Vaginal discharge: types, causes and treatment
What normal vaginal discharge looks like, which changes point to infection, the three most common causes and how each is treated.
Vaginal discharge is a natural part of reproductive health and most of the time a sign that everything is working as it should. Sometimes, though, its colour, smell or consistency changes, and itching or burning is added. Below is when discharge is considered normal, when it may point to infection, and how each situation is managed.
Normal (physiological) discharge
A healthy vagina has its own defence mechanism and a natural bacterial balance known as the flora. The central role belongs to beneficial bacteria called lactobacilli, which keep the vagina acidic and prevent harmful microbes from multiplying.
Normal discharge is usually clear or white, has no odour and causes no itching or burning. The amount varies with the menstrual cycle — particularly around ovulation — with pregnancy, and with factors such as stress. This kind of discharge is a product of the vagina's own mechanism for cleaning itself and staying moist.
When to see a doctor
If you notice any of the following changes, there may be an underlying problem:
- a change in colour (yellow, green, grey or bloodstained)
- an unpleasant odour, particularly one resembling fish
- a thickening of consistency (curd-like or frothy)
- severe itching, burning or redness in and around the vagina
- pain or burning when passing urine or during sex
The three most common causes
Bacterial vaginosis
The most frequent cause of abnormal discharge. It occurs when the beneficial lactobacilli decrease and other, harmful bacteria multiply excessively.
- Signs: a grey-white, thin, watery discharge with a fishy odour that becomes more noticeable after sex or a period. It does not usually cause severe itching or redness.
- What triggers it: douching — washing inside the vagina with water or soap — frequent changes of partner and smoking can all disturb the balance.
Thrush (candidiasis)
Usually caused by overgrowth of a yeast called Candida albicans. Most women experience it at least once.
- Signs: the most typical feature is a thick, white, odourless discharge with the consistency of cottage cheese, accompanied by severe itching, burning, redness and swelling of the external genital area.
- What triggers it: heavy antibiotic use (because it destroys the beneficial bacteria), pregnancy, diabetes, a weakened immune system, and nylon or tight underwear.
Trichomoniasis
A sexually transmitted infection caused by a microscopic parasite, Trichomonas vaginalis.
- Signs: a copious, frothy, yellow-green discharge with an unpleasant odour, along with irritation, itching and burning when passing urine.
How each is treated
- Bacterial vaginosis: tablets taken by mouth, or vaginal pessaries and creams (antibiotics) prescribed by your doctor.
- Thrush: antifungal vaginal creams or pessaries, or a single-dose capsule taken by mouth.
- Trichomoniasis and other sexually transmitted parasitic infections: treating the partner as well is essential, so that the infection does not return.
One important caution. Treating yourself on the basis of advice from others, or with a cream bought at random from a pharmacy, can mean the wrong medicine is used and can make the condition more resistant. If you have symptoms, being examined is the right course.
Everyday prevention
- Avoid douching. Washing inside the vagina with water, soap or cosmetic gels destroys the protective acid balance (the lactobacilli). Only the external area (the vulva) should be cleaned, with warm water.
- Choose the right underwear. Prefer cotton, which lets the area breathe, over synthetic fabrics, and avoid tight clothing.
- Keep dry. Yeasts favour warm, moist environments. Do not stay long in a wet swimsuit after bathing, the sea or a pool.
- Wipe front to back. This prevents bowel bacteria being carried to the vagina.
Frequently asked questions
What does normal vaginal discharge look like?
Usually clear or white, without odour, and causing no itching or burning.
What does a cottage-cheese-like discharge mean?
It may be a sign of thrush (candidiasis).
When should I see a doctor about discharge?
If there is a change in colour (yellow, green, grey), an unpleasant odour or severe itching.