A certain amount of vaginal discharge (fluid that flows out the vaginal opening) other than the expected vaginal bleeding at menstruation is normal. The vaginal walls and uterine cervix contain glands that produce a small amount of fluid that helps to keep the vagina clean. This normal fluid is usually thin and clear or milky white and does not have an unpleasant smell. Vaginal discharge is thicker at specific times of the menstrual cycle (at the time of ovulation), during breastfeeding, or during sexual arousal. This temporary thickening of the vaginal discharge is normal and is not associated with the symptoms and signs of vaginal infection.
Symptoms or signs of vaginal infection or other more serious disorders include:
- an increase in the amount of vaginal discharge,
- an abnormal odor or consistency of the fluid, or
- pain, itching, or burning that accompanies vaginal discharge.
Vaginitis, including bacterial vaginitis or candidiasis, can lead to changes in the appearance of the discharge, which can appear:
- cloudy,
- bloody,
- white,
- yellow, or
- green, and
- may be bloody in some cases.
Other causes of vaginal discharge
- Atrophic Vaginitis
- Cervical Polyp
- Cervicitis
- Foreign Body (Forgotten Tampon)
- Hormonal Changes
- Overgrow normal bacteria in the vagina
- Chemicals found in detergents, softeners, ointments, creams, and contraceptive foams, which may irritate the skin around vagina
Kasper, D.L., et al., eds. Harrison's Principles of Internal Medicine, 19th Ed. United States: McGraw-Hill Education, 2015.
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Causes of Vaginal Discharge
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Bacterial Vaginosis
Bacterial vaginosis is an abnormal vaginal condition with signs and symptoms of vaginal discharge, vaginal odor, and vaginal pain. Bacterial vaginosis results from an overgrowth of normal bacteria in the vagina. Although it may cause some disturbing symptoms (discharge and odor), it is not dangerous and cannot be passed by sex. Diagnosis becomes important to exclude serious infections like gonorrhea and Chlamydia. Many treatment options are available such as oral antibiotics and vaginal gels.
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Cervical Cancer (Cancer of the Cervix)
Cervical cancer is cancer of the entrance to the womb (uterus). Regular pelvic exams and Pap testing can detect precancerous changes in the cervix. Precancerous changes in the cervix may be treated with cryosurgery, cauterization, or laser surgery. The most common symptom of cancer of the cervix is abnormal bleeding.
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Chlamydia in Women
Chlamydia is the most common sexually transmitted disease in the U.S. Signs and symptoms of chlamydia, a bacterial infection, include vaginal discharge, abdominal pain, burning with urination, blood in the urine, and feelings of urinary urgency and frequency. Untreated chlamydia can cause pelvic inflammatory disease (PID), increased risk of ectopic pregnancy, and infertility. Chlamydia is diagnosed with a culture or by identification of the genetic material of the bacteria. Treatment of chlamydia consists of a course of antibiotics.
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Early Pregnancy Symptoms and Signs
Pregnancy symptoms can vary from woman to woman, and not all women experience the same symptoms. When women do experience pregnancy symptoms they may include symptoms include missed menstrual period, mood changes, headaches, lower back pain, fatigue, nausea, breast tenderness, and heartburn. Signs and symptoms in late pregnancy include leg swelling and shortness of breath. Options for relief of pregnancy symptoms include exercise, diet, and other lifestyle changes.
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Genital Warts (HPV) Infection in Women
Genital warts is a sexually transmitted infection (STI, STD) caused by the human papillomavirus (HPV). It is the most common STD in the US. The warts can appear anywhere on the skin where sexual contact has occurred. The warts look like raised, flesh-colored lumps or bumps that have a cauliflower-like appearance. Signs and symptoms of genital warts in women include vaginal, vulva, or groin pain, itching, and burning where the wart(s) is. Treatment can remove warts or lesions, but it does not prevent spread of the virus, and the warts usually grow back. Removing genital warts does not prevent the infection from spreading elsewhere on the body. There is no cure for genital warts, and there is no vaccine to prevent them; however, there is a vaccine to prevent infection from four common types of HPV. Gardasil vaccine available for female adolescents and teens to prevent HPV infection and cervical cancer.
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Gonorrhea In Women
Gonorrhea is a bacterial infection transmitted during sexual contact. In women, symptoms include a yellow vaginal discharge, burning or frequent urination, and redness, swelling, burning and itching of the vaginal area. Gonorrhea can be treated with injectable (penicillin) or oral medications.
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Is Chlamydia Contagious?
Chlamydia is a sexually transmitted disease (STD) that is contagious. Chlaymida is spread through sexual contact. (You cannot get chlamyidia from kissing or sharing utensils or drinks.) Chlamydia is the most common STD in the U.S. The incubation period for chlamydia ranges from days to months, and the contagious period ends seven days after patients begin treatment. Chlamydia signs and symptoms may include painful urination, rectal irritation (proctitis), eye infections, and infertility. Women can also develop chronic pelvic pain, salpingitis, and endometritis.
