When should you be concerned about vaginal discharge?

Vaginal discharge is the normal secretion produced in the glands inside the woman’s vagina and cervix. It consists of vaginal skin cells, bacteria and cervical mucus (fluid).

The purpose of discharge is to keep the vagina clean and healthy - in fact, apart from the eyes, the vagina is the only part of the human body that has the ability to clean itself! It cleanses out the old cells by flowing out of the vagina daily. It also provides natural lubrication to the vaginal tissue and protects the area against infections. In other words, having vaginal discharge is a completely normal bodily function and women should not be ashamed of it.

The most important healthy bacteria in the vagina are the lactobacilli. These bacteria help inhibit the growth of other, harmful bacteria and offer protection against infections. They contribute to the acidity in the vagina, helping to maintain a healthy pH. An imbalance of lactobacilli can therefore lead to various problems including changes in the composition and appearance of vaginal discharge.

Many women wonder if their vaginal discharge looks normal and what colour it should be. Other worries consider its quantity, consistency and odour.

Typically, the appearance of discharge is clear and whitish. However, the colour and consistency change during the menstrual cycle due to fluctuating oestrogen levels, and for some women these changes can be more noticeable. Research has also shown that, during a period, the vaginal flora becomes more unstable and the growth of lactobacilli increases towards the end of a woman's menstrual cycle. Therefore, the risk of getting an infection can be higher at certain times of your cycle.

Other typical, natural changes in vaginal discharge happen during sexual arousal, pregnancy and menopause.

What can the colour of my vaginal discharge tell me?

The colour of a woman’s discharge can vary from different shades of white to greyish, yellow and green and if it contains blood, discharge can appear brown, orange, red and even black.

There can be various explanations for changes in colour, most of them completely harmless, while some changes can be a sign of an infection or other medical condition. To figure out the cause behind abnormal discharge, you should always pay attention to any other possible accompanying symptoms, such as itching, pain or any other changes in the genital area.

White vaginal discharge

Vaginal discharge is typically a shade of white, and it is also called leukorrhea. Normal discharge ranges between clear and slippery to creamy and sticky, changing throughout the menstrual cycle:

• When ovulation is approaching, discharge typically becomes more wet and stretchy.
• 1-2 days before ovulation it is normal to see white creamy discharge that can resemble an eggwhite.
• After ovulation the amount decreases and may be almost absent before the period starts.
• After a period, once the oestrogen levels rise, the discharge becomes thicker again.

However, if you are experiencing white clumpy discharge that is clotted, lumpy and resembles cottage cheese, this may be a sign of a yeast infection. Cloudy or frothy white discharge can also be a symptom of other infections, like bacterial vaginosis, chlamydia or trichomoniasis.

Grey vaginal discharge

Grey discharge is not normal and is usually a sign of a vaginal infection. It is a typical symptom of bacterial vaginosis, and is a result of a mix of bacteria. Greyish discharge can also be a sign of an STI such as chlamydia, gonorrhoea and trichomoniasis.

Yellow vaginal discharge

Thin yellow discharge before your period starts is common. It happens when the cervical mucus becomes mixed with very early period blood. However, if the yellow discharge is very thick, watery, smells strong or fishy, or is accompanied by itching, burning and pain, it can be a sign of an infection.

Green vaginal discharge

Green discharge is a common symptom of gonorrhoea or trichomoniasis. It may also be caused by vulvovaginitis, which is a swelling of the vulva and vaginal lining.

Brown or orange vaginal discharge

Brown or orange discharge typically appears before or after your period when the blood becomes mixed with the discharge. When it appears irregularly during the cycle, it is often a sign of irregular menstruation (spotting) that can be caused for example by new hormonal contraception or conditions like polycystic ovary syndrome (PCOS) or endometriosis.

Pink vaginal discharge

Pink discharge will typically appear before a period and contains a tiny bit of blood. Continued pink spotting can, however, be a sign of an irregular menstrual cycle, or in rarer cases, a sign of endometriosis or ovarian cysts. It can also appear as a result of implantation of the egg at the beginning of pregnancy.

Red, bloody vaginal discharge

If red, bloody discharge appears irregularly, it is important to find out the cause. Bleeding may be caused by a cervical polyp, a harmful strain of HPV (human papillomavirus) or various sexually transmitted infections.

Black discharge

Black vaginal discharge can appear during a period when the blood is taking longer to exit the body. At other times, it can signal something more serious: a miscarriage, pelvic inflammatory disease (PID) or even cervical cancer.

It is normal for a healthy vagina to have a mild smell, which may vary throughout the menstrual cycle or can appear stronger after sexual intercourse. However, if the odour is unpleasant or unusually strong, it is often a sign that something is off balance.

If your vaginal discharge has a fishy smell, it is likely to be caused by bacterial vaginosis, especially if there is also a lot of watery discharge. Trichomoniasis may cause a fishy smell too. Poor hygiene is an obvious cause for smelly vaginal discharge, but it can also be influenced by factors such as your diet, the material of your underwear or excessive sweating.

Do not try to cover vaginal smell by using intimate deodorants or sprays as products like these are known to unbalance the vaginal flora and are likely to just worsen the problem.

