Vaginal discharge

What is it?

Normally, vaginal discharge is clear or white. It may become stretchy and slippery during ovulation, about two weeks after your menstrual period. A change in the color or amount of discharge, accompanied by other symptoms, may indicate that you have an infection.

The vagina normally contains bacteria. Bacterial growth is controlled and affected by many different factors, such as acid level (pH) and hormones. Anything that upsets this balance may increase your risk of infection or overgrowth of any of the normal bacteria or by yeast. Possible triggers include:

• antibiotic use
• birth control pills
• douching
• diabetes
• pregnancy
• stress
• tight or synthetic undergarments.

Vaginal discharge may result from infection with:

• yeast, also called Candida, a type of fungi that is part of the normal flora of human skin but can also cause infections
• Gardnerella, a type of bacteria found normally in the female genital tract that is the cause of bacterial vaginosis
• trichomonas, a type of protozoa, an organism made up of one cell.

Sexually transmitted diseases such as gonorrhea or chlamydia also can cause vaginal discharge. Other possible noninfectious causes include inflammation or irritation of the vagina from a scented product such as soap, douches, pads or tampons; diabetes; or low estrogen levels as in menopause (atrophic vaginitis).

Symptoms

You may notice a change in the color, amount or odor of discharge. A white, curd-like discharge that looks like cottage cheese is a classic sign of yeast infection. Yellow, green or gray discharge is usually a sign of trichomonas or bacterial vaginosis. Bacterial vaginosis also has an unusual, fishy odor.

Itching is usually most noticeable with a yeast infection, though it may occur with any type of infection or irritation. A dry, irritated vaginal lining, which may be particularly uncomfortable or painful during intercourse, is usually a more prominent symptom of atrophic vaginitis. A new vaginal discharge accompanied by fever, abdominal pain or pain during intercourse may indicate a sexually transmitted disease, such as gonorrhea or chlamydia. However, gonorrhea and chlamydia usually don't cause any symptoms at all.

Diagnosis

Your doctor will ask a variety of questions to help pinpoint the cause of your discharge, including questions about recent antibiotic use, whether you have a new sexual partner, menopausal symptoms, diabetes symptoms and other recent changes in your health or lifestyle.

You will then have a pelvic exam. Your doctor will use a device called a speculum to look at the cervix directly. During the pelvic exam, a sample of the discharge is collected for testing. By looking at the discharge under a microscope in the office, your doctor can diagnose yeast infection, bacterial vaginosis or trichomonas infection right away and start treatment. Based on the appearance of the vaginal walls, your doctor may make a diagnosis of atrophic vaginitis.

Your doctor will check the tenderness of your cervix, uterus or ovaries by placing his or her fingers inside your vagina. Tenderness may indicate that you have a sexually transmitted disease or pelvic inflammatory disease. Diagnosing gonorrhea or chlamydia requires the results of laboratory tests, which may take a few days.

Expected duration

Vaginal discharge from bacterial or yeast infections responds to treatment within a few days to a week. Sexually transmitted diseases should respond to antibiotic treatment within a week. If the infection progresses to a pelvic inflammatory disease beyond the vaginal area, it may take longer to treat.

Atrophic vaginitis responds best to hormonal therapy with vaginal creams or hormone-replacement therapy by mouth. It usually takes a few weeks to go away. Mild symptoms may be relieved within a few days with vaginal water-based lubricants. If an irritating substance causes your symptoms, identifying and removing the substance should relieve the symptoms within a week.

Prevention

Your doctor can work with you to identify whatever led to your symptoms, such as antibiotic use, wearing non-cotton underwear, wearing tight-fitting undergarments during exercise, using scented products that irritate the vaginal lining, or using birth control pills. If you use birth control pills, you may not need to stop using them to prevent recurrent infection. Changing the type or the strength of the hormone in the pill may be enough to stop symptoms from returning.

If you are diabetic, controlling blood sugar levels may help to avoid recurrent infections, especially yeast infections.

Treatment

Infections are treated with antibiotics. Often just one dose of antibiotics by mouth is enough. Another option is to use antibiotics in vaginal cream or gel form, especially if you have significant side effects when you take antibiotics by mouth. Also, the vaginal cream can be more soothing for the inflamed, sore vaginal lining.

If you are diagnosed with bacterial vaginosis or trichomoniasis, your doctor will prescribe an antibiotic. If your doctor suspects you have a sexually transmitted disease based on your history and physical exam, you may be given antibiotics by injection and by mouth in the office before the tests results can confirm the diagnosis.

If you have recurrent yeast infections and recognize the symptoms, you may use over-the-counter antifungal creams without a prescription. If your symptoms do not improve, see your doctor for an exam to confirm the diagnosis and change the treatment.

Atrophic vaginitis may develop with hormonal changes, most often during or after menopause. The most effective treatment is estrogen. Vaginal estrogen tablets creams or rings are the safest routes because you are exposed to lower estrogen levels compared to taking estrogen by mouth or a skin patch.

Sexual partners do not have to be treated unless you are diagnosed with a sexually transmitted disease, or you experience recurrent infections and no other factor is making you prone to infection. If your sexual partner experiences a new discharge or discomfort when urinating or during intercourse, he or she should be evaluated by a doctor.

When to call a professional

If you had a previous yeast infection, and you have repeat symptoms that are similar, you can start treatment with an over-the-counter antifungal medication. If your symptoms don't improve, make an appointment to see your doctor. See your doctor regarding any new discharge that does not improve when you stop using potential irritants. If you develop abdominal pain or a fever with a new vaginal discharge, you should see a doctor the same day.

Prognosis

Usually, the conditions that cause vaginal discharge respond to treatment within a few days. Atrophic vaginitis may take a few weeks to respond to hormone treatment because the vaginal layer takes time to strengthen. Occasionally, infections come back. Your doctor may determine a more effective course of treatment, suggest ways to self-treat at home or help you eliminate potential causes of infection.

Additional info

Centers for Disease Control and Prevention
https://www.cdc.gov

National Women's Health Information Center (NWHIC)
https://www.4woman.org/