Vaginal Discharge: What’s ‘Normal’, According To A Gynaecologist

Understandably, vaginal discharge isn’t a subject we relish discussing, even though it’s completely normal. That said, if something seems off to you, it’s crucial to know what constitutes a red flag – be it thrush or something more serious. To that end, we asked Dr Shazia Malik, consultant gynaecologist and obstetrician at London’s Portland Hospital, to answer some of the key questions…
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Firstly, what exactly is discharge?

“Vaginal discharge is a fluid secreted from the small glands in the vagina and cervix to help remove old cells and keep the reproductive tract clean and healthy. It keeps the vagina moist and helps to protect against infections. The amount of vaginal discharge produced can vary day to day or even depend on where someone is in their menstrual cycle or reproductive life.”

What are the different types of discharge?

“There are many different types of vaginal discharge which are categorised based on their colour and consistency. White discharge, especially at the beginning or end of your menstrual cycle, is completely normal and is a result of your vagina self-cleaning itself. White discharge that is clear and watery can occur at any time of the month and may increase after taking part in exercise, whereas discharge that is clear and stretchy is usually a sign that you are ovulating. Brown or bloody discharge can also be normal if it occurs during or straight after your menstrual cycle. Spotting, which is a small amount of bleeding between periods, can also occur for many reasons, including if you have recently changed birth control, have an infection or are in the early stages of pregnancy.

“In rare cases, bloody discharge can indicate an underlying condition such as endometrial or cervical cancer, fibroids, polyps or other abnormal growths. It’s always important to keep up to date with your smear tests to check for any cervical abnormalities early in their development and to seek medical advice if any unusual bleeding or discharge persists. Yellow or green discharge that is thick, chunky, and accompanied by an unpleasant odour is not normal and should be checked out by a medical professional as it could indicate a sexually transmitted infection such as trichomoniasis.”

Other signs that you should get a check-up are if:

  • It resembles cottage cheese in colour and consistency

  • It looks foamy or frothy

  • It has a strong smell of fish, yeast, or another odour

  • You develop pelvic pain, bleeding, or pain with intercourse

  • ​It’s associated with a fever

The amount of vaginal discharge produced can vary day to day or even depend on where someone is in their menstrual cycle or reproductive life.


What is ‘normal’ vaginal discharge to you?

“Normal vaginal discharge is usually clear or milky and may have a subtle musky scent that is not unpleasant smelling. The amount of discharge you produce varies from person to person, however, it’s important to keep account of what is normal for you as significantly more than usual could indicate an infection.” 

Does it change during each stage of your cycle?

“The amount of discharge you produce each month will change depending on where you are in your cycle. After you finish your period, you may not have much discharge because you are not producing as much cervical mucus. This does not mean that you are not producing any discharge, however, there will be significantly less compared to other times in the month. As your cycle progresses and your body starts to prepare for ovulation, your oestrogen levels will begin to increase. This can cause you to produce slightly more discharge that is often white, clear, or cloudy looking. As you get closer to ovulation, your discharge may become much thinner as you are expelling more cervical mucus. This mucus is produced to help the sperm travel up to the cervix to help you fall pregnant. It’s quite common for the amount of discharge to decrease after you go through the menopause and stop having cycles – this is because your levels of Oestrogen hormone drop and can be a cause of vaginal dryness.”

What about STIs – how can they affect your discharge?        

“Not all STIs will produce symptoms, so it’s important to get tested regularly if you’re seeing a new partner, and especially if you are not using condoms. The three STIs that most commonly affect vaginal discharge include trichomoniasis, chlamydia and gonorrhoea. Trichomoniasis can cause your discharge to turn a yellow-greenish colour which may also be frothy and have a distinct fishy odour. You may also experience more discharge than usual, especially as you approach your menstrual period. Chlamydia will often present no symptoms; however, it may cause your discharge to turn yellow and have a strong odour. Painful urination is often an accompanying symptom of chlamydia, so it’s important to go and see your GP if you suspect something may be wrong. Gonorrhoea can also turn your discharge yellow, and it may be thinner and much more watery than usual. Symptoms may also be accompanied by breast tenderness, painful urination and in-between bleeding.”

If you go to a sexual health clinic, what can you expect?

“It’s recommended to visit a sexual health clinic if you are experiencing any unusual symptoms or if you have recently started a sexual relationship with a new partner. I advise my patients that both partners should get a sexual health screen done at the beginning of a relationship before they are sexually active, and especially before considering not using condoms. They will ask you a bit about your most recent sexual activity, whether you are worried about any symptoms, and your sexual partners. They will also ask you about your menstrual cycle and if you use any contraception.” 

Not all STIs will produce symptoms, so it’s important to get tested regularly if you’re seeing a new partner, and especially if you are not using condoms. The three STIs that most commonly affect vaginal discharge include trichomoniasis, chlamydia and gonorrhoea.


When should you see a doctor?

“If your discharge has a different texture, colour or smell to what is normal for you, then you should see your doctor as soon as possible. Symptoms including unexplained weight loss, pain in your abdomen, increased urination and a fever could also indicate an underlying problem, as could bleeding between periods or after sex, or painful sex so it is important to see your doctor as soon as possible.”

What is bacterial vaginosis?

“Bacterial vaginosis is a fairly common bacterial infection in women that causes increased vaginal discharge with a strong odour. It is not an STI, although it is more common in women who are sexually active (including those in same sex relationships). The infection often occurs when there is an imbalance of the good and harmful bacteria that are normally found in the vagina. While bacterial vaginosis is not a sexually transmitted infection, it can increase your risk of catching an STI such as chlamydia. Treatment usually consists of antibiotic tablets or creams that are prescribed by your GP or sexual health clinic. It’s also important to avoid baths with scented products or oils, and wash the vulva with warm water, and not to practice vaginal douching. I advise my patients to wear cotton underwear and to take probiotic capsules regularly.”

