the risk of sexually transmitted diseases. However, because condoms can irritate the vaginal tissues, particularly in older women, using lubricants is essential. Only water-based lubricants should be used with latex condoms. Oil-based lubricants (such as petroleum jelly) can weaken latex and cause the condom to break.
Because the risk that vaginal bleeding is due to cancer increases after menopause, older women should see a doctor promptly if they have a discharge, particularly if the discharge contains blood or is brown or pink (possibly indicating a small amount of blood). A blood-tinged, pink, or brown discharge after menopause can be a warning sign of a precancerous disorder (such as thickening of the lining of the uterus) or cancer and should not be ignored.
Key Points
Last full review/revision May 2012 by David H. Barad, MD, MS
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