Vaginal Discharge: Causes, Types & When to See a Doctor

What Is Vaginal Discharge?

Vaginal discharge is a natural fluid produced by glands in the vagina and cervix that keeps the vagina clean, moist, and protected from infection. Normal discharge is typically clear to white, has a mild acidic smell similar to yogurt, and varies in amount and consistency throughout your menstrual cycle.

Vaginal discharge serves several essential functions in maintaining reproductive health. The fluid is produced by the cervix and vaginal walls and contains a mixture of cells, bacteria, and mucus. This discharge plays a crucial role in the body's natural cleaning process, continuously flushing out dead cells and potential pathogens from the vaginal canal.

The healthy vaginal environment is maintained by a community of beneficial bacteria, primarily lactobacilli, which produce lactic acid. This creates an acidic environment with a pH level between 3.8 and 4.5, which helps prevent the overgrowth of harmful bacteria and yeast. The slightly sour smell of normal discharge, often compared to yogurt or buttermilk, is a result of this beneficial bacterial activity.

The amount of discharge produced varies significantly from person to person and can range from minimal to about a teaspoon (4 ml) per day. Factors such as hydration, sexual activity, hormonal changes, and individual physiology all influence the quantity and characteristics of discharge. What is considered "normal" varies widely among individuals, and many women have more or less discharge than others without it indicating any problem.

During sexual arousal, the body produces additional lubrication through increased discharge. This is a separate physiological process called lubrication, and this discharge tends to be more clear and slippery. This is completely normal and helps facilitate comfortable intercourse.

When Does Vaginal Discharge Begin?

Vaginal discharge typically begins during puberty, often appearing 6 months to a year before the first menstrual period. This is a normal sign that the reproductive system is maturing and estrogen levels are rising. Discharge continues throughout a person's reproductive years and typically decreases after menopause as estrogen levels decline.

During the reproductive years, the characteristics of vaginal discharge change cyclically in response to hormonal fluctuations throughout the menstrual cycle. Understanding these normal variations can help distinguish healthy discharge from signs that might indicate a problem requiring medical attention.

How Hormones Affect Discharge

The menstrual cycle, which typically lasts between 21 and 35 days, causes predictable changes in vaginal discharge. During the first half of the cycle (follicular phase), estrogen levels rise, causing discharge to increase and become more watery and slippery, resembling raw egg whites around ovulation. This change facilitates sperm transport and indicates peak fertility.

After ovulation, progesterone becomes the dominant hormone, causing discharge to become thicker, stickier, and less abundant. Just before menstruation, discharge may become minimal or take on a slightly brownish tinge as small amounts of old blood mix with the fluid. These cyclic changes are entirely normal and reflect the body's hormonal rhythms.

Several other factors can influence hormonal balance and therefore discharge patterns:

• Hormonal contraceptives: Birth control pills, patches, rings, and hormonal IUDs can alter discharge patterns, sometimes making discharge more consistent throughout the month
• Pregnancy: Increased estrogen and blood flow lead to more abundant, thin, milky discharge throughout pregnancy
• Breastfeeding: Low estrogen levels can cause vaginal dryness and reduced discharge
• Menopause: Declining estrogen leads to less discharge and potentially vaginal dryness and atrophy

What Does Normal vs Abnormal Discharge Look Like?

Normal vaginal discharge is clear to white or slightly yellowish, has a mild acidic odor, and varies from thin to stretchy depending on your cycle. Abnormal discharge may be green, gray, or bright yellow, have a strong fishy or foul smell, appear cottage cheese-like, or be accompanied by itching, burning, or pain.

Understanding the difference between normal variations and signs of potential problems is crucial for maintaining vaginal health. Normal discharge can vary significantly in appearance throughout the menstrual cycle, but certain characteristics should always prompt medical evaluation.

The appearance of normal discharge changes predictably throughout the month. In the days immediately following menstruation, discharge is typically minimal and may appear slightly brownish as residual menstrual blood clears. As estrogen levels rise approaching ovulation, discharge becomes more abundant, clear, and stretchy, similar to raw egg white. After ovulation, discharge typically becomes thicker, white or cream-colored, and less abundant until the next period begins.

When discharge comes into contact with air, it may oxidize and turn slightly yellowish or develop a light brownish tint on underwear. This color change after exposure to air is normal and should not be confused with abnormal yellow or brown discharge that was that color when first produced.

