Unexpected marks in your underwear? In most cases, vaginal discharge is completely normal and all women (and those with vaginas) will experience it. Vaginal discharge can occur at any age, but as it serves an important female reproductive function, most women first experience discharge in the run-up to puberty and continue to until after the menopause.
Discharge is your body’s way of cleaning the vagina, and it’s usually nothing to worry about. However, if your discharge smells or looks unusual, it can sometimes indicate something is amiss, so it’s good to get clued up on the contents of your knickers and nip any potential infections in the bud.
We spoke to Mr Narendra Pisal, consultant gynaecologist of London Gynaecology, Dr Karen Morton, consultant gynaecologist and founder of Dr Morton’s and Dr Sarah Welsh, co-founder at HANX and gynaecology doctor, about the most common causes of vaginal discharge, so you’ll know when to sit pretty and when to seek medical help:
What is vaginal discharge?
Vaginal discharge is the result of secretions produced from small glands in the lining of the vagina and the cervix, and in most cases, it is nothing to worry about. The amount varies, but you may find you experience heavier discharge during pregnancy, when you ovulate and if you’re sexually active.
‘We are mammals, and like all other mammals, we have fluid coming out of the vagina most of the time,’ explains Dr Morton. ‘When it is not literally coming out and making a mark on our underwear, the vagina should nonetheless be moist. The general moisture is due to fluid exuding through the walls of the vagina. This is called a transudate. It increases massively during sexual arousal and it is this that makes a woman "wet."'
Vaginal discharge and your cycle
You’ve probably noticed your vaginal discharge changes in appearance from time to time. In fact, the colour, consistency, and amount can differ from day to day, depending where you are in your menstrual cycle. Here’s a breakdown of what to expect:
Days 1–5: otherwise known as your period, discharge is usually red or bloody as your body sheds your uterine lining.
Days 6–14: in the days following your period, you’ll notice there’s less vaginal discharge than usual. Then, as the egg starts to develop, it’ll become cloudy and may feel sticky.
Days 14–25: right before ovulation, discharge will be clear, thin and slippery. After ovulation, it’ll go back to being cloudy and possibly milky.
Days 25–28: again, you’ll notice a reduction in vaginal discharge just before starting your next period.
Types of vaginal discharge
Since ‘normal’ vaginal discharge varies so much, it can be tricky to know if something is up. Let’s take a look at the most common forms in more detail:
1. White vaginal discharge
White discharge is totally normal, particularly towards the beginning and end of your menstrual cycle. It may also be cream in colour, or occasionally a very pale yellow. ‘After you have ovulated and produced eggs, there will be a release of the hormone progesterone in the blood stream, and this is the reason for the white discharge,’ says Dr Morton.
2. Clear vaginal discharge
Clear, watery vaginal discharge is commonplace any time of the month, and is never anything to worry about. It may be especially prevalent after exercise, as intra-abdominal pressure forces your vagina to expel a little more than it normally would – this is totally normal.
When clear discharge becomes sticky or mucous-like, it’s a sign that you’re ovulating and your ovary is releasing a mature egg that will pass through the fallopian tube for fertilisation. ‘Two to three days before you start to ovulate, you will experience ovulation discharge, the texture being like raw egg white,’ says Dr Morton. This clear sticky fluid makes it easier for sperm to travel to the egg, which is also a great indicator for women who are wanting to conceive.
💡 If you're trying to get pregnant, it's wise to keep an eye on your discharge. It may also be worth using fertility lubricant.
3. Thick, gummy vaginal discharge
If you are pregnant you may notice a heavier, gummy or thick discharge. This is because the cervix and vaginal walls get softer, and discharge increases to help prevent any infections travelling up from the vagina to the womb.
You can also experience discharge towards the end of your pregnancy as well. ‘Most women will have an increased amount of vaginal discharge during pregnancy, particularly in the later stages,’ says Dr Morton. ‘As long as the discharge isn't smelly, itchy or blood stained then nothing needs to be done. The most important thing to be aware of is if there's a lot of watery loss, get checked out by your midwife or the hospital.’
4. Clumpy vaginal discharge
If your discharge has a thick, cottage cheese-like appearance, smells strongly, and is accompanied by itching or burning, it’s likely to be a yeast infection, otherwise known as thrush. You may also experience itching, soreness, burning and irritation.
‘Thrush usually occurs when there’s an overgrowth of yeast that lives normally in your gut. But if this yeast gets out of control, it can lead to unpleasant symptoms,’ says Dr Morton. ‘A typical reason is taking antibiotics, for something unrelated like earache or tonsillitis, which kills off healthy bacteria.’
5. Brown or red vaginal discharge
Brown or red vaginal discharge typically occurs during or immediately after your period, which is perfectly normal and usually nothing to worry.
