A discharge from the vagina may occur normally or may result from inflammation of the vagina (vaginitis), often 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 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 in the following situations:
During menstrual cycles a few days before the egg is released
A few months before girls have their first menstrual period
During pregnancy
In women who take drugs that contain estrogen or that increase estrogen production (such as some fertility drugs)
In newborns for a week or two after birth because they absorb estrogen from their mother before birth
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
Heavier than usual
Thicker than usual
Puslike
White and clumpy (like cottage cheese)
Grayish, greenish, yellowish, or blood-tinged
Foul- or fishy-smelling
Accompanied by itching, burning, a rash, or soreness
Causes of Vaginal Discharge
An abnormal vaginal discharge is usually caused by vaginitis, which most often results from irritation by a chemical or from an infection.
Common causes
Likely causes of a vaginal discharge depend on age.
During childhood, common causes include
An infection due to bacteria from the digestive tract
Chemicals in bubble baths or soaps
A foreign object (such as a piece of toilet paper or sometimes a toy) in the vagina
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 object 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
Candidiasis (a yeast infection)
Trichomonas vaginitis (trichomoniasis of the vagina), which is usually sexually transmitted
Sometimes a discharge is caused by another infection, including sexually transmitted infections (such as gonorrhea or a chlamydial infection).
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):
Use of antibiotics (because they may reduce the number of protective bacteria)
Menstrual blood or semen in the vagina (because they reduce the acidity of the vagina)
Douching (because it can reduce the acidity of the vagina)
Pregnancy
Diabetes mellitus
A foreign object, such as a forgotten tampon (because tampons provide a warm, moist environment where bacteria can thrive)
After menopause, many women have an abnormal discharge. It occurs because the decrease in estrogen levels causes the vagina to thin and become drier. A thin, dry vagina is more likely to become irritated and inflamed, resulting in a discharge. Symptoms that affect the vagina and urinary tract after menopause are called genitourinary syndrome of menopause. These symptoms include vaginal dryness, pain during sexual intercourse, urinary urgency, and urinary tract infections.
Less common causes
During childhood, sexual abuse may be the cause. Such abuse can result in injury or a sexually transmitted infection.
During the childbearing years, the cause is sometimes a foreign object (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, pessaries, 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 any of the following:
Damage to the vagina during delivery (mainly in developing countries)
An infection that occurs in a surgical incision or tear of the opening of the vagina during childbirth
Radiation therapy directed at the pelvis (the lowest part of the torso)
Injury during pelvic surgery
Tumors in the pelvis
Evaluation of Vaginal Discharge
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:
Fever
Pelvic pain
A bloody discharge, especially after menopause
Stool in the vaginal discharge
In children, a fever or a yellow or green discharge with a fishy odor due to trichomonas vaginitis (suggesting sexual abuse)
When to see a doctor
Women or girls with most warning signs should see a doctor within a day.
Women without warning signs should see a doctor within a few days.
If women recognize the symptoms of a yeast infection, are confident that what they have is a yeast infection, and have no other symptoms, they may use a nonprescription vaginal treatment if that is available. 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. If the discharge persists or symptoms return after treatment, women should see a doctor.
In children, a vaginal discharge may be due to a foreign object in the vagina. If no foreign object is present and children have signs of an injury, sexual abuse is possible. If they have unexplained vaginal discharge, a sample of the discharge is taken from the vagina or cervix and tested. If abuse is suspected, measures to ensure the child’s safety are taken, and the case is reported to the appropriate authorities.
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 discharge and the tests that may need to be done (see table Some Causes and Features of a Vaginal Discharge).
Doctors ask about the discharge:
What it looks and smells like
When it occurs in relation to menstrual periods and sexual intercourse
Whether other symptoms (such as itching) are present
Doctors also ask about other symptoms, such as abdominal or pelvic pain, pain during urination or sexual intercourse, itching, fever, and chills.
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 (such as taking antibiotics frequently or having diabetes). Doctors also ask about possible exposure to sexually transmitted infections.
The physical examination focuses on the pelvic examination.
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 of a vaginal discharge. Additional tests are done to confirm or, if needed, to identify the cause.
Unless the cause is obvious (such as a foreign object or an allergic reaction), doctors use a cotton swab to take a sample of the discharge from the vagina or cervix. They examine the sample under a microscope to check for the microorganisms that can cause 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 of Vaginal Discharge
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
Placing ice packs on the genital area or sitting in a warm sitz bath may reduce soreness and itching. A sitz bath is taken in the sitting position with water covering only the genital and rectal area. Sitz baths can be taken in the bathtub filled with a little water or in a large basin. Flushing the genital area with lukewarm water squeezed from a water bottle may also provide relief.
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.
Drugs
If a vaginal infection, such as bacterial vaginosis, a yeast infection, or Trichomonas vaginitis, is diagnosed, antibiotics or antifungal drugs (taken by mouth or inserted into the vagina) are required.
Essentials for Older Women: Vaginal Discharge
After menopause, estrogen levels decrease markedly. As a result, the amount of normal discharge usually decreases. However, the decrease in estrogen causes the lining of the vagina to thin and become drier and fragile. The thin, dry 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. Vaginal dryness may make sexual intercourse painful. Vaginal dryness, pain during sexual intercourse, urinary urgency, and urinary tract infections are symptoms of the genitourinary syndrome of menopause. Low-dose estrogen hormone therapy may be used to treat this syndrome.
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, may occur after menopause. 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 infections. 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.
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 discharge that occurs 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
A vaginal discharge may be accompanied by itching, redness, burning, and soreness.
Likely causes depend on age.
Usually, doctors examine a sample of the discharge to check for microorganisms that can cause infections.
Treatment depends on the cause, but applying cold packs or sitting in a warm sitz bath can help relieve symptoms.
Any discharge that occurs after menopause requires prompt evaluation by a doctor.
