Vaginal discharge: Difference between normal discharge and infection

Expelling old cells that once lined the walls of the vagina is the body’s way of keeping the vagina healthy and clean. Normal vaginal discharge is made from cells and fluid from the uterus (womb) and vagina.

The discharge is usually clear or milky-white and does not smell abnormal.

The color and thickness of vaginal discharge changes as the monthly cycle advances; for example, normal vaginal discharge is thicker and resembles egg white when a woman ovulates. Also, vaginal discharge changes when a woman is breastfeeding or when she is sexually excited.

Normal vaginal discharge has several purposes that are essential for a healthy environment of the vagina, such as [1]: 

• Cleaning and moistening the vagina 
• Help in the prevention and fighting of infections

Each woman should try to notice changes in her vaginal discharge, especially if the changes are accompanied by other symptoms, such as pain, a foul smell, or skin changes, because changes may indicate a problem. A woman who thinks she might have a problem should see a doctor as soon as possible.

It’s essential that each woman learns some differences between normal and abnormal vaginal discharge, as these might help you recognize changes that may occur. Normal vaginal fluids can vary somewhat in texture and color. They can be thin, sticky, and elastic, or thick and gooey. Vaginal fluids should be clear and white to slightly yellowish when the discharge dries. 

Different Types of Vaginal Discharge 

• White and thick discharge is common at the beginning and end of your cycle. Normal white discharge should not have other symptoms, such as itching. If itching is present with a thick white discharge that may resemble cottage cheese, this can indicate a vaginal yeast infection.
• Clear and stretchy discharge indicates fertile mucous and means a woman is ovulating.
• Clear and watery discharge occurs at different times of the cycle and can be particularly heavy after exercising.
• Yellow or green vaginal discharge may indicate an infection, especially if it is thick or clumpy like cottage cheese, or if it has a foul odor.
• Brown discharge may happen right at the end of menstrual bleeding or after it, and it only means your vagina is cleaning out. 
• Spotting blood and brown discharge may occur when you are ovulating — if this is the case, the spotting takes place in the middle of your menstrual cycle. Sometimes early in pregnancy, you may have spotting or brownish discharge at the time your period would normally appear. You should report any spotting or bleeding during pregnancy to your OBGYN. Besides, if you are spotting at the time of your normal period rather than experiencing the usual amount of menstrual flow, and if you had sexual intercourse without using birth control, you should take a pregnancy test.[2]

What changes may signify a problem?

Changes that may indicate a problem include [2]:

• An increased amount of vaginal discharge 
• Changes in color
• Changes in smell 

If this occurs accompanied by irritation, itchiness, or burning in or around the vagina, it is most likely the result of a condition called vaginitis. 

Discharge that is stained with blood when a woman is not having her period could also be a sign of a problem. If you have any of these signs, you should see your doctor. It is essential to keep an eye out for changes in vaginal fluids.

How to Prevent Vaginitis (Bacterial Vaginosis)

Here are some tips that will help you avoid or prevent vaginitis (bacterial vaginosis) [3]:

• After you use the toilet, you should always wipe from front to back, which may help to avoid getting bacteria from your rectal area into your vagina. 
• Wear cotton underpants during the day all the time. The cotton allows your genital area to breathe freely. Do not wear underpants during the night. 
• Try to avoid wearing tight pants, pantyhose, swimming suits, biking shorts, or leotards for extended periods of time. 
• Change your laundry detergent if you think it may be irritating your genital area. 
• The latex in condoms and diaphragms and the sperm-killing gels for birth control can be irritating for some women. If you think one of mentioned above is causing you problems, ask your doctor for advice about other types of birth control. 
• To prevent vaginitis, try to avoid hot tubs and bathe or shower daily instead, patting your genital area dry. 
• Avoid feminine hygiene sprays, colored or perfumed toilet paper, deodorant pads or tampons, and bubble baths if you want to prevent any vaginal infection and abnormal vaginal discharge. And most of all, avoid douching. 
• If you are, for any reason, treated with antibiotics, yogurt with live cultures or Lactobacillus acidophilus tablets can help you prevent a yeast infection. 
• Of course, use condoms to avoid catching or spreading sexually transmitted diseases. 
• If you have diabetes, you must keep your blood sugar under good control, since this can also cause abnormal vaginal discharge. 

If you notice changes in your vaginal discharge due to a sexually transmitted disease, you and your sexual partner must both receive treatment, even your partner shows no symptoms. Many organisms can harbor themselves without producing noticeable symptoms. If your partner isn't treated for an STD and you are, this can cause continual re-infection and could in some diseases, like Chlamydia, lead to serious problems such as infertility.

