Vaginal discharge

• A healthy vagina produces fluid that keeps the vagina clean. In certain circumstances, the vaginal fluid can change its composition, appearance and smell. This is a common occurrence that can have many possible causes.
• The type of treatment used for vaginal discharge will vary depending on its suspected cause. The conditions that cause most cases of vaginal discharge respond well to treatment.
• There are strategies that may help prevent vaginal discharge from recurring.

What is vaginal discharge?

The vagina acts as an important passageway between a woman's inner reproductive organs and the outside of her body. A healthy vagina produces fluid that keeps the vagina clean. This fluid is produced by glands in the vagina and cervix. Vaginal fluid helps maintain a healthy vaginal environment, as it carries away dead cells and bacteria and reduces the risk of infection.

The type and amount of vaginal discharge may vary between women and across a woman's lifetime. Changes in vaginal discharge can occur with pregnancy, ovulation, menopause or starting oral contraceptive medication.

Causes

There is a range of potential causes of abnormal vaginal discharge.

Common causes

Allergic vaginitis

The vagina is a delicate environment; using harsh products to clean this part of your body can affect its normal function. A common cause of a change in vaginal discharge is the use of harsh soaps or gels and douching while washing your body.

Bacterial infection

Although some bacteria are normally found in the vagina, the growth of other bacteria can cause vaginal infection. Vaginal discharge is often associated with bacterial vaginosis, which may be caused by a range of bacteria. Sexually-transmitted infections (STIs) with Neisseria gonorrhea and Chlamydia trachomatis bacteria (the bacteria that cause gonorrhea and chlamydia, respectively) may cause abnormal vaginal discharge.

Fungal infection

Yeast are normally found in the vagina, but if the pH of the vagina changes, the yeast can multiply far beyond their normal numbers. This is also more likely to occur after taking antibiotics.

Parasitic infection

The parasite Trichomonas vaginalis is not normally found in the vagina. It is almost always spread through sexual contact, but as this parasite is capable of surviving up to 24 hours in a moist environment, it can possibly be transmitted through wet towels or swimming clothes.

Less common causes

• Medications such as antibiotics, steroids and oral contraceptives;
• Herpes simplex virus (HSV) infection;
• Streptococcal vaginitis in adults;
• A foreign body, such as a tampon;
• Atrophic vaginitis - inflammation caused by a thinning and drying out of the vagina walls;
• Cervical cancer and other cancers of the female reproductive system, and;
• Vaginal fistula.

Signs and symptoms

Changes in the color or quantity of a vaginal discharge may prompt you to seek medical advice. It important for your doctor to correlate these changes with your menstrual cycle in order to determine whether they are normal.

Your menstrual cycle is not the only factor that determines changes of your vaginal discharge. Sexual activity, exercise and pregnancy are other very common causes of normal change to vaginal discharge.

Sometimes symptoms can be caused by overgrowth of normal flora or infection by parasites, yeasts or bacteria. These infections may cause a change in color, consistency and smell of your vaginal discharge.

Methods for diagnosis

Medical history and examination

To diagnose what is causing your abnormal vaginal discharge, your doctor may wish to take your detailed medical history. You may be asked questions such as:

• What color is the discharge?
• When did the discharge start?
• Does the discharge have a bad odor?
• Is there any pain or itching around the vagina?
• Do you experience any pain when having sex?
• Do you douche?
• Have you recently taken antibiotics?

Your doctor may also conduct a physical examination to inspect your vagina, vulva and cervix.

Diagnostic testing

Your doctor may take a swab during a physical examination to identify microbial growth. Depending on your age and sexual history, other tests could be carried out to check for the presence of sexually-transmitted infections. Your doctor may also consider performing a Pap test to check for abnormal cells.

A swab helps to assess the cause of vaginal discharge. 

Recurrent vaginal discharge

If vaginal discharge comes back several times, your doctor may suggest further diagnostic tests to check for an underlying medical condition that may be affecting your immune system, such as diabetes.

Types of treatment

The type of treatment used for vaginal discharge will vary depending on its suspected cause:

Vaginal discharge caused by infection

Vaginal discharge that is caused by an infection is treated with antibiotics, antifungal agents or a prescribed vaginal pessary cream.

Vaginal discharge caused by allergic vaginitis

Women who experience vaginal discharge and show no signs of abnormal microbial growth may have allergic vaginitis (contact dermatitis). Treatment for this condition usually involves avoiding the suspected irritant. Your doctor may prescribe a cream for symptomatic relief.

Potential complications

Chlamydia or gonorrhea infections, if left untreated, may progress to pelvic inflammatory disease, which can lead to other complications, including infertility.

Prognosis

The conditions that cause most cases of vaginal discharge respond well to treatment. Some cases of infection may return. Your doctor can discuss with you strategies to reduce your chance of recurring vaginal discharge.

Prevention

Once the cause of your vaginal discharge has been identified, there are strategies that may help prevent its recurrence. Some ways of reducing your risk of experiencing vaginal discharge may include:

• Avoiding douching;
• When going to the bathroom, wiping from front to back to avoid contaminating your vagina with bacteria;
• Choosing underwear made from natural fibers, to avoid excessive sweating, and;
• Practicing safe sex to reduce the chance of acquiring sexually-transmitted infections.