Vaginal discharge is the variable amounts of secretions from the glands in the vagina and cervix. A small amount of vaginal discharge, usually clear or whitish in color, with a mild odor or no smell at all is considered as normal in most women, especially in women of childbearing age. Underlying pathology may give rise to abnormal vaginal discharge which will present as copious discharge with :
- vaginal itching (itchy vagina)
- offensive smelling discharge
- change in color or texture of the discharge from the norm
Normal Vaginal Discharge
Normal vaginal discharge consists of dead, cast-off, vaginal skin cells, bacteria and secretions from the cervix and vaginal walls. Many types of bacteria are normally found in the vaginal discharge of a healthy woman, the most important of which is the Lactobacilli spp. Usually, from the time of puberty till menopause, the vaginal environment is kept acidic (pH 3.8 to 4.5) by the production of lactic acid by the cells in the vaginal epithelium. This favors the growth of Lactobacilli which further help to keep the environment acidic. The acidic environment discourages growth of bacteria and yeasts and acts as a barrier to infection traveling inside through the vulva and vagina into the cervix and uterus.
Vaginal secretion is necessary to keep the vagina lubricated and it also helps to keep the vagina clean by carrying away the exfoliated vaginal cells. Normal vaginal secretions may be clear or cloudy, thin or sticky, and usually odorless but sometimes with a mild although not offensive smell. The discharge may vary in appearance during different phases of the menstrual cycle.
Abnormal Vaginal Discharge
Certain factors tend to make the vagina alkaline, such as menstrual discharge, vaginal secretions during sexual excitement, male ejaculate, vaginal douches and infected cervical mucus. Under these circumstances the vagina is most likely to get infected.
An abnormal vaginal discharge may be excessive in amount or thick and curd-like or with a cottage cheese appearance. The color may be yellow, green, brown or blood stained. It may have a fishy odor or other offensive smell and is likely to be associated with vulval or vaginal irritation or itching, redness, swelling or other symptoms.
Abnormal vaginal discharge may occur due to :
- Vaginal infection
- Pelvic inflammatory disease (PID)
- Sexually transmitted diseases (STDs)
- Genital warts
- Atrophic vaginitis
- Cancer of vagina or cervix
- Radiation therapy (radiotherapy)
- Vesico-vaginal and recto-vaginal fistula
Types of Abnormal Vaginal Discharge
Excessive Vaginal Discharge
The amount of normal vaginal discharge may increase in certain situations.
- At the time of ovulation
- Pregnancy, as a result of increased estrogen secretion and greater blood flow to the vaginal area. As a woman approaches labor, the mucus plug blocking the cervical opening is released, which may cause further increase in the amount of discharge. Leakage of amniotic fluid may also present as a watery vaginal discharge.
- Sexual excitement
- Exposure to semen
- Emotional stress
- Certain drugs, including oral contraceptives.
- Chemicals that may enter the vagina including bubble bath foam, soaps and detergents. Tampons may also be a cause of excessive discharge.
- Regular vaginal douching
Change in Odor
A foul smelling vaginal discharge may occur due to :
- Bacterial vaginosis. This is an infection caused by an overgrowth of Gardnerella vaginalis, a type of bacteria which can normally be found in the vagina in small numbers. A typical foul, fishy odor may be present, especially after intercourse. This is the most common cause of vaginal discharge.
- A foul odor may also suggest trichomoniasis, an infection caused by the protozoa Trichomonas vaginalis. This type of infection is usually transmitted sexually.
- Sexually transmitted diseases (STDs) such as chlamydia and gonorrhea.
- Inadequate personal hygiene.
- A foreign body in the vagina, most often a forgotten tampon.
- Septic abortion.
- Vesico-vaginal or recto-vaginal fistula where there is urine or stool leaking into the vagina.
- Cancer of cervix or vagina.
Change in Color
- A thin grayish or whitish discharge, with or without a foul odor, with burning, itching and redness of the vaginal area may indicate bacterial vaginosis.
- A thick, white discharge, with cottage cheese appearance, usually accompanied by vaginal itching or burning is most likely to be due to an yeast (fungal) infection caused by Candida albicans. The discharge is usually odorless. This is the second most common cause of vaginal discharge.
- A thin, bubbly, yellowish green or grey discharge with a fishy odor may may be a sign of trichomoniasis.
- A yellowish vaginal discharge with itching and burning sensation during urination may be a symptom of chlamydia or gonorrhea.
- A blood stained discharge from the vagina in early pregnancy may indicate a miscarriage or ectopic pregnancy, and in late pregnancy it could be due to placenta previa or abruptio placentae.