As women, we all know that vaginal discharge is a fact of life, and we may not even think twice about it. But what is discharge, actually, and how can you tell what is normal, or what may be an indication of a problem? In this blog I’ll outline the role of vaginal discharge in keeping your body healthy, and ways to recognise abnormal discharge that require review by a clinician.
What is vaginal discharge?
By definition, a discharge is a fluid released from a hollow space, like the vagina. Vaginal discharge is produced by mucous-releasing glands on the cervix (called ‘Nabothian glands’), and the vaginal wall (during sexual arousal). The discharge slowly flows out of your vagina, thereby cleansing old cells that used to line the vagina.
What purpose does normal vaginal discharge serve?
‘Normal’ vaginal discharge is a healthy substance and process. It carries away fluid, cells and bacteria, thereby keeping your vagina clean and protected (from abnormal bugs). It also helps to maintain the vaginal ecosystem (or ‘microbiome’), and keeps the vagina moist.
What is ‘normal’ vaginal discharge like?
The amount, colour, and consistency of vaginal discharge can vary from person to person. Some women have discharge every day, while others experience it less frequently. It’s good to know what’s normal for you, so that you’ll recognise if there are any potential issues that warrant medical review.
Normal vaginal discharge can be thin, watery, sticky, or stretchy, or it may be thick and gooey at other times in your cycle.
It is usually clear, or milky in colour; there may be a slight yellow tinge in the two weeks prior to your period. It may have a subtle musky scent, this is neither strong, nor foul-smelling. The amount of discharge varies from person to person. The average woman produces about 4 millilitres of white or clear discharge each day. Most women produce more vaginal discharge around ovulation (ie. the middle of their menstrual cycle).
Normal changes to your discharge during your menstrual cycle
You may notice changes to your vaginal discharge during your menstrual cycle. The type, consistency and colour of your discharge will probably be affected by the phase of the menstrual cycle that you’re in.
Broadly speaking, your menstrual cycle consists of four key phases. During each phase, specific hormonal fluctuations occur: some hormones go up, while go down. As a result, various changes occur to different parts of your body: your breast, the mood, the lining of your uterus (called the ‘endometrium’), your ovaries, and… your vaginal discharge. Read on, to learn how vaginal discharge normally changes, over the course of a woman’s menstrual cycle.
Your menstrual cycle begins with the first day of one period (called ‘day one’), and ends when the next period begins (your next ‘day one’). While an ‘average’ woman has a menstrual cycle that is 28 days long, anything between 24 – 38 days is considered normal. Hence, the exact duration of each phase differs from person to person, and indeed month to month; the below is simply a guide.
Menstrual phase (days 1 – 5)
‘Day 1’ is the first day of your period, when your uterus (or ‘womb’) starts to shed its lining (called the ‘endometrium’). Over the course of each menstrual cycle, your body gradually thickens the uterine lining; this is to nurture and feed any potential pregnancy you might have. The bleeding you experience during a period is essentially your body realising that you aren’t actually pregnant, so it sheds the additional layer it had built up during the preceding month.
Period blood tends to start off as a brown discharge, become bright red, then have some more brown discharge as the period ends. Production of vaginal discharge is generally quite low during your period and, on the whole, you’re unlikely to notice its presence if you’re bleeding anyway.
It is normal for periods to last up to eight days; any longer than this, and it’s worth seeing your GP or gynaecologist, who may consider that a pelvic ultrasound is needed.
The menstrual phase of your cycle ends when your period finishes.
Follicular phase (days 6 – 13)
After the end of your period, rising oestrogen levels stimulate the development of follicles in your ovaries, ready for ovulation (the release of an egg).
The glands in your cervix start making cervical mucus, and this is what you may see as vaginal discharge. Vaginal discharge during the follicular phase tends to be creamy or white in colour, and can be thicker.
As you start to approach ovulation, you’re likely to notice your discharge become runnier.
Ovulation (day 14)
The next phase in your menstrual cycle is ovulation, when hormones tell one of your ovaries to release its mature egg. The time around ovulation is when you are most likely to get pregnant. Ovulation happens two weeks prior to your next period, so if your menstrual cycle is 28 days long, ovulation would occur around day 14.
