Patient education: Vaginal discharge in adult women (Beyond the Basics)
- Jack D Sobel, MD
Jack D Sobel, MD
- Wayne State University School of Medicine
Vaginal discharge is the term for fluid or mucus that comes from the vagina. Vaginal discharge is a common concern among women, and leads many women to see their healthcare provider. Some amount of vaginal discharge is normal, unless it occurs with itching, burning, or other bothersome symptoms. Most experts recommend an examination to determine the cause because different causes can have similar symptoms.
This topic will review the signs of normal and abnormal vaginal discharge, including the most common causes of abnormal discharge. Topics that discuss specific conditions that cause abnormal vaginal discharge are also available. (See "Patient education: Vaginal yeast infection (Beyond the Basics)" and "Patient education: Bacterial vaginosis (Beyond the Basics)" and "Patient education: Chlamydia (Beyond the Basics)" and "Patient education: Gonorrhea (Beyond the Basics)".)
Before discussing vaginal discharge, it is important to have a basic understanding of the female reproductive anatomy (figure 1).
Vaginal discharge is not usually noticeable until it exits the vagina, which is the passage from the uterus to the outside of the body. At the top end (inside) of the vagina is the cervix, while the lower end (outside) leads to the vulva and labia. The vulva is the name for the skin around the vaginal opening.
IS MY VAGINAL DISCHARGE NORMAL?
Vaginal discharge is made by the skin cells of the vagina and cervix under the influence of the female hormone, estrogen. Women who are menopausal normally have minimal vaginal discharge as a result of lower levels of estrogen.
In women who are premenopausal, it is normal to have about one-half to one teaspoon (2 to 5 mL) of white or clear, thick, mucus-like, and mostly odorless vaginal discharge every day. However, the amount and consistency of the discharge varies from one woman to another. The amount can also vary at different times during the menstrual cycle. It may become more noticeable at certain times, such as during pregnancy, with use of birth control pills/patch/vaginal ring, near ovulation, and in the week before the menstrual period.
Normally, discharge contains vaginal skin cells, bacteria, and mucus and fluid produced by the vagina and cervix. A normal discharge often has a slight odor and may cause mild irritation of the vulva. This discharge helps to protect the vaginal and urinary tract against infections and provides lubrication to the vaginal tissues.
WHEN TO SEEK HELP FOR VAGINAL DISCHARGE
Vaginal discharge is common and normal. However, vaginal discharge with the following signs and symptoms is not normal and should be evaluated by a healthcare provider:
●Itching of the vulva, vaginal opening, or labia
●Redness, burning, soreness, or swelling of the vulvar skin
●Foamy or greenish-yellow discharge
●Blood-tinged vaginal discharge
●Pain with intercourse or urination
●Abdominal or pelvic pain
CAUSES OF ABNORMAL VAGINAL DISCHARGE
The most common causes of vaginal discharge include:
●A vaginal infection (yeast or bacterial infection, trichomonas)
●The body's reaction to a foreign body (such as a forgotten tampon or condom) or substance (such as spermicide, soap).
●Changes that occur after menopause can cause vaginal dryness, especially during sex, as well as a watery vaginal discharge or other symptoms. (See "Desquamative inflammatory vaginitis".)
Do I need to be examined? — It is not usually possible to know if vaginal discharge is normal or not without an examination. A physical examination and testing of the obtained vaginal specimen is the most accurate way of determining the cause of abnormal vaginal discharge. Do not begin treatment at home before being examined because self-treatment can make it more difficult to make an accurate diagnosis.
Before the examination, the healthcare provider may ask questions, such as:
●Do you have pain in the back, abdomen, or pelvis?
●Do you have a new sexual partner?
●When was your last menstrual period?
●Do you take any medications (prescription, herbal, non-prescription)?
●Have you recently used pads, tampons, douches, "feminine hygiene" products, or lubricants?
During the examination, the healthcare provider will examine the entire outer genital area and will perform an internal examination. He/she will take a sample of the discharge to test for infection. It is useful for the provider to measure the pH or acidity of the secretions; bacterial vaginosis and trichomoniasis cause the pH to be higher than normal.
