It is rarely talked about and often misunderstood. The term “vaginal discharge” is unfairly associated with embarrassment and shame. Most vaginal discharge is normal. Every day, fluids are produced by small glands in the vagina and cervix. These fluids make up vaginal discharge, also called cervical mucus. Vaginal discharge provides clues to general vaginal health, as well as fertility. Changes from normal discharge can be signs of inflammation or hormonal imbalance. Becoming familiar with your own vaginal discharge can empower you to understand your body and the signals it is trying to send.
What is Considered a Normal Amount of Vaginal Discharge?
The vagina is a “self-cleaning oven”. One of the functions of this discharge is to help flush out unwanted substances or microorganisms (i.e., bacteria and yeast). Healthy microscopic organisms live inside the vagina, interacting with cervical mucus, fluids, and your body’s epithelial cells. It creates an environment that benefits the female human body, just like the relationship with our gut bacteria and digestion. The good bacterium that keeps vaginas healthy is called Lactobacillus. There are several species of Lactobacillus, and they can vary from person to person. There is never a need to clean out the vagina with douching or soap because healthy Lactobacillus keep potentially harmful microorganisms from growing. A sign of healthy vaginal environments is discharge that is clear or creamy consistency, and mostly odorless.
The pH, or acidity, of the vagina is an essential part of vaginal health. The typical pH is 4.0 to 4.5. It is balanced and maintained with a combination of the natural fluids secreted by the tissue, microorganisms, and hormone balance. This pH allows healthy Lactobacillus organisms to thrive, while keeping more harmful microorganisms that cause bacterial vaginosis (BV), yeast infections, and others from flourishing. When there is a noticeable change in vaginal discharge, it may be a sign of infection.
What Can Vaginal Discharge Tell You?
- Egg white: For women who menstruate, discharge changes throughout the menstrual cycle. The color, texture, and consistency may change depending on the cycle’s relation to ovulation. One to two days prior to ovulation, estrogen levels rise, and discharge becomes clear and sticky. It is referred to as “egg white” discharge because it resembles clear sticky raw egg whites. This time is called the fertile window and is an ideal time to try to conceive. This discharge supports the transport of sperm for fertilization and lubrication during sex. If pregnancy is not your goal, avoid unprotected sex especially during this time
- Creamy white: Milky or creamy discharge that is white or off-white is called leukorrhea. This normal discharge is present throughout the cycle and can dramatically increase in quantity during pregnancy. White discharge may be more noticeable toward the end of your cycle and the before the start of your period.
- Clear watery: As the fertile window approaches, discharge may become clearer in color. Clear slippery discharge is also produced after arousal or exercise.
Abnormal Vaginal Discharge
- Thick white “cottage cheese”: Thick white discharge may indicate that you have yeast infection, a.k.a Candida. Candida are species of fungus that are normally present inside the vagina in low levels. When the healthy flora or pH of the vagina is disrupted, these fungal organisms flourish and cause a yeast infection. Additional symptoms may include itching, redness, and pain with urination or sex. Candida is the most common cause of vulvar and vaginal irritation, with nearly half of all women reporting a history of at least one diagnosed yeast infection in their life. About 1 in 10 women report having at least 4 yeast infections in a year. Recurrent yeast infections can be a sign of another underlying condition that increases the likelihood of recurrence. Women with frequent yeast infections should seek care from their gynecology healthcare provider. Yeast infections can be treated with over-the-counter or prescription antifungals.
- Watery-grey with “fishy” odor: This abnormal discharge is characteristic of bacterial vaginosis (BV). BV is an overgrowth of a bacteria called Gardnerella, which is also normally present in the vagina. BV is the most common cause of vaginal discharge. BV also occurs when the normal flora of the vagina is imbalanced. BV infections are not normally associated with pain or itching and may require antibiotics to clear. Like yeast infections, frequent reoccurrence of BV may be a sign of an underlying condition and seeing a gynecology healthcare provider is recommended.
- Frothy yellow or green: This characteristic discharge, along with a foul odor, may indicate an infection of a protozoan called Trichomonas vaginalis (aka Trich). Trich is a sexually transmitted infection that can be treated with prescription antibiotics. It is necessary for sexual partners to also get treated, although men may not show any symptoms. The most common symptoms that women may experience in addition to the abnormal discharge are burning, itching, pain with sex or urination. Anyone with these symptoms should seek care from a gynecology healthcare provider.
- Blood or dark brown spotting: Dark brown discharge or dark colored blood may be caused by several various conditions. It is normal to experience dark brown spotting right before or after a period. In this case, it is most likely oxidized or “old” blood. Thick brown discharge may be a sign of a foreign body left in the vagina or a cervical blockage. Continual dark discharge may also be caused cervical irritation, lesions, hormonal changes, or stress. If these symptoms are present between periods, you should be evaluated by gynecology healthcare provider.
Sexually transmitted infections, such as chlamydia and gonorrhea may be asymptomatic. However, many women may experience abnormal discharge, burning, pain with sex or urination, bleeding after sex, or unusually spotting. Birth control does not protect against STIs, so use condoms every time you have intercourse with a new partner.
Healthy habits and hygiene practices can optimize your vaginal health and decrease the chances of developing abnormal discharge. Here are some helpful tips to keep your vagina happy:
- Avoid douching and scented soaps: These may disrupt your vagina’s normal pH and increase the chances of developing an infection. In fact, you vagina does not require soap at all. Health Lactobacillus inside the vagina will keep it clean. Sensitive unscented soaps are appropriate externally to keep your body clean and free from irritants.
- Wear 100% cotton underwear: Cotton is soft and absorbent to whisk away moisture. Silky polyester and other synthetic fabric may keep moisture trapped, increasing the likelihood of developing a yeast infection.
- Change your exercise clothes and swimsuits as soon as you are done: Tight leggings, especially after intense exercise keep your groin moist, leading to increased risk of yeast and BV. After swimming or working out, change out of the damp clothing and keep your vagina dry.
- Always wipe from front to back: After using the restroom, always wipe in a front-to-back direction. This is especially true for going number 2. Wiping the opposite direction can push stool and potentially pathogenic bacteria into the vagina and urethra, leading to vaginal infections or urinary tract infections (UTIs)
- Vaginal Probiotics: If you are prone to getting yeast infections, BV, or abnormal discharge, you may want to consider adding a vaginal probiotic to your daily routine. The supplements contain the good bacteria that you want in your vagina to maintain a healthy flora and pH
- See your gynecologist every year- It is highly recommended to see your gynecologist for a yearly preventative exam. Women aged 21-65 may need to get their pap smear done about every 3 years with regular vaginal check-ups in between. And of course, see your gynecologist sooner than a year if you are concerned about any symptoms.
Understanding what is normal may help you feel more confident in your vaginal and health. Most vaginal discharge is normal, but when it is not, seek help from your gynecologist for accurate diagnosis and treatment.
Tessa has been a Phoenix resident for over 15 years. She graduated from Arizona State University with undergraduate degrees in both Nursing and Biology. She worked as a Labor and Delivery nurse at Banner University Medical Center, beginning her career in Women’s Health. She continued to grow her practice and expertise by earning her Doctorate in Nursing Practice.