Patient education: Vaginal discharge in adult women (Beyond the Basics)

INTRODUCTION — 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 health care 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)".)

FEMALE ANATOMY — 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 cells lining 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 approximately 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 health care provider:

●Itching of the vulva, vaginal opening, or labia

●Redness, burning, soreness, or swelling of the vulvar skin

●Foamy or greenish-yellow discharge

●Bad odor

●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 (DIV)".)

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. Do not start treatment based upon internet or social media recommendations.

Before the examination, the health care 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, nonprescription)?

●Have you recently used pads, tampons, douches, "feminine hygiene" products, lubricants, pH altering treatments, or boric acid?

During the examination, the health care 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 and rapid bedside laboratory tests. In other cases, the provider may recommend delaying treatment until other test results are available. Recognize that not all vaginal symptoms are due to infection. (See "Patient education: Vaginal yeast infection (Beyond the Basics)" and "Patient education: Bacterial vaginosis (Beyond the Basics)".)

If a clinician recommends treatment for your vaginal symptoms, make sure you understand what your test results showed and what type of infection you have. 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 health care 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. Similarly, you should avoid using boric acid vaginal capsules.

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)".)

HEALTHY HYGIENE — Abnormal vaginal discharge may be more likely to develop in women who practice certain habits, such as those who use:

●Douches

●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 health care 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 health care 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 health care 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 (The Basics)
Patient education: Vulvovaginal yeast infection (The Basics)
Patient education: Bacterial vaginosis (The Basics)
Patient education: Sexually transmitted infections (The Basics)
Patient education: Trichomoniasis (The Basics)
Patient education: Vaginal dryness (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
Acute cervicitis
Desquamative inflammatory vaginitis (DIV)
Vaginitis in adults: Initial evaluation
Trichomoniasis: Clinical manifestations and diagnosis

The following organizations also provide reliable health information.

●National Library of Medicine

(https://medlineplus.gov/ency/article/003158.htm, available in Spanish)

●KidsHealth.org

(https://kidshealth.org/en/teens/vdischarge2.html)

●Mayo Clinic

(https://www.mayoclinic.org/symptoms/vaginal-discharge/basics/definition/sym-20050825)

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