Vaginal discharge – what you need to know

The first thing to say is that vaginal discharge is normal! All women have discharge sometimes and it can change depending on your menstrual cycle as well as other factors. Women often have lots of questions about discharge but are sometimes too embarrassed to ask!

What does normal vaginal discharge look like? Is white discharge every day normal? Does discharge change during pregnancy? Can I stop myself from getting vaginal discharge?

Let’s explore what vaginal discharge is, what is normal and what warrants a trip to the doctor.

What is vaginal discharge?

In women between puberty and menopause (sometimes referred to as “women of reproductive age”), vaginal discharge is normal. The amount, colour and texture of the discharge can vary between women and yours probably changes at different stages of your menstrual cycle. Lots of things can affect discharge, such as hormonal contraception (birth control), menstrual cycle changes, infections or sex.

Sometimes people think of discharge as ”gross” but it is actually really important for keeping your vaginal healthy. It is sometimes called cervical mucous as it is produced by the cervix. The cervical mucous is what keeps the vagina clean and protects the vagina, cervix and uterus from infection.

If you have ”natural” menstrual cycles without hormonal contraception, your vaginal discharge might increase in volume and become clearer just before ovulation. The opposite happens before the beginning of the next period, where the volume decreases and the discharge often becomes more sticky. You can monitor these changes to help track your cycle.

Some women also get brown/red discharge just before and/or just after their period as well.

What does normal vaginal discharge look like?

If your vaginal discharge is white or clear, is thick and sticky, or slippery and wet and does not have a particularly strong or unpleasant smell then it is likely to be normal.

Keep in mind that everyone is different and sometimes it can take time to work out what your own normal is, especially if you have recently changed contraception (birth control), been treated for an infection or been pregnant.

What causes abnormal vaginal discharge?

There are many things that can cause “abnormal” discharge, some of these are infections and some are just a disruption in the normal bacteria that live in the vagina. Yes, having bacteria in the vagina is normal and healthy. Sometimes though, the balance can be disrupted which can cause symptoms. There are also other causes of changes to discharge such as pregnancy and menopause.

Non-sexually transmitted infections

Bacterial vaginosis (BV):

BV is not a sexually transmitted infection but rather a disruption in the normal bacteria that live in the vagina. It is only seen in women who are sexually active but is not an “infection” as such. BV often causes smelly discharge which is often referred to as “fishy”. It is usually white/grey in colour. BV doesn’t usually cause any other problems with the cervix or vagina. It can be diagnosed with a vaginal swab which can be done by your doctor or you can do this yourself. It is easy to treat BV with an antibiotic that can be prescribed by your doctor.

If you have an STI screen that shows BV but you do not have symptoms it does not need to be treated. The only exception to this rule is if you are pregnant, in which case it should be treated even if you have no abnormal discharge.

Candidiasis (thrush):

Thrush is also caused by a disruption in the vaginal bacteria and is a fungal or “yeast” infection. It usually causes itching or burning around the vulva (the skin around the outside of your vagina, including the labia) and vagina. It may also sometimes cause pain. The pain can sometimes be made worse by having sex or passing urine (peeing). The discharge caused by thrush is usually thick and white and is sometimes described as looking like cottage cheese (sorry if that put you off eating cottage cheese ever again!). Discharge caused by thrush is not usually smelly. Things like recent antibiotics, pregnancy or other medical conditions can increase the chances of developing thrush. It is not dangerous but can be very annoying!  Thrush can be diagnosed with vaginal swabs or can be recognised by your doctor.

Some women get thrush quite frequently and they can recognise when this happens and access treatment without being tested. The treatment for thrush is either tablet anti-fungal treatment or anti-fungal cream that is put in the vagina before you go to sleep. The best option for you will depend on several factors but a pharmacist or your GP can help.

Sexually transmitted infections (STIs)

STIs are infections that are spread through sex. Many STIs don’t cause any symptoms at all and are only diagnosed when someone has swabs taken as part of STI screening or for another reason. Some of them can, however, cause abnormal discharge so we will talk about these ones here. STIs are more likely to occur if you have sex without condoms but even condoms are not 100% effective in preventing STIs.

Chlamydia: Chlamydia can cause yellowish discharge that looks like pus (because that is what it is). It can also cause pain with sex, pelvic pain or pain when you pee. It is important that chlamydia is treated with antibiotics as it can cause complications such as pelvic inflammatory disease (PID) which can affect fertility and cause pelvic pain in the future. Chlamydia is diagnosed on a vaginal swab and is treated with antibiotics.

Gonorrhoea: Gonorrhoea can often be present at the same time as chlamydia and causes similar symptoms. Like chlamydia, gonorrhoea can cause PID and trouble with pain or infertility so should be treated if it is found. This is done easily with antibiotics and your GP or a sexual health clinic can provide these.

Trichomonas: Trichomonas is another STI that can cause abnormal vaginal discharge. It might cause itching or burning around the vulva and vagina, pain with sex or pain when you pee. The discharge is often green/yellow, “frothy” and looks a bit like pus. It often smells as well. Trichomonas is treated with the same antibiotic as BV, however, because this is an STI (and BV is not) the guidelines below should be followed.