So, is douching harmful?

“Douching is the act of washing or cleaning the inside of the vagina with water or other mixtures of fluids. I wouldn’t recommend douching as it can change the necessary balance of vaginal bacteria as well as the vagina’s natural acidity. This can definitely increase your chances of getting infections, and most importantly it really isn’t necessary as your vagina is designed to be a self-cleaning organ.” 

Talk to us about thrush… What is it?

“Thrush is a fungal infection that can grow in your mouth, throat and other intimate parts of your body. The most common symptoms of vaginal thrush in women include itching and soreness around the entrance of the vagina, pain during sex, painful urination, and unusual vaginal discharge which is often described as looking like curd or cottage cheese. Some women find that they get a flare-up just before a period or at times of stress, so it helps to treat it preemptively if it’s a recurrent issue. Antifungal medicine is usually needed to treat thrush. This can be taken as an oral tablet, a vaginal tablet (pessary) or a topical cream to relieve the irritation. The infection should begin to clear up with seven to 14 days of starting treatment.”

Does yoghurt help or is that an old wives’ tale?

“Yoghurt is often recommended to help treat thrush because it contains helpful bacteria (lactobacilli) that may help to restore a healthy balance of yeast and bacteria in the vagina. Vaginal yeast infections are often caused by an overgrowth of the fungus, Candida, which normally lives outside of your body on your skin. Lactobacillus, the bacteria that is often found in yoghurt, releases hydrogen peroxide which kills Candida, helping to treat the infection quicker. The yoghurt is best applied topically to the vulva, or in the opening of the vagina. If preferred, you can consume it as part of your diet, however, this will not be as effective as applying the yoghurt as a cream. I often recommend using a clean tampon daily coated in fresh organic live plain yoghurt for six hours a day for a week. You must remember to remove it after six to eight hours though.”

Can contraception affect it?

“Taking the contraceptive pill can cause some people to experience an increase in vaginal discharge. This is because, in your natural cycle, there is a rise in the hormone, oestrogen, around day fourteen when you begin to ovulate. This causes an increase in vaginal discharge that can appear thick and stretchy. The combined pill contains two synthetic hormones – oestrogen and progesterone. When you take the pill, the levels of oestrogen in your blood increase, in a similar way to when you are ovulating, which tricks your body into thinking it needs to produce more discharge.”

Some people believe that if you see any vaginal discharge, then something must be wrong, however, this is not true. It’s normal and healthy to have vaginal secretions throughout the month which help to keep your vagina clean.

Does discharge change during pregnancy?

“One of the earliest signs that you could be pregnant is an increase in vaginal discharge. When you fall pregnant, you experience a surge in hormones and vaginal blood flow that can cause an increase in discharge. This discharge is created to help prevent infections as the cervix and vaginal walls soften. These changes to your discharge can occur as early as one to two weeks after conception. As your pregnancy progresses, the discharge will become more noticeable and may contain streaks of thick mucus with blood once you reach the early signs of labour.

What are some of the common misconceptions and myths about discharge?

“Some people believe that if you see any vaginal discharge, then something must be wrong, however, this is not true. It’s normal and healthy to have vaginal secretions throughout the month which help to keep your vagina clean. During your fertile period, you may also produce more lubricant to help the sperm reach the egg. It’s also quite normal to have increased discharge if you are on hormonal contraception or are pregnant – as long as it is not associated with any of the worrying signs discussed above. There is also a misconception that healthy vaginas do not smell, however, all genitals will have a light, natural odour. The vagina can also smell slightly stronger due to hormonal fluctuations, during pregnancy or after sex. The most important thing is to know is what is normal for you, so you can keep track of any abnormalities to discuss with your doctor.”

What’s the best way to clean your intimate area?         

“Simplicity is best when it comes to cleaning your intimate areas. Using plain and unperfumed soap to gently wash around the vulva should suffice and it’s always best to leave the vagina to clean itself with its natural vaginal secretions. In fact, it’s best to just use warm water around the vulva, but you can use soap to clean around the anus when you have opened your bowels. As our Mums say, remember to always wipe from front to back when you go to the toilet!”

What’s your take on intimate products and wipes? Are they helpful or not?

“I’d recommend against scented wipes and other products as the chemicals in these items can disrupt the vagina’s natural PH levels and balance of bacteria, leading to an infection. They can also aggravate any skin conditions such as eczema.”

How can you prevent irritations and infections?

“As stated above, the main ways to prevent irritations and infections is to avoid using scented sanitary wipes, pads, and tampons and to avoid partaking in any practices that could disrupt your body’s natural PH balance and bacteria such as douching. Avoiding hot baths, wearing loose cotton underwear, and wiping from front to back when using the bathroom will also all help to minimise your chances of infection. It’s also best not to wear any underwear at all at night when you are asleep, and wash your underwear at high temperatures separate from your other clothes.”

Is it helpful to track your discharge on an app? 

“Period tracking can be a useful tool to help you identify any changes to your menstrual cycle that could indicate a potential health issue. Apps such as clue help you identify unique patterns in your menstrual cycle as well as get to know your own body and work out when you are most likely to be fertile. But otherwise, I don’t think you need to monitor your discharge as well – just remember to seek help if you notice a change that doesn’t feel right.”

Dr Shazia Malik is a consultant gynaecologist and obstetrician at The Portland Hospital in Westminster. For more information, visit HCA Healthcare UK

 

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