What is Abnormal Vaginal Discharge?

We all know that feeling of looking at the discharge on our panties and wondering, "is this normal?" and "should I get this checked out?"

So let's start by clarifying that most discharge is completely normal. It's produced by the cervix and is necessary for flushing away bacteria and dead cells and keeping the vagina clean and healthy from infections.

Here are the major differences between normal and abnormal discharge:

Normal discharge:

Normal discharge can be identified based on certain characteristics [1]:

Colour: Clear or milky white.
Smell: Shouldn't have a noticeable smell to it.
Consistency: Non-adherent to the vaginal wall, egg-white consistency during ovulation, thin or stringy.
Timing: Changes a bit depending on ovulation, arousal, menopause, oral contraceptives, or pregnancy.
Symptoms: No itchiness, redness, or swelling of the vulva and vaginal walls.

Abnormal discharge:

Abnormal discharge has certain unique features that can help us distinguish it from normal discharge [1]:

Colour: White, grey, greenish-yellow, yellow, or brown (if mixed with blood), red (if not menstruating).
Smell: Fishy, strong, or foul-smelling discharge.
Consistency: Mucoid, thick, frothy, or cheesy (in yeast infections, it looks like cottage cheese). Can be excessive, or more discharge than usual.
Timing: Infections are most likely to occur right before and during menstruation, but can occur anytime. Bleeding when not menstruating is not normal.
Symptoms: Burning during urination, itchiness, redness, or swelling.

What causes abnormal discharge?

The main reason for abnormal discharge is a vaginal infection, cervical infection, or bacterial imbalance. Less frequently, it may be a sign of a more serious condition, such as cervical cancer or an STI [3].

Depending on a variety of factors, you can figure out if your discharge is normal or not. But, if you aren't sure about it, the best option is to talk to a healthcare professional about it.

Let's go through some of the most common culprits:

Bacterial Vaginosis (BV): This is the most common cause of abnormal discharge, and is caused by a bacterial imbalance. Usually, there's a fishy odour and a thin grey or white discharge [1]. It's treated with antibiotics.
Yeast Infections: This is also a common infection caused by a yeast called Candida albicans. The discharge is white, looks a bit like cottage cheese, and adheres to the vaginal wall [9]. It can be treated with over-the-counter medication. However, you should still get diagnosed by a healthcare provider.
Trichomoniasis: This is a sexually transmitted infection (STI) caused by a parasite called Trichomonas vaginalis. The discharge can be green, yellow, or grey, has a foul odour and can be bubbly or frothy. Luckily, it's curable, and treated with antibiotics [6].
Chlamydia: This is the most common sexually transmitted infection, and is caused by a bacteria called Chlamydia trachomatis. The discharge can have a strong smell and the colour can be cloudy, grey or yellow [2].
Gonorrhea: This is a sexually transmitted infection caused by bacteria called Neisseria gonorrhoeae. The discharge can be thinner or creamier than usual, with white or yellow colour. It's treated with antibiotics [3].
Herpes: This is caused by a virus called the Herpes simplex virus. The discharge might have a smelly discharge and is accompanied by sores or blisters [10].
Non-infections causes: Other causes of an unusual discharge can include atrophic vaginitis, a foreign body, certain cancers, contact dermatitis, or irritation. An IUD or intrauterine device can also cause abnormal vaginal discharge [1].

Risk factors and prevention

The most important factor to consider is hygiene. Tampons should be changed regularly, and diaphragms should not be left inside for too long. But while it's important to stay clean, it's equally important to not overdo it. Douching is a major risk factor for certain infections and bacterial imbalances and should be avoided. Scented toilet paper and deodorants can also cause problems, leading to abnormal discharge [1].

The best way to stay clean is to gently wash the vulvar area with water or mild soap, then thoroughly dry it with a clean towel. It can also be helpful to wipe your vagina from front to back after using the toilet to prevent contamination from bacteria in the stool. Additionally, wearing loose underwear and clothing and keeping the area dry can help prevent bacterial growth [11].

It's also worth noting that you are more prone to infections just before and during menstruation. The reason is that the pH balance varies depending on where you are in your cycle and during this time the pH increases and becomes more alkaline due to the heavy blood flow, making it a nicer habitat for unwanted bacteria to multiply [4]. Pregnancy, diabetes, certain medications, and birth control pills can predispose you to infections [1]. If you have any of these conditions or are taking medication, talk to your healthcare provider about how to avoid infections.

Alternatively, post-menopausal people are more likely to have non-infectious causes due to thinning vaginal lining from a decrease in estrogen [5].

What to do about it?

If you aren't sure about your discharge, the smartest thing to do is to simply get it checked out by a healthcare professional. Certain infections can lead to complications, so it's important to get them treated as soon as possible.

If you find it embarrassing, remember that you're not alone! Yeast infections and bacterial vaginosis are extremely common. If you think you might have an STI, make sure to inform any sexual partners about it to prevent further transmission.

If you are trying to become pregnant, or just want to monitor your cycle more accurately, you can try out a hormone-tracking device such as the inne minilab. This device uses your saliva to track when you are ovulating, so you don't only have to rely on discharge and body temperature.

In conclusion

Discharge is the vagina's way of staying clean and healthy, but removing cells and bacteria. If you have uncomfortable symptoms or notice unusual changes in colour, consistency, or smell, be sure to contact your healthcare provider to investigate further. Remember that infections are common, but luckily they're manageable with the right care!

References:

Bishop GB. Vaginal Discharge. In: Walker HK, Hall WD, Hurst JW, editors. Clinical Methods: The History, Physical, and Laboratory Examinations. 3rd edition. Boston: Butterworths; 1990. Chapter 172. Available from: https://www.ncbi.nlm.nih.gov/books/NBK281/
Chlamydia. (2021, November 1). Cleveland Clinic https://my.clevelandclinic.org/health/diseases/4023-chlamydia (Accessed 1/23/23)
Gonorrhea. (2022, September 2). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4217-gonorrhea (Accessed 1/23/23)
Lin, Y.-P., Chen, W.-C., Cheng, C.-M., & Shen, C.-J. (2021). Vaginal pH Value for Clinical Diagnosis and Treatment of Common Vaginitis. Diagnostics, 11(11), 1996. MDPI AG. Retrieved from http://dx.doi.org/10.3390/diagnostics11111996
Vagina: What’s typical, what’s not. (2022, December 6). Mayo Clinic https://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/vagina/art-20046562 (Accessed 1/23/23)
Trichomoniasis. (2022, December 27). Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/4696-trichomoniasis#management-and-treatment (Accessed 1/23/23)
Vaginal Discharge. (2021, January 25). UK National Health Service. https://www.nhs.uk/conditions/vaginal-discharge/ (Accessed 1/23/23).
Vaginal Discharge. (2022, July 22). Cleveland Clinic. https://my.clevelandclinic.org/health/symptoms/4719-vaginal-discharge (Accessed 1/23/23)
Oluwatosin Goje, MD, MSCR. Candidal Vagnitis. (2022, September).Merck Manual. https://www.merckmanuals.com/professional/gynecology-and-obstetrics/vaginitis,-cervicitis,-and-pelvic-inflammatory-disease-pid/candidal-vaginitis
Genital Herpes – CDC Basic Fact Sheet. (2022, January 3). Center for Disease Control and Prevention. https://www.cdc.gov/std/herpes/stdfact-herpes.htm
Vulvar Care. (2018, March 23). Cleveland Clinic. https://my.clevelandclinic.org/health/articles/4976-vulvar-care (Accessed 1/23/23)