Vaginal Discharge

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 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

Sometimes a discharge is caused by another infection, including sexually transmitted infections (such as gonorrhea Gonorrhea Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, or throat, or the membranes that cover... read more or a chlamydial infection Chlamydia and Other Nongonococcal Infections Chlamydial infections include sexually transmitted infections of the urethra, cervix, and rectum that are caused by the bacteria Chlamydia trachomatis. These bacteria can also infect... read more ).

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. 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.

During childhood, sexual abuse Sexual abuse Child maltreatment includes all types of abuse and neglect of a child under the age of 18 by a parent, caregiver, or another person in a custodial role (for example, clergy, coach, or teacher)... read more 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 Pessaries Pelvic organ prolapse involves relaxation or weakening of the ligaments, connective tissue, and muscles of the pelvis, causing the bladder, urethra, small intestine, rectum, or uterus to bulge... read more , 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:

In women with an abnormal discharge, certain characteristics are cause for concern:

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 Vaginal Yeast Infection (Candidiasis) A vaginal yeast infection (also called candidiasis) is caused by an infectious organism called Candida, usually Candida albicans. A vaginal yeast infection may cause intense itching... read more , 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.

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 Some Causes and Features of a Vaginal Discharge ).

Doctors ask about the discharge:

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 Pelvic Examination For gynecologic care, a woman should choose a health care practitioner with whom she can comfortably discuss sensitive topics, such as sex, birth control, pregnancy, and problems related to... read more .

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 Diagnosis Gonorrhea is a sexually transmitted infection caused by the bacteria Neisseria gonorrhoeae, which infect the lining of the urethra, cervix, rectum, or throat, or the membranes that cover... read more and chlamydial infections Diagnosis Chlamydial infections include sexually transmitted infections of the urethra, cervix, and rectum that are caused by the bacteria Chlamydia trachomatis. These bacteria can also infect... read more (which are sexually transmitted).

Washing every day without soap or, if soap is necessary, with a mild, nonallergenic 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.

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 Pelvic Inflammatory Disease (PID) Pelvic inflammatory disease is an infection of the upper female reproductive organs (the cervix, uterus, fallopian tubes, and ovaries). Pelvic inflammatory disease is often caused by a sexually... read more .

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. Some antihistamines also cause drowsiness and may be useful if symptoms interfere with sleep.

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.