But a prolonged blood stained discharge can be more of a worry, so if you have any concerns get it checked out. ‘This could be a brown staining, slightly unpleasant smelling discharge,’ says Dr Morton. 'It should be investigated as it could be something more serious higher up on the cervix or in the uterus.’
Brown or red vaginal discharge could also be spotting or inter-menstrual bleeding:
Spotting: you might experience a small amount of blood between your period called spotting. If you’re on the pill, you may also experience spotting throughout your cycle. If you have spotting in place of your period, and you’ve recently had unprotected sex, it can also indicate pregnancy. Spotting early in pregnancy can also be a sign of miscarriage, so it’s worth speaking to a doctor.
Inter-menstrual bleeding: while spotting can be normal and is common, regularly bleeding between your periods is called inter-menstrual bleeding. There are many causes of inter-menstrual bleeding which are not serious but rarely it can be due to a problem with the womb or cervix, including cervical cancer, so if it is happening to you then make an appointment with your doctor.
6. Grey, yellow or green vaginal discharge
Vaginal discharge that is a dark shade of yellow or light green typically signals a bacterial or sexually transmitted infection – especially if it’s thick or clumpy and has a strong odour. Similarly, grey vaginal discharge can be a symptom of a common bacterial infection called bacterial vaginosis.
STIs can often can lie dormant with no symptoms – so if in doubt, always get it checked out. ‘All common infections, such as chlamydia and gonorrhoea, can cause vaginal discharge,’ says Dr Morton, ‘but they are also often silent and are causing much more serious problems higher up in the tubes’ – so if in doubt, it’s better to get checked out.
7. Smelly vaginal discharge
If you have an unpleasant looking mucus discharge that is accompanied by a fishy odour and a burning sensation, it could be bacterial vaginosis.
‘This is due to a loss of balance of the normal bacteria of the vagina,’ says Dr Morton. ‘It’s also very common in older women when they don’t have oestrogen, which creates moisture in the vagina and keeps germs in the right balance.’
Vaginal discharge causes
Most of the time, vaginal discharge is a healthy bodily function – but sometimes it can indicate thrush, bacterial vaginosis, or a sexually transmitted infection so it is worth getting checked out if you're not sure:
✔️ Bacterial vaginosis
Bacterial vaginosis (BV) is a common infection of the vagina that can occur when the natural balance of the bacteria in the vagina changes, says Mr Pisal. ‘It’s an overgrowth of bacteria and is different to thrush which is an overgrowth of yeast,’ he explains. ‘This can cause intense vaginal irritation, a foul, fishy smell and sometimes itching. It may cause burning pain during intercourse.’
There’s no single cause for BV, but stress seems to trigger it, so make sure you take care of your mental health, says Mr Pisal. Chronic medical conditions such as diabetes also increase the likelihood of BV. Avoiding perfumed body wash and taking oral probiotics may help keep the condition at bay. ‘Making a diagnosis isn’t always straightforward so visit your GP or gynaecologist,’ he adds.
Trichomoniasis is a sexually transmitted infection caused by parasite Trichomonas vaginalis, says Mr Pisal, and is usually spread by having intercourse without using a condom and also sharing of sex toys.
‘Frothy green vaginal discharge with an unpleasant odour is typical of trichomoniasis,’ he says. ‘It can cause itching, irritation and painful sex. If it affects the urethra there may be associated pain when passing urine.’
✔️ Yeast infection
A yeast infection – or thrush as it is often known – is a common vaginal infection caused by an overgrowth of yeasts that usually live in the bowel, says Mr Pisal, most often Candida albicans, a yeast-like fungus. ‘Thrush occurs when the good bacteria in the vagina can't keep the fungus under control, creating a suitable environment for the overgrowth of this fungus,’ he says. It causes symptoms of itching and irritation with a thick, white, curd-like discharge.
Thrush is more likely to occur in pregnancy, while taking an oral contraceptive pill or antibiotics, or due to stress or uncontrolled diabetes, Mr Pisal continues. ‘There has been some association with low iron and vitamin D levels,’ he says. ‘Antibiotics can cause imbalance of the good bacteria in the vagina, thereby promoting overgrowth of the yeast – causing thrush.’
Chlamydia is among the most common sexually transmitted infections in the UK, and if left untreated, it can cause fertility issues. ‘Often chlamydia presents with no symptoms but in some cases there is discharge and irregular bleeding,’ says Mr Pisal. ‘Symptoms can increase with severity of the disease to include abdominal pain, fever and abscesses in the fallopian tube or ovary.’ If you're in any doubt, call your local sexual health clinic and get yourself tested as soon as possible.
✔️ Pelvic inflammatory disease (PID)
When an infection is not diagnosed and treated promptly, it can spread to the fallopian tubes and the pelvis which can lead to pelvic inflammatory disease (PID). PID is an infection of the female upper genital tract, and can lead to blocked fallopian tubes and infertility.