What causes the changes in vaginal discharge?

Changes in vaginal discharge can occur if the normal balance of healthy germs in your vagina is upset. Many things can disturb the balance of a healthy vagina, including douching, feminine hygiene sprays, certain soaps or bubble baths, antibiotics, diabetes, pregnancy, or infections, as you’ve already read. Vaginal infections, such as bacterial vaginosis, candidiasis, and trichomoniasis are common causes of abnormal vaginal discharge. Some infections are transmitted sexually, such as gonorrhea, while others can occur with or without having sex, such as bacterial vaginosis or a yeast infection. Although the symptoms of these infections can be very similar, there are some differences.

• Yeast infections may cause your discharge to become white and thick, resembling cottage cheese formations. A yeast infection usually does not cause a strong odor, but it may cause severe itching and burning as the main symptom. [4]
• Bacterial vaginosis (BV) can cause your discharge to be heavier than usual. The fluids may become foamy or frothy, and grayish, with an unpleasant fishy odor. [3]
• Trichomoniasis is a common sexually transmitted disease, and it may cause a musty, stale odor. If this happens, the discharge may become grayish or yellow-green and may thicken. It could also often cause vaginal itching and pain during urination. [5]

If you have any symptoms of abnormal vaginal discharge, it is essential to see a doctor or visit a clinic, especially for girls who have recently had sex without using a condom. Many sexually transmitted diseases cause changes in vaginal discharge or can cause other infections that affect discharge as well.

How Can Douching Be Harmful to the Vagina and Cause Vaginal Discharge?

In the United States, almost one in five women 15 to 44 years old douche. Doctors recommend that you do not douche because the chemicals in douches may irritate the vagina and change the normal balance of germs. Douching can also spread an infection into the uterus, increasing your risk of pelvic inflammatory disease. This is an infection of the of the female reproductive organs, and it usually occurs when sexually transmitted bacteria spread from your vagina to your uterus, fallopian tubes or ovaries, and can cause infertility and other serious conditions. [6]

What is the treatment of common vaginal conditions?

A self-care action plan could be the best treatment for your vaginal condition. You may be familiar with the symptoms of thrush (yeast infection) and make your own diagnosis even before you visit the doctor. If you have used thrush treatment with no improvement, then there may be another cause for the discharge. In this case, you should see your doctor. You should also see your doctor if you find any swelling, sores or skin changes, or if you have any unexpected bleeding.

Bubble baths, perfumed soaps, vaginal douches, or the use of disinfectant all destroy the natural acidic vaginal secretions that protect against abnormal conditions. Women who have recurrent thrush infections may need to take vaginal tablets as the only treatment option.

Trichomonal, chlamydial, and gonorrhoeal infections must be treated with antibiotics. [7]

Bacterial vaginosis may require antibiotic treatment as well. [7] 

The doctor will treat genital warts with a solution, or with cryotherapy. [8]

A recurrent attack of herpes simplex can be controlled with antiviral medications, especially if outbreaks are frequent or severe. [9]

Most commonly, post-menopausal changes require estrogen-containing creams or hormone replacement therapy. [10]

Surgery may be necessary for infected Bartholin’s glands, and occasionally in case of severe skin changes or cancers.

How to Help the Doctor Determine Appropriate Treatment?

Your doctor will take a medical history and perform a physical examination including a pelvic exam to establish the right diagnosis. Medical history questions may include the following:

• When did the abnormal vaginal discharge begin?
• Did you have the same amount and type of vaginal discharge throughout the month?
• What does the discharge look like?

You have to inform your doctor about possible odor, pain, itching, burning and you also have to mention if your sexual partner has abnormal discharge. For the diagnosis of abnormal vaginal discharge, it is also important to report your sexual relationship specifics, like multiple sexual partners, or sexual partners that you do not know very well. It might be important to know if there is anything that relieves the discharge.

Specific tests can determine the underlying cause of vaginal discharge. These tests include [1]: :

• Pelvic exam — the health care provider looks at the vagina and cervix (the part of the uterus at the top of the vagina).
• pH test — the health care provider checks the acid level of the discharge.
• Pap smear — during the pelvic exam, the health care provider takes a sample to check for cell changes and cancer.
• Wet mount — a sample of discharge is examined under the microscope to check for infection
• A culture of the discharge — a sample is taken from the vagina to check for infection.