During ovulation, more cervical mucous is produced, and vaginal discharge becomes clear, stretchy and slippery: not unlike egg whites. This slippery discharge helps sperm move more easily up through the cervix, and into the Fallopian tubes to meet your egg. This slippery discharge normally lasts for a few days, and is a sign of increased fecundity (reproductive capacity).
Luteal phase (days 15 – 28)
The luteal phase of your menstrual cycle starts after ovulation, and lasts until your next period begins. The luteal phase lasts for 14 days. After ovulation, the levels of progesterone hormone increase significantly.
Vaginal discharge during the luteal phrase tends to become lower in volume, drier, thicker, and more opaque. It tends to white, with / without a slight yellow tinge.
What are the symptoms or signs of abnormal vaginal discharge?
Vaginal discharge with an unusual colour, odour, texture, or volume may be a sign that something’s wrong. While the correct diagnosis cannot necessarily be made by just looking at a woman’s vaginal discharge, the below is a rough guide as to which conditions or infections may be contributing to a particular change in your vaginal discharge.
Symptoms like vaginal or vulval itch, swelling, discomfort or pain, pain with urination and / or pain during penetrative sex need to be discussed with your GP or gynaecologist. Relevant testing will help determine the cause for these changes to your vaginal discharge (ie. a fungal, viral or bacterial infection), and guide appropriate treatment.
If you are not sure whether your discharge is normal, talk to your GP. If you have a fever or abdominal pain as well as a discharge, seek care immediately (through an Emergency Department if needed), as this could mean a serious infection.
It can be helpful to keep a diary of your symptoms: what symptoms occurred when, when they occurred in relation to your period, any sexual partner(s), any changes to your diet or lifestyle. This may guide your doctor as to which investigations are needed.
Chunky white discharge, like cottage cheese: possible thrush
Thick, white vaginal discharge that resembles cottage cheese can be a sign of a common yeast (or fungal) infection, thrush (or ‘candidiasis’). Thrush also tends to cause itch, swelling, and soreness of the vulva (the skin around the vaginal opening).
Thrush is often precipitated by tablet antibiotics, which can lead to an imbalance in your vagina’s healthy ecosystem. Thrush can be easily treated by over-the-counter anti-fungal pessaries or ointments. If in doubt, see your GP to confirm the diagnosis and follow their advice.
Thrush yeast can live in the vagina in low numbers without causing any symptoms; it’s only when they take over the vaginal ecosystem that they cause problems!
Watery, grey discharge, with a ‘fishy’ odour: possible bacterial vaginosis
Thin, grey and fish-smelling discharge may indicate a common bacterial imbalance called bacterial vaginosis (BV). BV occurs due to an imbalance of ‘healthy’ and ‘harmful’ bacteria. BV can cause mild vaginal irritation, but doesn’t tend to cause significant discomfort.
Cloudy yellow / green, thick or chunky discharge: possible trichomoniasis or gonorrhoea
Sexually transmitted diseases (STDs) trichomoniasis and gonorrhoea can both cause thick yellow or green vaginal discharge. They can both also cause vulval itching, burning, redness or discomfort. There may also be discomfort when urinating.
If you think you may have either condition, you should visit your local GP, sexual health clinic, or gynaecologist, to undergo relevant investigations (eg. vaginal swab and / or urine test), and get any necessary treatment.
Smelly white, yellow or grey discharge: possible chlamydia
Chlamydia, another STD, can cause abnormal vaginal discharge. It can cause white, yellow or grey discharge, which can be smelly. Additional symptoms include: bleeding after penetrative sex, bleeding between periods, abdominal pain, fever, and pain when urinating.
Pink discharge
Pink discharge between periods can be completely normal for some women, who experience spotting mid-cycle when they ovulate.
For other women, having a pink vaginal discharge between periods may be a sign of:
– Endometrial / cervical polyp
– Cervical ectropion
– Vaginal irritation
– Chlamydia
– Pre-cancerous changes to the uterine lining or cervix
If you’re experiencing any unusual bleeding between periods, please see your GP and ask for a pelvic ultrasound. (They may also consider that STD testing is needed.) If your cervical screening test is due, it would be prudent to undertake one. Your GP can refer you on to see a gynaecologist if needed.
How is the cause of abnormal vaginal discharge diagnosed?
If you’re concerned about an abnormal vaginal discharge, please see your GP. They may:
Ask questions about the discharge, other symptoms, your sexual history etc
– Perform a speculum examination to take vaginal swabs
– Undertake a cervical screening test
– Recommend a urine test, where you urinate into a small jar and it’s then tested for infection
– Recommend that you have a pelvic ultrasound
How is abnormal vaginal discharge treated?
