Vaginal discharge

Vaginal discharge is normal in girls and women. It is a fluid or mucus that is produced at any age and in varying amounts. It keeps your vagina clean and moist and protects it from infection. Vaginal discharge usually gets heavier if you are pregnant, using birth control or sexually active. For a few days between periods, it can be more slippery and wet.  

Normal vaginal discharge can be:

• Clear or white
• Slippery and wet
• Thick and sticky 

It does not have a strong or unpleasant smell.

If your vaginal discharge changes colour, consistency or smell, or you experience itching or pain in your genitals area, there may be something wrong. 

You may have a vaginal infection, such as candida (a yeast infection also called thrush) or bacterial vaginosis. Both of these common conditions can be treated at home.

Abnormal vaginal discharge, such as persistent or uncomfortable discharge, and itchy genitals can also be a symptom of a sexually transmitted infection (STI). STIs can be successfully treated by your GP or at a sexual health clinic.

A change in your vaginal discharge can also be a symptom of:

• An allergy
• Certain cancers
• Menopause
• Skin conditions

Your GP will be able to diagnose and arrange treatment for the cause of your abnormal vaginal discharge.

If you have a thick, creamy, white discharge with a cottage cheese texture, you may have the common yeast infection candida, also known as thrush. In some cases, the discharge may be watery. Thrush is the second most common cause of abnormal vaginal discharge after bacterial vaginosis. It does not usually cause a change in the way your vaginal discharge smells. Other symptoms of thrush include: 

• Discomfort, itchiness, pain or redness around the outside of your vagina
• Discomfort or pain while having sex
• Discomfort or pain while urinating

Grey vaginal discharge with a fishy smell may be bacterial vaginosis, which is the most common cause of abnormal vaginal discharge. It is not an STI and is caused by a bacterial imbalance in your vagina. The fishy smell may get stronger after a period or sex. Bacterial vaginosis can go away without treatment and the symptoms are usually mild. However, if it does not go away, your GP may prescribe antibiotics.

During or after the menopause, abnormal vaginal discharge, dryness and itching may be caused by low oestrogen levels.

A foul-smelling vaginal discharge may be caused by a foreign body in your vagina, such as a forgotten tampon.

Discharge with irritation around the vaginal area may be the result of an allergic reaction, such as to chemicals in detergents.

STIs are another possible cause of vaginal discharge. You’re at a higher risk of an STI if you:

• Are under the age of 25
• Have a new sexual partner
• Have had more than one sexual partner in the last year
• Have previously had an STI

Common types of STIs and their symptoms include:

• Chlamydia — more vaginal discharge than normal, possibly yellow discharge, along with pain during sex or when passing urine and bleeding between periods
• Genital herpes — abnormal vaginal discharge along with painful genital blisters
• Gonorrhoea — more vaginal discharge than normal, accompanied by pain in your lower abdomen (stomach) or when passing urine and bleeding between periods
• Trichomoniasis — a green, yellow or white discharge, which may be frothy, along with pain around your vulva and when passing urine

Normal changes to your body during your menstrual cycle can also cause changes in your vaginal discharge. After you have produced an egg (ovulated), which occurs at about day 14 of your menstrual cycle, your vaginal discharge may increase in volume up until your period starts. This is normal and is caused by changes in your hormones during your menstrual cycle. Your vaginal discharge will usually remain clear and not smell. 

You may also notice more vaginal discharge one or two days after having sex if your male partner ejaculated into your vagina and did not use a condom. This is because most of his semen will exit your body as vaginal discharge alongside fluids made by your vagina as a response to having sex. 

