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Am Fam Physician. 2004;69(9):2191-2192

Is vaginal discharge normal?

Yes. The glands inside your vagina and cervix make small amounts of fluid. This fluid flows out of the vagina each day, carrying out old cells. This is your body’s way of keeping your vagina healthy and clean. The discharge is usually clear or milky and does not smell bad.

The color and thickness of the discharge change with your menstrual cycle. There is more discharge when you ovulate or breastfeed, or when you are sexually excited.

How do I know if I have a problem?

Changes that may signal a problem include an increase in the amount of discharge, a change in the color or smell of the discharge, and irritation, itchiness, or burning in or around your vagina. This is called vaginitis. Discharge that is stained with blood when you are not having your period also can be a sign of a problem. Talk to your doctor if you have any of these symptoms.

What causes these changes?

Changes in vaginal discharge can occur if the normal balance of healthy bacteria in your vagina is upset. Many things can cause this imbalance, including douching, feminine hygiene sprays, certain soaps or bubble baths, antibiotics, diabetes, pregnancy, or infections.

How can douching be harmful?

The chemicals in vaginal douches may irritate your vagina and change the normal balance of good bacteria. Douching also can spread an infection from your vagina or cervix up into the uterus, increasing your risk of getting pelvic inflammatory disease (also called PID). PID is a painful infection of the fallopian tubes that can cause you to be unable to get pregnant.

Douching is not necessary to keep your body clean. Odors usually come from outside the vagina. Keeping this area clean with gentle soap and water can prevent odors.

What is a yeast infection?

Small amounts of yeast are often found in a healthy vagina. But if too much yeast grows, it can cause an infection. Symptoms of yeast infection include the following:

  • A thick white discharge that looks like cottage cheese

  • Swelling and pain around the vulva (the skin around the vagina)

  • Intense itching

  • Painful sexual intercourse

Yeast infections usually are not caught from a sex partner. You may be more likely to get a yeast infection if you are using antibiotics or steroids, are pregnant, or have diabetes. Some women get frequent yeast infections for no obvious reason.

How are yeast infections treated?

Yeast infections usually are treated with a cream or gel that you put into your vagina. Yeast infections also can be treated with medicine that you take by mouth.

If you have yeast infections often, your doctor might tell you to use a medicine you can buy without a prescription. But if you have any questions about what is causing your vaginitis, or if you are pregnant, you should call your doctor. Many other things besides a yeast infection can cause vaginitis.

What is bacterial vaginosis?

Bacterial vaginosis usually is caused by an overgrowth of a certain kind of bacteria. No one knows why some women get this infection. Symptoms of bacterial vaginosis include the following:

  • White, gray, or yellowish vaginal discharge

  • A fishy odor that is strongest after sex or after washing with soap

  • Itching or burning

  • Slight redness and swelling of the vagina or vulva

Bacterial vaginosis usually is treated with antibiotic pills or creams.

What is trichomoniasis?

Trichomoniasis (say: trik-oh-mown-eye-a-sis) is an infection caused by a parasite. It is usually caught by having sex without a condom with a person who is infected with Trichomona. Some people who are infected may not have any symptoms for a long time. Symptoms include the following:

  • A watery, yellowish or greenish, bubbly discharge

  • A bad smell

  • Pain and itching when urinating

Trichomoniasis usually is treated with antibiotic pills.

What about other infections?

Two sexually transmitted diseases, chlamydia and gonorrhea, also can cause vaginal discharge. These are infections of the cervix that are caused by bacteria. Sometimes the only symptom of these infections is an increased vaginal discharge. Both of these infections can be treated with antibiotic shots or pills.

Should my sex partner be treated?

If you have trichomoniasis, chlamydia, or gonorrhea, your sex partner also must be treated. If you have a yeast infection, your sex partner may not need to be treated. Talk with your doctor to find out. You and your partner should avoid sex until after you have been treated.

Tips on preventing vaginitis

  • Do not douche.

  • Avoid using feminine hygiene sprays, colored or perfumed toilet paper, sanitary pads or tampons that contain a deodorant, and bubble bath.

  • After using the toilet, always wipe from front to back. Doing this may help keep bacteria from your rectal area from getting into your vagina.

  • Wear cotton underpants during the day. Cotton allows your genital area to “breathe.” Do not wear underpants at night.

  • Avoid wearing tight pants, pantyhose, swimming suits, biking shorts, or leotards for long periods.

  • Change your laundry detergent or fabric softener if you think it may be irritating your genital area.

  • The latex in condoms and diaphragms and the sperm-killing gels that are used for birth control can be irritating to some women. If you think one of these things is a problem for you, talk to your doctor about other types of birth control.

  • Avoid using hot tubs.

  • Bathe or shower daily and gently pat your genital area dry with a clean towel.

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