Many women wonder if it is normal to have discharge every day and if they should be worried about the amount of their discharge. If you are experiencing more discharge than usual, there is no need to panic. Just like its consistency and colour, the amount of vaginal discharge will vary throughout your menstrual cycle. On average, women will have up to a teaspoon of discharge daily. However, this will vary between women, and what you would count as excessive discharge for you, might be normal for someone else.

When the oestrogen levels start to drop due to menopause, the amount of discharge will decrease and as a result, many postmenopausal women experience vaginal dryness. There are several other reasons that can affect the amount of discharge. These include the use of hormonal contraception, such as birth control pills, and pregnancy.

There are numerous possible causes for abnormal discharge. The most common culprits are bacterial infections where the pH of the vagina has become unbalanced.

One of these is bacterial vaginosis. As many as 1 in 3 women will suffer from it at some point in their lives. The typical symptoms include a watery and smelly discharge with a foul and fishy odour. Another common cause is a vaginal yeast infection also known as thrush or vulvovaginal candidiasis, which is a fungal infection caused by the overgrowth of fungus called Candida albicans. It is experienced by up to 75% of all women at some point. Along with abnormal discharge, it is often accompanied by inflammation of the vulva, itching, burning and soreness.

Sexually transmitted diseases (STDs) are another possible reason for changes in discharge. Chlamydia (chlamydia trachomatis) and gonorrhoea are both bacterial infections that spread via unprotected sexual intercourse or other type of genital contact with an infected person. STIs often cause symptoms like genital itching, strong-smelling discharge and pain. Another STI, trichomoniasis, is caused by a parasite called trichomonas vaginalis, and commonly presents with itching, burning, pain and excessive, smelly discharge. Other bacterial STIs behind changes in vaginal discharge can be mycoplasma genitalium or ureaplasma urealyticum. Viral STDs, such as genital herpes, may also cause similar symptoms. It is, however, important to remember that many STIs are often symptomless.

Other, rarer causes behind abnormal discharge include conditions such as PID, which can be a complication of an STI, endometriosis, vulvovaginitis, endocervical polyps or cervical cancer.

The vaginal flora can become unbalanced due to poor intimate hygiene, such as not washing regularly during a period or wearing the same tampon for too long. However, in developed countries today the reasons are even more likely due to ‘over-hygienic’ cleaning routines. The use of scented soaps, sprays and scented pads can be very irritating for the vaginal area and hygiene routines like douching and bubble baths can upset the normal bacteria in the vagina, often resulting in bacterial vaginosis or thrush.

Ways to prevent infections

The most important factor in keeping your vagina healthy is taking care of your hygiene:

• Wash your vagina every day and only wash the outside, and do not point water directly in the vagina
• Wipe from front to back and wear breathable underwear
• Avoid scented products, such as soaps, shower gels and deodorants in the vaginal area, and the same applies to scented pantyliners and menstrual pads

These are the best ways to avoid irritating the natural flora and keeping the healthy bacteria in balance.

Taking probiotic supplements which contain healthy lactobacillus and help lower pH levels can also be a way to prevent bacterial infections from recurring.

Another important rule is healthy sexual behaviour. To avoid catching a sexually transmitted infection, follow these simple rules:

• Always wear a condom with a new partner or anyone whose sexual history you are not aware of
• Always clean sex toys properly and avoid sharing them
• Limit your number of sexual partners

Prescription treatments

The treatment for abnormal discharge will depend on what is causing it.

Bacterial vaginosis

BV can often be treated with over-the-counter treatments, such as vaginal creams or suppositories. However, recurring infections are best treated with prescription medication, typically metronidazole. Other treatment options are antiseptic treatments containing dequalinium chloride (like Fluomizin) or antibiotic creams containing clindamycin (like Dalacin).

Thrush

Yeast infections can be treated with antifungal treatments, most commonly with miconazole (sold under the name Diflucan) or fluconazole (sold under the name Gyno-Daktarin), either in the form of a cream or capsules.

Sexually transmitted infections

Sexually transmitted diseases, including chlamydia, gonorrhea and trichomoniasis should always be diagnosed by a healthcare professional and treated with prescribed medicine to avoid potentially dangerous complications.

Bacterial STIs can be treated with antibiotics. Azithromycin can be used to treat many bacterial infections, including chlamydia, gonorrhoea, ureaplasma urealyticum and mycoplasma genitalium. Doxycycline can also be used to treat chlamydia, u. urealyticum and m. genitalium. Trichomoniasis is normally treated with metronidazole. For gonorrhoea, a combination of two antibiotics can be used, or it may be treated with a single intramuscular injection of Ceftriaxone.

Viral STIs cannot be cured, but their symptoms can be treated. If your symptoms are caused by genital herpes, they can be managed and prevented from reoccurring by medications such as aciclovir or famciclovir (Famvir).

euroClinix offers a wide range of treatments for women’s health. Whether you suffering from bacterial vaginosis or thrush, or you have been diagnosed with a sexually transmitted infection, we can help you get the treatment you need quickly and discreetly with our online consultation.