Vaginal Discharge

What is vaginal discharge?

Vaginal discharge is a mixture of human cells, bacterial cells, and fluids. Normal discharge is a good thing [1]. It keeps tissues healthy by lubricating the vagina and protecting it from infections. The amount and consistency can change naturally due to hormonal fluctuations such as around ovulation or during pregnancy, but changes in texture, smell, quantity or color can sometimes be warning signs of a vaginal infection. Since what is “normal” varies from person to person, it is important to understand what is abnormal for you to determine what changes to keep an eye out for [2]. 

How common is it?

Considering that all women have some form of discharge, it is not only very common but, most of the time, it is also very normal. Most women will notice changes in their discharge during the course of the menstrual cycle and as they get older. It’s important to look out for changes to discharge caused by something being ‘off’ and to seek advice from a doctor when this happens. 

How is vaginal discharge linked to the vaginal microbiome?

Vaginal discharge actually helps to protect vaginal tissues. Some variation isn’t anything to worry about and discharge is usually normal if it is [1,2]:

• Clear, white, or slightly off white
• Anything from thin and fluid to somewhat thick and sticky
• Fairly odorless (although this varies from woman to woman)
• Around 0.5-1 tsp per day in terms of volume 
  

Normal changes to the quantity or consistency include less discharge (more dryness) as a woman ages, changes in consistency during pregnancy, and more slippery discharge around ovulation. You might also notice changes if you start taking birth control or after vigorous exercise. 

On the other hand, some changes can indicate an infection [1-4]. Consult your doctor if your discharge is:

• Yellow, green or brown. The color will vary depending on what kind of infection or disease is present. For example, brown discharge could be a sign of cervical cancer.

• Thick or cottage-cheese like, which can be a sign of a yeast infection (a.k.a. thrush) 
• Foul smelling. Any kind of strong odor tends to indicate dysbiosis, an imbalance in the vaginal microbiome bacteria, or an infection. For example, bacterial vaginosis and trichomoniasis both cause a “fishy” smell.
• A lot more than usual
  

What are the diagnostic and treatment options?

If you suspect that your vaginal discharge is abnormal, your doctor will likely ask questions about your symptoms and might even take a sample of it for further tests. Although yeast infections, BV, chlamydia, gonorrhea, trichomonas, and many other infections all cause unusual vaginal discharge, treatment will depend entirely on the diagnosis of the underlying condition. For example, a yeast infection is usually treated with antifungal medications whereas bacterial vaginosis is treated with antibiotics [1-2]. 

Can abnormal vaginal discharge lead to other complications?

Abnormal vaginal discharge is a symptom of a condition, and that underlying condition can cause complications if left untreated. Therefore, it is important to treat infections and not mask abnormal discharge with scented soaps or by douching. For example, without proper treatment, BV can lead to pelvic inflammatory disease which in turn can lead to fertility issues [5]. 

What can be done to prevent abnormal vaginal discharge?

To protect yourself against infections that can cause abnormal discharge, avoid disrupting the balance of protective bacteria in the vaginal microbiome by limiting the use of douches as well as the use of scented soaps, tampons or pads. To reduce your chances of getting an STI, practice safe sex by always discussing sexual health with your partner, using barrier protection correctly (such as a condom or dental dam), and getting tested regularly.