Rare causes of changes in your vaginal discharge include:

• Cancer — cancer of the cervix (neck of the womb) or womb; these cancers cause other major symptoms and it is rare for abnormal vaginal discharge to be the main symptom
• Cervical ectopy — cells lining the inner surface of the neck of your womb spread to the outer surface; this is not a serious condition and usually does not need treatment
• Cervical polyps — small, fleshy lumps on the neck of your womb, which are usually not cancerous and can be removed easily with surgery; cervical polyps can usually be detected by a physical examination carried out by a doctor or nurse
• Skin conditions — eg dermatitis and lichen planus; these conditions also cause other symptoms such as itchiness

See your GP if your vaginal discharge: 

• Changes colour — eg becomes bloody, green, grey, pink or yellow
• Changes smell — eg smells fishy or like rotten meat
• Changes texture — eg becomes lumpy or thick, like cottage cheese
• Increases in amount more than usual 
• Is accompanied by itchiness or soreness around the outside of your vagina

You should also see your GP if: 

• You have pain when urinating
• You have pelvic pain (pain in the area between your thighs and stomach)
• You have vaginal bleeding after sex or between your periods

During your appointment, your GP will ask about your general health and your symptoms eg how long you've had symptoms and the changes you've noticed. As your symptoms may be due to an STI, they may also ask about your sexual history, any contraception you’re using and if you use condoms — condoms protect against catching STIs.

Your GP may carry out a pelvic examination. You’re entitled to a chaperone during your examination, whether your GP is male or female. You will be asked to remove your clothing from the waist down. If you are wearing a loose skirt, you may only need to remove your knickers. Next, you will be asked to lie down on your back on the examination bed. Using gloved fingers, your GP will examine the inside of your vagina to check if your fallopian tubes, ovaries or womb are tender.

In some cases, your GP will use an instrument called a speculum to gently open the vagina so they can get a clear view of your cervix. This will allow them to detect any discharge, polyps or sore areas. They may collect a sample of your discharge using a swab. These samples will be tested for infections such as bacterial vaginosis, candida and STIs. 

If you have been sexually active, your GP may recommend blood tests in addition to collecting a sample of your discharge for testing. Your sexual partner may also need to be tested. 

Depending on the results of your examination and any tests, your GP will recommend whether you need further investigations, such as an ultrasound scan. If needed, they may refer you to a specialist (gynaecologist).

If your GP diagnoses an STI, you may be referred to a sexual health clinic for treatment.

To relieve the irritation of abnormal vaginal discharge, try:

• Avoiding using scented products around the vaginal area
• Using sanitary towels instead of tampons
• Washing your vaginal area gently with warm water or soaking in a warm bath and drying the affected area thoroughly afterwards
• Wearing cotton pants
• Wearing panty liners to absorb heavy discharge or if you’re concerned about the smell

If you have a yeast infection such as candida, your GP will recommend over-the-counter medication or prescribe medication. These will usually be pessaries (small, soluble pellets that you insert into your vagina) or creams containing clotrimazole, econazole, fenticonazole or miconazole.

If you have bacterial vaginosis, your GP will prescribe antibiotics, either as a cream, gel, pessaries or tablets, containing clindamycin or metronidazole.

Most STIs can be successfully treated with antibiotics or antivirals, which your GP will prescribe. STIs must be treated as they can lead to serious complications, including pelvic inflammatory disease (PID) and infertility.

If your abnormal vaginal discharge is menopausal, your GP may recommend treatment to rebalance your hormones and relieve dryness.

If a foreign object is the cause of your abnormal vaginal discharge (eg a forgotten tampon), it can usually be removed during your physical examination. Smaller objects may need to be flushed out. For larger objects, you may need to be given some sedation before removal and stay in hospital for several hours. Your doctor may prescribe antibiotics to take after removal of the foreign object. 

If you have cervical polyps, these can be removed surgically, either by your GP or a specialist. 

If you have cervical ectopy, the cells that have spread from the inner surface of the neck of your womb to the outer surface can be removed under local anaesthetic using cautery to burn them away (cauterisation).

If another underlying condition is responsible for your vaginal discharge, your GP will recommend treatment depending on your diagnosis.