Important points about STIs

It is important that if you have an STI, you tell anyone you have had sex within the last 3 months. This can be an intimidating thing to do but it is important! It is to make sure people are aware they might have an infection so they can get tested and treated. Your GP can often provide you with a letter or a suggestion of what to say to make this process easier. If you are having treatment for an STI you should avoid having sex or use condoms for a week after beginning treatment or until a week after your sexual contact/s (anyone you are having sex with) has/have been treated. If you are pregnant, or your symptoms don’t go away with treatment then you might need another swab in five weeks to check the infection has been successfully treated.

We should all have regular STI screening checks to check for infections. It is especially important before and after you start having sex with someone new.

It is also important to know that some STIs can “hide” in your body for a long time without causing you any symptoms. This means that if you find out you have an STI it DOES NOT necessarily mean you got it recently. If you have a stable sexual partner, you will need to tell them about your infection but this does not necessarily mean anyone in the relationship is having sex with anyone else. One of you could have picked up the infection a long time ago without realising.

Other STIs

There are also other STIs such as HIV or herpes which do not usually cause vaginal discharge. If you have any concerns about STIs see your GP or go to a sexual health clinic. There are some links below to help you with this.

Other causes of changes in vaginal discharge

Pregnancy: Vaginal discharge can be an unsual early symptom of pregnancy. Pregnancy can cause changes in vaginal discharge as it changes the hormones in the body. This is NORMAL but does not necessarily happen for all pregnant women. Usually, the volume of clear or white discharge increases in pregnancy. This is often most noticeable in the second and third trimester.

Foreign body: Sometimes foreign bodies (such as a tampon that has been forgotten) can cause a smelly discharge. Foreign bodies may also cause bleeding, itching or pain. This is not usually dangerous and can easily be removed by a doctor or nurse if you can’t remove it yourself.

Atrophic vaginitis: After menopause, the levels of oestrogen in a woman’s body decrease. This can affect the tissues around the vagina and make them less resilient to dealing with the activities of daily life (this is called atrophic vaginitis). It can also lead to discharge, pain, itching or pain with passing urine. Atrophic vaginitis can be treated with oestrogen cream as long as there is no other reason for your symptoms. It is a good idea to speak to your GP if you are having trouble with symptoms of menopause as there are many options available to help.

Pelvic inflammatory disease (PID): PID is an infection of the cervix and uterus that can sometimes result in brown vaginal discharge. It’s usually caused by an untreated STI like gonorrhea or chlamydia. Other PID symptoms include pain in the lower abdomen and pelvis, pain during sex, fever, painful urination, and heavy discharge with a bad smell. PID is a serious medical condition that needs prompt evaluation and treatment.

Cervical polyp: Cervical polyps are small outgrowths of tissue that grow from the cervix. They are not usually dangerous but can cause annoying symptoms such as bleeding after sex, spotting between periods or increased discharge. Polyps are usually visible if your GP does a vaginal examination. They are often noticed when women go for their cervical smear. If they are causing trouble they are usually easy for your doctor to remove.

A rare but important cause of different vaginal discharge:

Cancer: An unlikely but important cause of abnormal discharge to keep in mind is cancer. This might be affecting the vagina, cervix or inside of the uterus. It is very uncommon in young women but is important to keep in mind if you are concerned. It is especially important to think about if you are having discharge that is blood-stained which is not around the time of your period, or if you have other symptoms such as weight loss or pain. Having cervical smears as recommended is an important way to reduce the chance of cancer going unnoticed.

When should I see a doctor?

If you think you have any of the conditions we just discussed it is a good idea to see your doctor. They will tell you if you need tests or treatment.

It is also a good idea if you notice that your discharge has changed significantly in colour, smell or texture. Bleeding between periods or after sex is also a good reason to get checked out.

If you have pain in your pelvis (between your tummy and thighs), pain when you pee or pain around the vulva or vagina then talk to a doctor.

How do I access testing and treatment?

Under the NHS, you can see your GP or a sexual health clinic for STI screening or treatment. If you are under the age of 25 you can get an STI screening kit posted to you for free. This allows you to do the swabs at home and then send them back. If you need a prescription for treatment you can then contact your GP.

The NHS website has more information about self-testing kits for STIs as well as other kits such as ovulation or HIV

Some pharmacies also provide STI screening and treatment.

This NHS link can help you find a sexual health clinic near you.

Can I prevent vaginal discharge?

No, discharge is normal! However, there are some things you can do to keep your vulva and vagina healthy.

If you notice you have particularly heavy discharge you might find panty liners or period-proof underwear helpful. Keep in mind that panty liners can irritate the skin if you wear them all the time though.

Tips for avoiding pain, irritation and itch:

• Gently wash around the vulva (skin around the outside of the vagina) with water
• Avoid using soaps or shower gels on this area
• Avoid “deodorants” or “hygiene wipes”
• Do not wash inside your vagina

By now, you know that there are always bacteria that live in your vagina and this is normal. The balance of these bacteria is also important for the health of your vagina and vulva. Your vagina keeps itself clean and does not need to be washed inside. Wash the vulva with plain water but avoid using soaps or shower gels on this area. This will help maintain a healthy balance of bacteria.

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