Vaginal Discharge

You may assume that all vaginal discharge means infection, or that its colour and smell can identify the exact cause. Normal discharge varies with hormones, pregnancy and sexual activity. A new change may reflect bacterial vaginosis, thrush, a sexually transmitted infection, irritation, a retained object, tissue changes after menopause or another gynaecological condition. Symptoms and examination are more reliable than colour alone.

Vaginal discharge is usually normal Normal discharge helps keep the vagina moist and contributes to its protective environment. It is commonly clear or white, mucus like, non offensive, variable in amount, and different at different stages of the cycle. Most women and girls have vaginal discharge. Normal discharge changes with hormones The amount or consistency may change around ovulation, before a period, during pregnancy, with sexual arousal, while using hormonal contraception, during puberty, during breastfeeding, or around menopause. A change does not automatically mean infection. Compare the symptom with what is usual for you Possible abnormal changes include: A new strong or unpleasant smell. Grey, green, yellow or blood stained discharge. Markedly increased volume. Thick or frothy texture. Discharge accompanied by itch. Vulval soreness. Pain when passing urine. Pelvic pain. Bleeding after sex. Bleeding between periods These features guide assessment but do not determine one diagnosis. Bacterial vaginosis involves a change in vaginal bacteria Bacterial vaginosis, or BV, occurs when the usual balance of vaginal bacteria changes. A typical pattern may include thin discharge, white or grey colour, a noticeable fish like smell, and little or no itching. BV is not classified as a sexually transmitted infection, although sexual activity and changes in partners may influence the vaginal bacterial environment. The smell may become more noticeable after sex or during a period. Thrush commonly causes itching and soreness Vulvovaginal candidiasis, commonly called thrush, may cause marked itch, vulval soreness, burning, pain during sex, external pain when urine touches the skin, thick white discharge, and little or no strong smell. Discharge may be absent. Itch and irritation with non offensive discharge is a typical pattern. Not every itchy discharge is thrush. Repeated symptoms may instead reflect dermatitis, lichen sclerosus, herpes, BV, an STI, menopause related tissue change, diabetes, or another vulval condition. Seek assessment if treatment repeatedly fails, symptoms recur or the pattern differs from previous confirmed thrush. Chlamydia, gonorrhoea and trichomoniasis may cause discharge Chlamydia and gonorrhoea may cause increased vaginal discharge, bleeding between periods, bleeding after sex, pelvic pain, pain during sex, or pain when passing urine. Many infections cause no symptoms. Testing is the only reliable way to confirm them. A diagnosis does not establish when or from whom an infection was acquired, because some infections may remain unnoticed. Trichomoniasis may cause yellow green discharge, frothy discharge, strong smell, itch or soreness, pain when passing urine, or pain during sex. The appearance overlaps with other infections, so laboratory testing is required. Discharge with pelvic pain may indicate PID Pelvic inflammatory disease may cause lower abdominal or pelvic pain, abnormal discharge, deep pain during sex, bleeding after sex, bleeding between periods, fever, or urinary discomfort. PID requires prompt antibiotic treatment. Symptoms can be mild, and a negative cervical swab does not necessarily exclude infection higher in the reproductive tract. Call 999 or attend A&E when possible PID symptoms occur with severe or worsening pain, heavy bleeding, sudden intense lower abdominal pain, faintness, high fever, repeated vomiting, or marked illness. Pregnancy lowers the threshold for urgent hospital assessment. Cervical inflammation and vaginal irritation Cervicitis means inflammation of the cervix and may cause increased discharge, bleeding after sex, bleeding between periods, or pelvic discomfort. Possible causes include infection, irritation or cervical changes. A speculum examination and appropriate swabs may be needed. Vaginal irritation may not be infectious. Possible triggers include fragranced soap, bubble bath, vaginal deodorants, douching, laundry products, spermicides, lubricants, tight or damp clothing, sanitary products, or topical medicines. Symptoms may include burning, itching, redness, soreness, or watery discharge. Avoid placing antiseptics or cleansing products inside the vagina. The vagina does not need internal washing. A retained object can cause discharge Possible retained objects include a tampon, a contraceptive device placed in the vagina, or tissue or another foreign object. Possible features include strong offensive smell, brown or blood stained discharge, unexpected bleeding, discomfort, or fever