Vaginal Discharge – When You Should Worry

All women have variable amounts of vaginal discharge, and many, at some point in their life, will complain of what they perceive to be an abnormal discharge which is often just normal.

The majority will have at least one episode of an infective vaginal discharge, and it is essential for women to distinguish normal from abnormal discharge.

What is normal vaginal discharge?

Barring a few instances, which we will discuss later in this blog, vaginal secretion or discharge is an entirely normal and continuous process containing water, nutrients, electrolytes, and antibodies. It helps to keep the vagina moist, clean, and infection free.

Normal vaginal discharge will look different at different points of your menstrual cycle, but it is always non-offensive, white, or clear and is not associated with irritation or itchiness.

Vaginal discharge is completely normal, and you should not worry as long as:

• It is not foul-smelling or does not have a strong unpleasant odor
• Is white in color or clear-looking,
• There may be a slight yellow tint at times,
• Can be both thick or thin in consistency (changes with your cycles), is not associated with itchiness or irritation.

Assuming a 28-day menstrual cycle, this is how your vaginal secretion or discharge changes:

• Days 1-4 after your period ends: Dry or minimal sticky discharge, which can be white or yellow-tinged.
• Days 4-6: Sticky, minimal, and white.
• Days 7-9: Creamy, white, thick, and cloudy.
• Days 10-14: Resembles raw egg white. Stretchy, slippery, and very wet.
• Says 14-28: Dry or minimal discharge till menstruation starts.

*At times, just after the end of your period or 2-3 days before it, you might experience minimal brownish or reddish discharge.

*And remember, with a normal vaginal discharge, there is never, at any point, a strong or foul-smelling odor; there is also no irritation, itching, or redness locally.

How do I know if my vaginal discharge is abnormal?

*Each person’s experience with their vaginal discharge is different, with some having heavy or some having light discharge. One of the signs of an abnormal discharge may be significant changes from your usual patterns.

Possible changes to look out for:

1. Unpleasant, offensive odor – particularly fishy smell.
2. Changes in color – green, yellow, pink, brown.
3. Changes in texture – cottage cheese-like, frothy.
4. Vaginal itching, redness, rashes, eruptions, or swelling.
   Other symptoms to look out for along with the discharge:
5. Pain during coitus.
6. Abnormal bleeding during coitus.
7. Pain or burning sensation during urination.
8. Lower abdomen pain.
9. Fever.

What causes an abnormal vaginal discharge?

Causes of abnormal vaginal discharge can broadly be divided into:

• Non-sexually transmitted infections,
• Sexually transmitted infections,
• Other causes.

Non-sexually transmitted infections are the most common cause and include:

• Thrush: caused by an overgrowth of yeast (Candida albicans) that normally lives in the vagina and the bowel. Discharge is thick, cottage cheese consistency, and generally does not smell. It tends to be very itchy.
• Bacterial vaginosis: Caused by an imbalance of the normal bacteria in the vagina. Discharge is often grey, thin, and watery with a strong, foul odor that is described typically as ‘fishy’ smelling. Itching may be minimal.

Sexually transmissible infections (STIs)

Chlamydia and gonorrhea: The infection is often asymptomatic, esp in females. It is often associated with burning or pain during urination and greenish or yellowish discharge or even white, thick pus-like discharge. It can be associated with lower abdomen pain and pain during coitus.

Genital herpes: Most will not have any or only mild symptoms. The discharge is thick and foul-smelling. It is often associated with intense itching and pain or burning during urination.

Trichomoniasis – This can also spread through sharing personal items like bathing suits or towels. Many may be asymptomatic. Discharge is yellow, green, or frothy with an unpleasant odor. Pain, redness, and itch around the vagina and when urinating or having sex are also common.

Other causes include:

• Cervical or vaginal cancer – thin watery discharge, often blood-stained. Commonly presents as abnormal bleeding, like after coitus or post-menopause.
• Foreign bodies, e.g., retained tampons.
• Prolonged use of certain medications like steroids and antibiotics.
• Use of birth control pills.
• Diabetes.
• Perfumed soaps and lotions.
• Douching.

*Ideally, a medical professional should evaluate any abnormal discharge instead of being self-managed by over-the-counter (OTC) medicines or home treatment. The following, however, should always undergo an evaluation in the event of a vaginal discharge:

1. Girls under the age of 10.
2. New discharge in post-menopausal women.
3. Pregnant women with a change in the nature of discharge (pregnant women naturally have a lot thicker discharge than non-pregnant).
4. Change in vaginal secretion with a new partner, or your current partner is also with a new person.
5. Discharge is associated with fever, pelvic pain, and pain or bleeding during coitus.

Takeaway

• Vaginal discharge is a normal phenomenon, and it is essential to know when it becomes abnormal, indicating a disease process.
• The characteristics of normal discharge change with your menstrual cycle.
• Abnormal discharge is marked by a foul smell, itching, and color changes (yellow, grey, green, etc.), but there might be no apparent discharge at times.
• All cases should be evaluated by a medical professional.