Treatment — In some cases, it is possible to make a diagnosis and begin treatment immediately, based upon the examination. In other cases, the provider may recommend delaying treatment until test results are available. (See "Patient education: Vaginal yeast infection (Beyond the Basics)" and "Patient education: Bacterial vaginosis (Beyond the Basics)".)
Sexual partners of women with a sexually transmitted infection, such as chlamydia, gonorrhea, or trichomonas, need evaluation and treatment. For other infections, such as yeast or bacterial vaginosis, the sexual partner does not need treatment. (See "Patient education: Chlamydia (Beyond the Basics)" and "Patient education: Gonorrhea (Beyond the Basics)".)
If treatment is needed, you should avoid having intercourse until the treatment is completed.
Can I treat myself? — Many women would prefer to avoid seeing their healthcare provider. However, self-treatment can delay getting the correct diagnosis, be costly, or even cause worsened symptoms. In most cases, a physical examination should be performed before any treatment is used. In particular, you should not douche to get rid of the discharge because douching can make the discharge worse if it is due to an infection.
Women who develop bacterial or yeast infections frequently may be advised to use a preventive treatment. (See "Patient education: Vaginal yeast infection (Beyond the Basics)" and "Patient education: Bacterial vaginosis (Beyond the Basics)".)
Abnormal vaginal discharge may be more likely to develop in women who practice certain habits, such as those who use:
●Pantyliners every day
●"Feminine hygiene" sprays, powders, or rinses
●Bubble baths or other scented bath products
●Tight or restrictive synthetic clothing (eg, thongs, synthetic underwear)
Healthier practices include the following:
●Use water or unscented non-soap cleanser to wash genitalia, use warm (not hot) water and the hand (not a washcloth)
●Do not douche or use feminine hygiene products; if odor or discharge is bothersome, see a healthcare provider
●Avoid hot baths with scented products; plain warm water is preferred
●Wear cotton underwear; avoid thongs and lycra underwear
●Rinse genitals with water and/or pat dry after toileting; avoid use of baby wipes or scented toilet paper
WHERE TO GET MORE INFORMATION
Your healthcare provider is the best source of information for questions and concerns related to your medical problem.
This article will be updated as needed on our web site (www.uptodate.com/patients). Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.
Patient level information — UpToDate offers two types of patient education materials.
The Basics — The Basics patient education pieces answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials.
Patient education: Vaginal discharge in adults (The Basics)
Patient education: Vulvovaginal yeast infection (The Basics)
Patient education: Bacterial vaginosis (The Basics)
Patient education: Screening for sexually transmitted infections (The Basics)
Patient education: Trichomoniasis (The Basics)
Patient education: Atrophic vaginitis (The Basics)
Patient education: Syphilis (The Basics)
Patient education: Vulvar itching (The Basics)
Patient education: Vaginal cancer (The Basics)
Beyond the Basics — Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are best for patients who want in-depth information and are comfortable with some medical jargon.
Patient education: Vaginal yeast infection (Beyond the Basics)
Patient education: Bacterial vaginosis (Beyond the Basics)
Patient education: Chlamydia (Beyond the Basics)
Patient education: Gonorrhea (Beyond the Basics)
Professional level information — Professional level articles are designed to keep doctors and other health professionals up-to-date on the latest medical findings. These articles are thorough, long, and complex, and they contain multiple references to the research on which they are based. Professional level articles are best for people who are comfortable with a lot of medical terminology and who want to read the same materials their doctors are reading.
Bacterial vaginosis: Clinical manifestations and diagnosis
Candida vulvovaginitis: Clinical manifestations and diagnosis
Desquamative inflammatory vaginitis
Approach to women with symptoms of vaginitis
The following organizations also provide reliable health information.
●National Library of Medicine
(www.nlm.nih.gov/medlineplus/ency/article/003158.htm, available in Spanish)
- Anderson MR, Klink K, Cohrssen A. Evaluation of vaginal complaints. JAMA 2004; 291:1368.
- Nyirjesy P, Peyton C, Weitz MV, et al. Causes of chronic vaginitis: analysis of a prospective database of affected women. Obstet Gynecol 2006; 108:1185.
- Anderson M, Karasz A, Friedland S. Are vaginal symptoms ever normal? a review of the literature. MedGenMed 2004; 6:49.
All topics are updated as new information becomes available. Our peer review process typically takes one to six weeks depending on the issue.