Vaginal discharge

What is Vaginal Discharge?

Vaginal discharge or simply called discharge is a normal secretion of your body that is continuously produced by glands in your uterus, cervix, and vagina. It comprises epithelial cells, tissue fluid, electrolytes, proteins, and some bacteria (lactobacilli). This clear-looking fluid has an acidic pH and is vital for good reproductive health. It keeps your vagina moist and lubricated and also protects your genital area from infections. You should consider it just like any other normal body fluid like saliva or tears. 

How do I know if my vaginal discharge is normal ?

Normal vaginal discharge is usually watery, clear or whitish and does not smell. The amount and consistency is not constant and varies based on many factors like phase of menstrual cycle, sexual activity, age related hormonal changes or hormonal surges as in puberty, pregnancy or sexual act etc. These variations are normal and are usually not a cause for concern.

The following are features of normal vaginal discharge:

• Color – Normal discharge is clear or whitish looking.
  
• Consistency – mostly watery. But it changes during the three phases of your menstrual cycle from watery to thick to sticky. All these are regular cyclical changes associated with your menstrual cycles and you do not need to worry about them.
  
• Smell – No smell or mild smell is normal. However, normal discharge will never be strongly smelling or foul smelling or unpleasant smelling. Remember that a foul smelling discharge is always abnormal and needs a gynae consult.
  
• Amount – On an average, about 4 ml of vaginal discharge is normally secreted per day. This amount can increase in conditions like sexual arousal or in keeping with hormonal changes of the menstrual cycle. It can also be affected by Pregnancy or birth control pills.

What is Abnormal Vaginal Discharge ?

Sometimes, vaginal discharge can be abnormal and needs medical attention. A vaginal discharge is considered abnormal if it undergoes:

• Color changes: As discussed above, normal discharge is clear or whitish. An excessively white discharge, curdy discharge, cheesy discharge, greenish discharge, yellowish discharge, brownish discharge, greyish discharge or a cloudy discharge, etc are abnormal and indicate infection.
  
• Smell: Normal discharge is odorless or has a mild smell. However, a strong-smelling discharge, unpleasant-smelling discharge, foul-smelling discharge, sour-smelling discharge or a discharge with a fishy smell are abnormal and indicate infection.
  
• Texture Changes: Although normal vaginal discharge consistency also changes throughout the menstrual cycle, there are certain changes in consistency that indicate infection. For example, thick and curdy discharge indicates a fungal infection (candidiasis), a yellowish-green, frothy or purulent discharge with a bad smell indicates a parasitic infection (trichomoniasis).
  
• Accompanying changes: Symptoms like painful urination (dysuria) or painful intercourse (dyspareunia), vaginal itching, redness/irritation in and around the vagina, change in skin color of the genital area to blackish or reddish, etc are all indicative of infection and need medical attention.
  
• Amount: Increase in vaginal discharge may indicates infection especially when accompanied by color, texture or smell changes and other accompanying changes as mentioned above.

When should I consult my Gynaec

You should consult your gynaecologist if you have any of the following:

• Increase in vaginal discharge which is more than routine variation
• Change in smell of discharge especially when its fishy, strong, unpleasant
• Change in texture especially when curdy, frothy, bubbly
• Change in color – All colors – yellow, green, grey, brown, cloudy, curdy white are abnormal. Normal discharge is clear or whitish
• Accompanying changes –Any of the above accompanied by changes like itching, redness, irritation in and around vaginal area, skin color changes, painful urination or painful intercourse

If you feel that your discharge is abnormal, you should consult your gynaec early as most of these infections can be managed easily in early phases. But untreated, they can worsen and cause further complications which are difficult to treat and take much longer time. The rule of thumb is that it’s better to consult early and have a normal exam finding than to present late and have complications.