if infection develops. Do not repeatedly insert tools or fingers when removal is difficult. Seek clinical help. Young children need careful assessment Before puberty, vaginal discharge may occur with local irritation, poor wiping or retained toilet tissue, threadworms, skin conditions, foreign body, infection, or less commonly, safeguarding concerns. A child with blood stained, offensive or persistent discharge needs medical assessment. Safeguarding should be considered carefully and professionally where the history or findings raise concern, without questioning the child repeatedly or assuming abuse from discharge alone. Pregnancy increases normal discharge Pregnancy often increases clear or milky discharge. This is usually not concerning when it has no unpleasant smell, does not cause significant itch, and is not accompanied by pain or bleeding. Contact your maternity team when discharge becomes foul smelling, green or yellow, blood stained, accompanied by pelvic pain, associated with urinary burning, or very watery and continuous. A sudden gush or persistent watery leakage later in pregnancy may represent ruptured membranes rather than ordinary discharge. Brown, pink or blood stained discharge may represent vaginal bleeding. Seek pregnancy advice rather than treating it as infection alone, particularly when it occurs with pain, dizziness or shoulder tip pain. Menopause changes the vaginal tissues Lower oestrogen can make vaginal tissues thinner, drier, less elastic, more easily irritated, and more prone to small tears. Possible symptoms include watery or pale discharge, dryness, burning, pain during sex, or light bleeding. Part of the genitourinary syndrome of menopause. A new discharge after menopause still requires assessment, particularly when blood stained, offensive or persistent. Urgent direct access ultrasound should be considered for people aged 55 or over with a first presentation of unexplained vaginal discharge or discharge associated with certain blood test or urinary findings, because endometrial disease may need exclusion. This does not mean cancer is the likely cause. It means the symptom deserves structured investigation. Cervical cancer can change discharge Possible cervical cancer symptoms include unusual vaginal bleeding, changes in discharge, pain during sex, or pelvic or lower abdominal pain. These symptoms have many benign causes. Do not wait for cervical screening when symptoms are present. Screening does not diagnose symptomatic disease. Vulval conditions can be mistaken for vaginal discharge Moisture, inflammation or weeping from the vulval skin may be interpreted as vaginal discharge. Look for external soreness, skin colour or texture change, cracks, ulcers, lumps, or persistent itch. A clinician may need to examine both the vulva and vagina. Do not diagnose by smell alone Descriptions such as "fishy", "yeasty" or "offensive" can guide testing, but smell is subjective and affected by menstrual blood, semen, sweat, urine, hygiene products, or retained material. Testing may be needed before treatment. Assessment and avoiding unnecessary treatment Your clinician may ask what is normal for you, when the change began, whether there is itch, soreness or pain, whether there is pelvic pain or bleeding, whether you could be pregnant. Whether you have recently used antibiotics, whether there is a new sexual partner, whether you are postmenopausal, whether you have used intravaginal products, and whether an object is possibly retained. Possible assessment includes external vulval examination, speculum examination, vaginal or cervical swabs, urine testing, pregnancy testing, STI testing, vaginal pH or microscopy, pelvic examination, or ultrasound in selected circumstances. Self collected sexual health samples may be available in some services. Using antifungal or antibiotic treatment without confirming the likely cause may delay the correct diagnosis, irritate tissues, cause side effects, alter vaginal bacteria, or contribute to antimicrobial resistance. A pharmacist may advise on a familiar, uncomplicated episode of thrush, but first, recurrent, atypical, pregnancy related or treatment resistant symptoms need clinical review. Some STIs require partner testing, partner treatment, temporary avoidance of sex, or repeat testing. BV and uncomplicated thrush do not routinely require the same partner management approach. Follow the advice for the confirmed condition rather than applying one rule to every discharge.

Vaginal discharge is assessed by comparing it with your usual pattern: has the amount, colour, consistency or smell changed, is there itch, soreness, pain, bleeding or urinary discomfort, is there pregnancy, menopause, recent antibiotics or a new sexual exposure, could infection have spread beyond the vagina, and is this a first unexplained discharge after menopause. The aim is to distinguish normal variation from local irritation, infection and upper pelvic disease.