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Pelvic Inflammatory Disease (PID)
Pelvic inflammatory disease (PID) is the most common and serious complication of sexually transmitted diseases (STDs), aside from AIDS, among women. The signs and symptoms of pelvic inflammatory disease include: fever, vaginal discharge with a foul odor, abdominal pain, including pain during intercourse, and irregular vaginal bleeding. Pelvic inflammatory disease can scar the Fallopian tubes, ovaries, and related structures and lead to ectopic pregnancies, infertility, chronic pelvic pain, and other serious consequences. Pelvic inflammatory disease treatment includes several types of antibiotics.
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Pinworms (Infection in Children and Adults, Enterobiasis)
Pinworm infection is an intestinal infection caused by a pinworm, seatworm, or threadworm. Female pinworms leave the intestine through the ankus and deposit eggs on the skin around the anus while a person is asleep. Pinworm infection is the most common worm infection in the U.S. Symptoms include anal itching or vaginal itching. Pinworm infection is generally spread by inadequate handwashing from infected persons. Treatment is effective after a diagnosis is made with a pinworm test.
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Sexually Transmitted Diseases in Women (STDs)
Sexually transmitted diseases (STDs) are among the most common infectious diseases in the United States. STDs can be spread through any type of sexual activity involving the sex organs, the anus or mouth, or through contact with blood during sexual activity. Examples of STDs include, chancroid, chlamydia, gonorrhea, granuloma inguinale, lymphogranuloma venereum, syphilis, genital herpes, genital warts, trichomoniasis, pubic lice (crabs), and scabies. Treatment is generally with antibiotics; however, some STDs that go untreated can lead to death.
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Trichomoniasis
Trichomoniasis is a sexually transmitted disease (STD) caused by a parasite passed from person to person. Trichomoniasis can be picked up from contact with damp, moist objects like towels, wet clothing, or toilet seat. Symptoms include yellow, green, or gray vaginal discharge with a strong odor, painful intercourse or urination, genital irritation and itching, and lower abdominal pain. Antibiotics are the only treatment to cure trichomoniasis.
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Uterine Cancer
Though uterine cancer's cause is unknown, there are many factors that will put a woman at risk, including being over age 50, having endometrial hyperplasia, using hormone replacement therapy, obesity, using tamoxifen, being Caucasian, and/or having colorectal cancer. Symptoms and signs of cancer of the uterus (endometrial cancer) include abnormal vaginal bleeding, painful urination, painful intercourse, and pelvic pain. Treatment depends on staging and may include radiation therapy or hormone therapy.
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Vaginal Bleeding
Normal vaginal bleeding (menorrhea) occurs through the process of menstruation. Abnormal vaginal bleeding in women who are ovulating regularly most commonly involves excessive, frequent, irregular, or decreased bleeding. Causes of abnormal may arise from a variety of conditions that may include, uterine fibroids, IUDs, hypothyroidism, hyperthyroidism, lupus, STDs, pelvic inflammatory disease, emotional stress, anorexia nervosa, polycystic ovary syndrome (PCOS), cancers, early pregnancy.
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Vaginal Cancer
Vaginal cancer is fairly uncommon. There are two types of vaginal cancer: squamous cell carcinoma and adenocarcinoma. Risk factors include being 60 or older, exposure to DES while in the womb, HPV infection, and having a history of abnormal cervical cells. Painful intercourse, pelvic pain, vaginal lumps, and abnormal vaginal bleeding or discharge are all symptoms of vaginal cancer. Treatment depends upon the stage of the vaginal cancer and may involve surgery, radiation therapy, chemotherapy, and the use of radiosensitizers.
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Vaginal Yeast Infection (in Women and Men)
Vaginal yeast infections in women are caused by an organism called Candida albicans. Symptoms of a vaginal yeast infection include vaginal pain with urination, vaginal discharge, odor, and itching. Treatment is generally OTC medications. A man can contract a yeast infection from his female sexual partner. Symptoms of a yeast infection in men include penile itching. Treatment is with oral or topical medication.
Examples of Medications for Vaginal Discharge
- azithromycin (Zithromax, Zithromax Z-Pak, Zithromax Tri-Pak, Zmax)
- clindamycin vaginal cream (Cleocin, Clindesse)
- Diflucan (fluconazole)
- metronidazole (Flagyl, Flagyl ER) Antibiotic
- miconazole, Monistat, M-Zole, Micatin
- nystatin/metronidazole-vaginal cream
- nystatin/metronidazole-vaginal insert
- terconazole (Terazol, Zazole)
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