Signs of Abnormal Discharge

While variations in discharge are normal, certain changes warrant medical attention. The following characteristics suggest that something may be disrupting the vaginal environment and should be evaluated by a healthcare provider:

• Color changes: Green, bright yellow, or gray discharge often indicates infection
• Strong odor: A fishy smell, especially after sex, strongly suggests bacterial vaginosis
• Texture changes: Cottage cheese-like, chunky, or foamy discharge
• Blood-tinged discharge: Outside of menstruation or between periods (unless related to hormonal contraceptives)
• Accompanying symptoms: Itching, burning, pain, redness, or swelling in the vulvar area

It's worth noting that while these changes can indicate problems, they don't always mean something serious is wrong. Many causes of abnormal discharge are easily treatable once properly diagnosed by a healthcare provider.

What About Discharge from the Penis?

Unlike vaginal discharge, any discharge from the penis (other than pre-ejaculate during arousal or semen) is almost always a sign of infection and requires medical evaluation. Common causes include sexually transmitted infections like chlamydia and gonorrhea.

Penile discharge is fundamentally different from vaginal discharge. While vaginal discharge is a normal, healthy occurrence that serves important physiological functions, discharge from the penis outside of sexual arousal is typically pathological and indicates a problem that needs medical attention.

The only normal fluids that emerge from the penis are pre-ejaculatory fluid (pre-cum) during sexual arousal, which is clear and serves to neutralize the acidity of the urethra and provide lubrication, and semen during ejaculation. Any other discharge from the penis should be evaluated by a healthcare provider promptly.

Penile discharge often indicates a sexually transmitted infection (STI) such as chlamydia or gonorrhea. These infections can be asymptomatic in many cases, but when symptoms occur, they may include discharge that can be clear, white, yellow, or green, and may be accompanied by burning during urination, pain in the testicles, or urethral itching.

It is essential to seek medical testing if you notice any penile discharge, as untreated STIs can lead to serious complications including infertility, epididymitis, and reactive arthritis, and can be transmitted to sexual partners. Early treatment with appropriate antibiotics is highly effective for most bacterial STIs.

What Causes Abnormal Vaginal Discharge?

Abnormal vaginal discharge can be caused by infections (bacterial vaginosis, yeast infections, STIs), hormonal changes, irritation from products, forgotten tampons, or underlying conditions affecting the cervix or uterus. The most common cause is bacterial vaginosis, affecting up to 30% of women at some point.

Understanding the various causes of abnormal discharge helps in seeking appropriate care and treatment. While infections are the most common cause, other factors can also disrupt the vaginal environment and lead to changes in discharge.

Yeast Infections (Vaginal Candidiasis)

Yeast infections are caused by an overgrowth of Candida fungi, most commonly Candida albicans. While small amounts of yeast are normally present in the vagina as part of the healthy microbial community, disruption of the bacterial balance can allow yeast to proliferate beyond normal levels.

This produces the characteristic thick, white, cottage cheese-like discharge often accompanied by intense itching, redness, and swelling of the vulva and vagina. Many women also experience burning, especially during urination or intercourse. The discharge typically does not have a strong odor, which helps distinguish yeast infections from bacterial vaginosis.

Factors that increase the risk of yeast infections include antibiotic use (which kills beneficial bacteria that normally keep yeast in check), high blood sugar or diabetes, pregnancy, hormonal contraceptives, weakened immune system, and wearing tight, non-breathable clothing. Most yeast infections respond well to treatment and often clear up within a few days, either on their own or with over-the-counter antifungal treatment.

Bacterial Vaginosis (BV)

Bacterial vaginosis occurs when the normal balance of vaginal bacteria is disrupted, leading to an overgrowth of anaerobic bacteria at the expense of protective lactobacilli. This is the most common cause of abnormal vaginal discharge in women of reproductive age, affecting an estimated 10-30% of women at some point in their lives.

BV produces a thin, grayish-white discharge with a characteristic strong fishy odor that often becomes more noticeable after sexual intercourse or during menstruation. Unlike yeast infections, BV typically does not cause significant itching or external irritation, though some women experience mild symptoms. Treatment involves antibiotics such as metronidazole or clindamycin, available as pills, gels, or creams.

While BV is not considered a sexually transmitted infection, it is more common in women who are sexually active and those with multiple partners. Douching and smoking also increase the risk. BV can sometimes resolve on its own, but treatment is recommended to prevent potential complications including increased susceptibility to other infections.