‘PID is often characterised by severe pelvic pain, raised temperature and an increase in vaginal discharge, which may have a fishy smell,’ says Mr Pisal. ‘Admission to the hospital and intravenous antibiotics are sometimes needed.’
✔️ Human papillomavirus (HPV)
HPV is the name given to a group of viruses that affect your skin and the moist membranes lining the body, says Mr Pisal. It’s extremely common – so common, it’s impossible to avoid unless you don’t have sex at all. Certain strains of the virus can cause cervical cancer, though this takes a very long time.
‘Early diagnosis through regular screening offers the best chance of stopping any irregularities in their tracks,’ he says. ‘If you have regular cervical screenings every three years, the abnormality will be detected before it becomes anything serious.’
HPV can cause genital warts and can affect the vaginal mucosa. While there are often no signs of early cervical cancer, there may be an increase in vaginal discharge, which may be pale, watery, pink, brown, bloody or unpleasant-smelling.
How much vaginal discharge is normal?
When it comes to discharge, there is no normal amount. Every woman is different, and the amounts will often fluctuate. ‘The exact nature of the fluid which comes out of the vagina will vary during the monthly cycle, and the amount will vary from woman-to-woman, in the same way as periods themselves will be variably heavy,’ explains Dr Morton.
If you experience an unusual amount of discharge, it may be a warning sign. ‘The vagina is self-cleaning, so sometimes vaginal discharge could simply be telling you to stop messing around with it!’ says Dr Walsh.
‘The vaginal pH balance is very delicate, and the normal pH is between 3.8-4.5, making it moderately acidic. However, we can disrupt this balance by using perfumed soaps washes or wipes down there, or douching,’ she explains. ‘These products or excessive washing can disrupt the vaginal pH, making it more alkaline and easier for ‘bad’ bacteria to grow, causing abnormal discharge. This is what happens with BV for example.’
When to be concerned about vaginal discharge
The colour of healthy discharge is usually clear, or milky white. If the colour, smell, or consistency of your discharge is different to usual, and especially if you also have vaginal itching, burning, pelvic pain or a high temperature, you could be dealing with an infection or other condition, so get checked out by a medical professional.
‘You should be concerned if it is smelly, itchy, sore or blood-stained,’ says Dr Morton. ‘On top of the physiological normal discharge there may be abnormal discharge which may be causing itching or soreness or have an unpleasant smell. Discharge should not be stained with blood, except mid-cycle, when there may be a tinge of blood in the ovulation mucus.’
If you notice any change from your ‘normal’ pattern – for example, a sudden increase in discharge that continues for a number of weeks, you should seek medical attention promptly, advises Mr Pisal. ‘This can be due to infections or retained tampon,’ he says. Meanwhile, an excessive amount of discharge ‘can be caused by some common and benign conditions, such as cervical polyps and cervical ectropion,’ he adds.
What to expect at a doctor’s appointment
When you see your doctor for abnormal vaginal discharge, they’ll likely conduct a physical exam. You can also expect to be asked questions about your symptoms, menstrual cycle, and recent sexual activity.
‘The examination may include a feel of your tummy, then look at your vulva and vagina,’ says Dr Walsh. ‘The doctor or nurse will have a look at your vulva to see if there are any rashes, or sores, and then use a speculum to examine the vaginal walls, look at the discharge, look at the cervix (the neck of the womb) and are likely to take swabs too. These swabs will be sent to the lab for testing to see whether any infection is present.’
The examination is usually quick and shouldn’t be painful. ‘You will be offered a chaperone, and the health professionals will support you through the examination, so if you’re feeling anxious, let them know,’ adds Dr Walsh.
What if you have an STI or infection?
If your discharge is typical of a particular infection, your doctor or health advisor may tell you there and then what the infection is and give treatment, explains Dr Walsh. ‘For example, with vaginal thrush, it has very typical signs and symptoms, so they may give you treatment for this if that’s the diagnosis.
Other infections, such as herpes, may be diagnosed on taking a history and carrying out an examination.’
Where the doctor can’t immediately diagnose the problem, they may run further tests – for example, they may take some cell samples from your cervix to check for HPV, or examine your discharge under a microscope to determine the cause of the infection.
If this occurs, they will likely send the swabs for testing and let you know as soon as they have the results, as well as letting you know if you may need any treatment. If the tests are taken at your GP surgery they may refer you to a sexual health clinic for treatment and follow up.
Further help and support
If you are at all concerned about vaginal discharge, it's worth getting checked out. Try one of the following resources:
Ask your GP for advice.
Find a sexual health clinic near you.
Try Brook's Find a Service tool
Call the national sexual health line 0300 123 7123.
Call Worth Talking About on 0300 123 2930 (for under-18s).
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