Normal vaginal discharge does not need treatment; it is a normal healthy process, which keeps the vagina clean.
If the investigations listed above diagnose a particular infection or condition, your GP and / or gynaecologist will be able treat it with the appropriate medications.
If you are found to have an STD, your sexual partner(s) may also need to be treated, even if they don’t have symptoms.
When should I see my doctor?
Reasons to see your GP or gynaecologist include:
– Pain, burning or other discomfort in and / or around the vagina
– Thick chunky cottage-cheese-like discharge
– Green or yellow discharge
– A strong or foul vaginal odour
– Fever, especially if ≥ 37.5
– New abdominal pain
– A dramatic increase in the volume of discharge
– Rash or sores on the skin around the vagina, with or without vaginal discharge
– Burning sensation when passing urine
– Abnormal bleeding between periods
How to look after your vulva and vagina
The vagina is a ‘self-cleaning’ organ: they’ve been keeping themselves clear for many centuries, without needing any ‘intimate cleaning products’. When keeping your vagina and vulva clean, water is all you need. Less Gwyneth Paltrow’s jade eggs; more a ‘less is more’ approach!
When in the shower, gentle wash the skin around the outside of the vagina with clean warm water; there’s no need to use any sort of soap or body wash. Don’t insert soaps, perfume sprays or bubble bath liquid up into the vagina; there’s no need to use scented wipes. Avoid vaginal douching, as it can disrupt the vagina’s health pH balance and ‘microbiome’.
Wipe your vulva dry from front to back. Cotton underwear is recommended, to let the area breathe a little. Consider not wearing underwear at night, to improve air flow.
If you use a menstrual cup during your period, clean it with soap then rinse it thoroughly to wash all the soap bubbles off before inserting it back into your vagina.
If you have penetrative sex, use a male condom, to decrease the likelihood of getting an STD.
Conclusion
For the most part, vaginal discharge is a sign of a healthy reproductive system. It’s normal and needed: it’s doing a vital job down there. It’s good to keep an eye on your vaginal discharge, and get used to recognising the normal variations that occur over the course of your menstrual cycle.
If you notice a dramatic or unusual change (such as yellow, green, or thick white discharge, or a strong foul odour, or any new associated symptoms such as vulval swelling, discomfort, or itch), please see your GP or gynaecologist to have this investigated!
Topic area frequently asked questions (FAQs)
What if all my swabs are normal?
Very occasionally, some women notice a dramatic change in their vaginal discharge (eg. a significant increase in volume, without any other changes to colour / smell / consistency). Their clinician takes a thorough history and appropriate investigations (eg. vaginal swabs), but no abnormalities are found. This can be frustrating – how do you treat something that you can’t diagnose!
Sometimes, your gynaecologist may suggest a trial of some medicines / creams to improve the pH balance of your vagina, which may help. If all diseases have been ruled out, it may be a matter of acknowledging that this is your ‘new normal’, in terms of vaginal discharge.
Should any bugs ‘live’ in my vaginal normally?
Many different bacteria, yeasts and parasites (all microscopic forms of life, or ‘bugs’) normally live in your vagina, without causing any symptoms. For example, candida (a type of yeast) can live in the vagina in low numbers without causing any symptoms, and should not be a cause of concern. Normal bugs help protect the vagina from the kinds of bacteria that cause disease.
The only thing wrong with my vaginal discharge is that there’s too much of it! What can I do about this?
There is a wide variety in the amount of vaginal discharge women normally have. Increased volumes of discharge can occur during pregnancy, during certain times of your menstrual cycle, or while on the contraceptive pill. This is completely normal, and expected.
As long as your discharge isn’t a strange colour, smell, or associated with any other symptoms (eg. vaginal itch or burning), there is nothing to worry about.
Do women have vaginal discharge from birth until death?
Prior to puberty, young girls shouldn’t have any significant vaginal discharge. Most teenagers start to experience vaginal discharge during the year before their first period.
At the other end of the reproductive spectrum: women approaching menopause may find that the amount of vaginal discharge decreases significantly. Elderly women shouldn’t have any significant vaginal discharge. If they do, it warrants investigation by their GP or gynaecologist.