Sexually Transmitted Infections

Several sexually transmitted infections can cause changes in vaginal discharge. Because many of these infections can be present without obvious symptoms, regular testing is important for sexually active individuals, especially those with new or multiple partners:

• Chlamydia: Often completely asymptomatic (up to 70% of cases), but may cause increased yellowish discharge, burning with urination, and spotting between periods
• Gonorrhea: May produce yellow or green purulent discharge, often with pelvic pain and burning urination, though many infections are asymptomatic
• Trichomoniasis: Causes frothy, greenish-yellow discharge with a strong unpleasant odor, often accompanied by intense itching, irritation, and discomfort during urination and sex

All of these infections can be effectively treated with appropriate antibiotics, and early treatment prevents complications and transmission to partners. If diagnosed with an STI, sexual partners should also be tested and treated.

Other Causes of Abnormal Discharge

Beyond infections, several other conditions can affect vaginal discharge:

• Pelvic inflammatory disease (PID): Infection of the upper reproductive tract (uterus, fallopian tubes) causing abnormal discharge, pelvic pain, and fever. Often a complication of untreated chlamydia or gonorrhea.
• Cervical ectropion: When glandular cells from inside the cervix extend onto the outer surface, potentially causing increased mucus discharge. Common in young women and during pregnancy.
• Cervical polyps or abnormalities: May cause blood-tinged or increased discharge, especially after intercourse
• Forgotten tampon: Can cause very foul-smelling discharge and, rarely, toxic shock syndrome (TSS)
• Vaginal atrophy: Thinning vaginal tissues after menopause can cause watery discharge and discomfort
• Skin conditions: Lichen sclerosus and lichen planus can affect the vulva and vagina, causing discharge, itching, and white patches

What Can You Do at Home?

Maintain vaginal health by avoiding douching and scented products, wearing breathable cotton underwear, wiping front to back, and changing out of wet clothes promptly. For yeast infections you've had before, over-the-counter antifungal treatments are available. Never use tampons to absorb excessive discharge.

There are several evidence-based practices that can help maintain healthy vaginal discharge and prevent problems. The vagina is designed to be self-cleaning, and many common practices can actually disrupt this natural process and lead to problems.

Daily Vaginal Care

Proper hygiene is important, but less is often more when it comes to vaginal care. The vagina maintains its own healthy environment through the activity of beneficial bacteria, and over-cleaning can disrupt this delicate balance.

• Wash the external genital area gently with warm water alone, or with a mild, unscented soap if desired. The inside of the vagina does not need to be cleaned.
• Avoid douching completely: This practice disrupts the natural bacterial balance and can increase the risk of infections. The vagina cleans itself.
• Skip scented products: Avoid scented tampons, pads, sprays, wipes, and bubble baths in the genital area
• Wipe front to back: After using the toilet, always wipe from front to back to prevent bacteria from the rectum entering the vagina
• Wear breathable underwear: Cotton underwear allows air circulation and reduces moisture buildup
• Change out of wet clothes: Don't stay in wet swimsuits or sweaty workout clothes longer than necessary
• Allow air circulation: Going without underwear at night can help keep the area dry
• Avoid tight clothing: Tight pants and synthetic fabrics can trap heat and moisture

Over-the-Counter Treatments

If you recognize the symptoms of a yeast infection that you've had before and been diagnosed with, over-the-counter antifungal treatments are available. These come in various forms including creams, suppositories, and oral tablets. Common options include clotrimazole and miconazole.

However, if symptoms don't improve after treatment, if this is your first suspected yeast infection, or if you've had more than two yeast infections in the past six months, see a healthcare provider for proper diagnosis. Other conditions can mimic yeast infection symptoms.

For those experiencing vaginal dryness, especially during or after menopause or while breastfeeding, over-the-counter vaginal moisturizers or lubricants may help. Consult with a healthcare provider about the most appropriate options for your situation.

When Should You See a Doctor?

See a doctor if discharge changes to an abnormal color (green, yellow, gray), develops a strong or foul odor, becomes cottage cheese-like, or is accompanied by itching, burning, pelvic pain, or fever. Seek immediate care if you have severe abdominal pain with fever and abnormal discharge.

While many cases of abnormal discharge can be managed with over-the-counter treatments or may resolve on their own, certain situations warrant medical evaluation. Knowing when to seek care helps ensure prompt treatment and prevents potential complications.