Causes of Abnormal Vaginal Discharge

• Fungal infection or yeast infection (Candidiasis): A fungal infection can cause a thick white discharge or a curdy discharge or a cottage cheese like discharge along with excessive itching, irritation and redness of vagina and surrounding skin. You are more vulnerable to develop a fungal infection if you are on steroid or immunosuppressive medication, are diabetic, HIV positive or maintain a poor hygiene. Topical and/or oral antifungal drugs are needed to treat it (For more info, please read Curdy vaginal discharge).
• Bacterial Vaginosis: It simply means an imbalance in the types of bacteria that are naturally found in your vagina. The good bacteria (lactobacilli or doderlain bacilli) which are the normal vaginal flora of a healthy woman, get overpowered by the bad anaerobic bacteria like Gardnerella. Such imbalance presents as greyish, green or whitish discharge which has a characteristic fishy odour. You may also have itching or pain during urination. It is easily treated with antibiotics (see treatment of vaginal discharge below).
• Sexually transmitted Infections (STI’s) or Sexually transmitted Diseases (STD’s): These are infections that you can get by having sexual contact with an infected person. Many a times these can be present without any symptoms which means that anyone can be infected with an STI without their knowledge of having it. These include Chlamydia, Gonorrhoea and Trichomoniasis. All of them are easily treatable with proper antibiotics and even more easily preventable if both partners are monogamous (have only one sexual partner) and use barrier methods like condoms during sexual act. For more information on STI’s, see Sexually Transmitted Infections.
• Non-Infectious Factors: As stated earlier, the amount and consistency of discharge can change in conditions like puberty, pregnancy, sexual arousal, birth control pills, phases of menstrual cycle, leucorrhoea, foreign body like retained tampon or an allergic reaction from lubricants, ointments, soaps, vaginal washes, perfumed products.
• Leucorrhoea: Usually, it’s just an excess of normal vaginal discharge which is seen during high estrogen states like puberty, ovulation, pregnancy. It also occurs during sexual excitement due to added secretions from Bartholin’s  glands in vaginal wall. Sometimes it can be caused by conditions like cervical polyps, chronic cervicitis, chronic pelvic inflammation, birth control pill use etc. Consult your gynaec if leucorrhoea persists, becomes troublesome or develops bad smell or color change.

Treatment of vaginal discharge

As the name suggests, normal vaginal discharge is a normal body secretion and needs no treatment.

Treatment is needed for abnormal vaginal discharge. It’s best to consult your gynaecologist for proper diagnosis and treatment if the discharge appears abnormal.

General guidelines for prevention and treatment of abnormal vaginal discharge are as follows:

1. Keep good vaginal hygiene.
2. take daily bath and change undergarments daily.
3. Always clean your perineal area from front to back (vagina towards buttocks) and not the other way round (buttocks to vagina) as it brings dirty bacteria from buttocks towards vagina and cause infection.
4. Avoid multiple sexual partners.
5. Use condom during sexual act unless planning to conceive
6. If there is sudden change in amount or consistency of discharge after change of soap/detergent/lubricant jelly/ointment/vaginal wash etc., try to pinpoint it and change it. Potential irritants should be avoided and irritable symptoms treated with anti-inflammatory ointments. Foreign body like a retained tampon should be removed as soon as possible.
7. If the cause of abnormal discharge turns out to be an STI like Chlamydia, Gonorrhoea, Trichomoniasis, Syphilis etc., then both male and female partners must be treated simultaneously so to prevent reinfection from each other. Also, sex should be avoided or condoms used till both partners are declared treated by your doctor.
8. Treatment of infective causes: Treatments mentioned below are guidelines for informational purposes; however, you must consult your gynaecologist for proper diagnosis and management of your discharge.

• Bacterial Vaginosis (BV): Easily treatable with Antibiotics like Metronidazole or Clindamycin
• Sexually Transmitted Infections (STIs): Antibiotics are based on the STI that is diagnosed. For example Chlamydia – doxycycline or azithromycin, Gonorrhoea – intramuscular ceftriaxone or oral cefixime/azithromycin, Trichomoniasis: Metronidazole, Syphilis – treated with antibiotics called Penicillins).
• Fungal/Yeast Infection (Candidiasis): Antifungals like topical antifungal ointment (Clotrimazole) used as local application is effective in most patients. Sometimes oral drugs like tab fluconazole are also needed.

Carry home message

Your vaginal secretions are as normal as your saliva or tears and have very important functions in your reproductive health. It is very important to know what is normal discharge and also learn to recognize abnormal discharge. Obtain a gynae consult early if you suspect abnormal discharge. Stay healthy!

For more such interesting information on women's health, kindly visit our website Expert Gynae Care and our YouTube channel @drnidhigarg

To consult Dr. Nidhi Garg, please visit us at Kamal Hospital, Doaba Chowk, Jalandhar-144004 or Visit our website kamal Hospital jalandhar or Expert Gynae Care