Contact a healthcare provider if:

• Any discharge from the penis (other than pre-ejaculate or semen)
• Vaginal discharge has a foul, fishy, or unusual strong odor
• Discharge color changes to green, bright yellow, or gray and persists more than 3 days
• Discharge becomes cottage cheese-like, clumpy, or unusually thick
• You've had recurrent yeast infections (more than 2-3 times in six months)
• You've had unprotected sex and suspect you may have an STI
• Discharge is accompanied by persistent itching, burning, or pain
• You notice blood-tinged discharge outside of your period

How Is the Cause of Abnormal Discharge Diagnosed?

Diagnosis typically involves discussing your symptoms and medical history, a physical examination of the genital area, testing the pH of vaginal discharge, microscopic examination of the discharge, and sometimes laboratory tests for STIs or other conditions.

When you see a healthcare provider about abnormal discharge, they will use several methods to determine the cause. Accurate diagnosis is important because different conditions require different treatments, and using the wrong treatment may not help and could worsen the problem.

Medical History and Symptoms

Your provider will ask about your symptoms, including when they started, how the discharge looks and smells, any accompanying symptoms like itching or pain, your sexual history, recent antibiotic use, and any previous similar episodes. Being open and honest about these details helps guide diagnosis and ensures you receive appropriate care.

Physical Examination

For those with a vagina, the provider will examine the external genitalia and may perform a speculum examination to view the vaginal walls and cervix. They'll note the appearance and characteristics of the discharge, any redness, swelling, or lesions, and the condition of the cervix.

Diagnostic Tests

Several tests may be performed to identify the cause of abnormal discharge:

• pH testing: Normal vaginal pH is 3.8-4.5. Higher pH (above 4.5) suggests bacterial vaginosis or trichomoniasis; yeast infections typically don't significantly change pH
• Wet mount microscopy: A sample of discharge is examined under a microscope to identify yeast cells, bacterial overgrowth (clue cells), or parasites (trichomonads)
• Whiff test: Adding a drop of potassium hydroxide to discharge that produces a fishy odor strongly suggests bacterial vaginosis
• STI testing: Swabs or urine samples may be tested for chlamydia, gonorrhea, trichomoniasis, and other infections using nucleic acid amplification tests (NAATs)
• Pap smear: If cervical abnormalities are suspected, a Pap test may be performed

It's helpful to avoid urinating for at least an hour before your appointment, as a urine test may be needed. Additionally, avoid using vaginal medications, douching, or having intercourse for 24-48 hours before the exam, as these can interfere with test results.

How Is Abnormal Vaginal Discharge Treated?

Treatment depends on the cause: yeast infections are treated with antifungal medications, bacterial vaginosis with antibiotics (metronidazole or clindamycin), STIs with appropriate antibiotics, and hormonal changes may be addressed with estrogen therapy. Sexual partners may need treatment for some infections.

Once the cause of abnormal discharge is identified, targeted treatment can begin. The specific treatment depends entirely on what's causing the problem, which is why accurate diagnosis is so important before starting treatment.

Treatment for Yeast Infections

Yeast infections are treated with antifungal medications, which are available both over-the-counter and by prescription. Options include topical creams and suppositories containing clotrimazole, miconazole, or terconazole, applied for 1-7 days depending on the formulation. Oral fluconazole (a single-dose pill) is also effective and may be preferred for convenience.

For recurrent yeast infections (four or more per year), longer-term treatment strategies may be needed, including extended antifungal courses or maintenance therapy with weekly fluconazole for several months. Your provider may also investigate underlying causes such as diabetes or immune suppression.

Treatment for Bacterial Vaginosis

BV is treated with antibiotics, most commonly metronidazole (oral tablets or vaginal gel) or clindamycin (vaginal cream or suppository). Treatment typically lasts 5-7 days. It's important to complete the full course of treatment even if symptoms improve earlier to ensure the infection is fully cleared.

BV has a relatively high recurrence rate, with up to 30% of women experiencing recurrence within three months. Probiotics containing lactobacillus strains may help restore healthy vaginal flora and reduce recurrence, though evidence is still evolving. Avoiding practices that disrupt vaginal pH, such as douching, may also help prevent recurrence.

Treatment for Sexually Transmitted Infections

STIs require specific antibiotic treatment based on the infection:

• Chlamydia: Typically treated with doxycycline (7-day course) or azithromycin (single dose)
• Gonorrhea: Usually requires dual therapy with ceftriaxone injection plus oral azithromycin due to increasing antibiotic resistance
• Trichomoniasis: Treated with metronidazole or tinidazole, usually as a single dose

When diagnosed with an STI, it's crucial that sexual partners are also tested and treated to prevent reinfection and further transmission. Abstain from sexual contact until both you and your partner(s) have completed treatment and been cleared. Some clinics offer expedited partner therapy (EPT), where patients can give antibiotics directly to their partners.

Vaginal Discharge During Pregnancy and Breastfeeding

Increased thin, white, mild-smelling discharge (leukorrhea) is normal during pregnancy due to higher estrogen levels. However, any colored, foul-smelling, or irritating discharge during pregnancy should be reported to your healthcare provider promptly. Breastfeeding can cause vaginal dryness due to low estrogen.

Hormonal changes during pregnancy and breastfeeding significantly affect vaginal discharge. Understanding what's normal during these times can help distinguish harmless changes from potential problems that need attention.

Discharge During Pregnancy

During pregnancy, increased estrogen levels and blood flow to the vaginal area lead to more abundant vaginal discharge. This thin, white, milky discharge, called leukorrhea, is completely normal and actually helps protect the reproductive tract by preventing infections from traveling up through the vagina to the uterus where they could affect the pregnancy.

Normal pregnancy discharge should be relatively mild-smelling and shouldn't cause irritation. Any of the following should be reported to your healthcare provider:

• Discharge that is green, yellow, gray, or has an unusual color
• Discharge with a strong, foul, or fishy odor
• Discharge accompanied by itching, burning, or pain
• Blood-tinged discharge (especially after the first trimester)
• Watery discharge that might indicate amniotic fluid leakage

Yeast infections are more common during pregnancy due to hormonal changes that alter the vaginal environment. While they don't harm the baby, they should be treated to relieve symptoms. Always consult your healthcare provider before using any medication during pregnancy, as not all treatments are safe.

Discharge While Breastfeeding

Breastfeeding suppresses estrogen production, which can lead to vaginal dryness and reduced discharge. The vaginal walls may become thinner and more fragile, potentially causing discomfort during intercourse. These changes are temporary and typically resolve after breastfeeding ends and normal hormone levels return.

Over-the-counter vaginal moisturizers or lubricants can help manage dryness during this time. In some cases, low-dose vaginal estrogen may be recommended; discuss options with your healthcare provider if dryness is causing significant discomfort.

Vaginal Discharge in Children

Children typically don't have significant vaginal discharge until puberty approaches. Discharge in young children may be caused by bacterial infection (often streptococcus), poor hygiene, irritation, or rarely a foreign object. Foul-smelling, discolored, or persistent discharge in children should be evaluated by a healthcare provider.

Understanding vaginal discharge in children helps parents and caregivers know when to seek medical attention. The causes and expectations differ significantly from those in adults.

Normal Discharge in Children

Newborn baby girls may have a small amount of vaginal discharge, sometimes even blood-tinged, in the first few days of life. This is caused by maternal hormones that crossed the placenta and resolves within a few days without any treatment needed.

Before puberty, children typically don't have noticeable vaginal discharge because estrogen levels are low. The appearance of clear or white discharge without odor or irritation usually signals the approach of puberty and is normal, often appearing 6-12 months before the first menstrual period.

Causes of Abnormal Discharge in Children

When young children develop vaginal discharge before the approach of puberty, potential causes include:

• Bacterial infection: Often caused by streptococcus bacteria (the same type that causes strep throat). Children spread these bacteria by touching their genitals after touching their mouth, nose, or throat
• Poor hygiene: Incomplete wiping or wiping back to front can introduce fecal bacteria
• Irritation: Bubble baths, harsh soaps, or synthetic underwear can cause irritation and discharge
• Pinworms: These intestinal parasites can migrate to the vaginal area and cause irritation, itching, and discharge
• Foreign object: Rarely, young children may insert small objects (like tissue, beads, or small toys) into the vagina, causing infection and foul-smelling discharge

When to Seek Care for Children

Contact a healthcare provider if your child has:

• Discharge that is discolored (yellow, green, gray)
• Discharge with a foul or unusual odor
• Discharge that doesn't resolve within a few days
• Genital redness, swelling, or pain
• Difficulty urinating or pain with urination
• Recurrent episodes of discharge

Treatment depends on the cause. Bacterial infections require antibiotics. Pinworms are treated with over-the-counter antiparasitic medication (and the whole family may need treatment). If a foreign object is suspected, it needs to be removed, which may require examination under sedation if it cannot be easily visualized.