Vaginal discharge
Discharge is not an illness and not a sign of poor hygiene. The vagina cleans itself, and the fluid made by its walls and by the neck of the womb carries…
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Medicines commonly prescribed for Vaginal discharge
For informational purposes only. Always consult a doctor before taking any medication.
Dosage form: ORAL SOLUTION/SUSPENSION, 125 mg metronidazole benzoateActive substance: metronidazoleManufacturer: Laboratorios Fidia Farmaceutica S.L.Prescription requiredDosage form: TABLET, 250 mgActive substance: azithromycinManufacturer: Teva Pharma S.L.U.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 200 MG/5 ML.Active substance: azithromycinManufacturer: Viatris Pharmaceuticals S.L.U.Prescription required
Discharge is not an illness and not a sign of poor hygiene. The vagina cleans itself, and the fluid made by its walls and by the neck of the womb carries dead cells and surplus microbes outwards. So the question is almost never whether there is discharge or not: every woman and girl has it once puberty has begun. What needs looking at is something else — what has changed: the smell, the colour, the consistency, the amount, and whether itching, pain or blood have appeared. The change is what matters, and it usually shows whether a doctor is needed and how soon.
What ordinary discharge is like and how it varies
Ordinary discharge is clear or milky white, has no strong smell, and causes no itching or stinging. On underwear it may dry to a yellowish mark: that is normal and not a sign of infection.
Across the cycle it changes in a predictable way, and knowing that rhythm saves a great deal of worry.
- Just after a period there is little discharge and it is on the thick side.
- Around the middle of the cycle, in the days of ovulation, it becomes noticeably heavier, clear, slippery and stretchy, rather like raw egg white. This is the commonest reason for alarm and at the same time the most normal version of all.
- In the second half of the cycle it thickens again, turns whiter and becomes less noticeable.
There is more discharge in pregnancy, with arousal, on hormonal contraception and with a coil, while breastfeeding, and in the teenage years while the cycle is still settling. The smell varies too: it is faint and individual, and it grows stronger by the end of the day, after exercise and during a period — which is likewise nothing out of the ordinary.
What should put you on alert
What needs weighing up is not the discharge itself but the change. See a doctor if any one of these appears:
- a strong or unpleasant smell, especially a fishy one;
- the colour turns grey, green or yellowish green, or it becomes frothy;
- itching, stinging, redness, swelling, pain on passing urine;
- pain low in the abdomen or deep pain during sex;
- blood outside a period, including bleeding after sex;
- sores, blisters or small cracks in the skin and lining;
- the amount has increased a great deal with no obvious reason;
- the discharge started after a new partner or after unprotected sex.
It is not worth deducing the cause from the colour: the same shades occur in different conditions, and infections often come in combination. A swab answers that question in a single visit, whereas putting in an antifungal pessary on your own when the problem is bacterial vaginosis simply loses time.
Bacterial vaginosis and thrush: how they differ
These are the two commonest reasons for discharge to change, and they work in quite different ways, although neither counts as a sexually transmitted infection.
Bacterial vaginosis is a shift among the vagina's own microbes: the helpful lactobacilli fall in number and the rest increase. The discharge is thin, uniform and greyish white; there is not much of it, but it carries an unmistakable fishy smell that becomes stronger after sex and during a period. There is usually no itching at all, and that is the main distinguishing feature. What brings it on is precisely the attempt to "wash out" the vagina, along with a new partner and smoking. It is treated with antibacterial pessaries, gel or tablets prescribed by a doctor; in pregnancy it must always be treated.
Thrush is an overgrowth of the candida fungus. The discharge is thick, white and lumpy, like cottage cheese or curdled milk, and has almost no smell. Instead there is marked itching, stinging, swelling and redness, pain during sex and sometimes on passing urine. It is commoner after a course of antibiotics, with poorly controlled diabetes, in pregnancy and when the immune system is weakened. It is treated with antifungal pessaries, cream or a tablet by mouth.
The short rule: smell without itching points to vaginosis; itching without smell points to thrush. It helps you get your bearings, but it does not replace a swab, especially if treatment has already been tried and either failed or everything came back straight away.
Sexually transmitted infections
These deserve a section of their own, because what is at stake here is more than discomfort. Chlamydia and gonorrhoea often run with no symptoms at all, or barely alter the discharge, while inflammation climbs towards the womb, the tubes and the ovaries. That is where chronic pelvic pain, ectopic pregnancy and difficulty conceiving come from, and the later treatment starts the more often it happens.
- Chlamydia is the commonest and the quietest. Sometimes the only sign is slightly more discharge and a little bleeding after sex.
- Gonorrhoea can give thick yellowish green discharge and pain on passing urine, but in women it too often goes unnoticed.
- Trichomoniasis gives yellowish green frothy discharge with a smell, itching and soreness.
- Genital herpes causes painful blisters and sores, sometimes with a flu-like feeling during the first episode.
If such an infection is confirmed, both partners are tested and treated — along with all partners from the preceding months — otherwise the infection comes back round in a circle. Sex is avoided until treatment is finished. It is worth being tested after every change of partner even when nothing is troubling you: a urine test or a swab is quick, and a condom lowers the risk without removing the need to check. A routine examination and a swab for "flora" do not pick up sexually transmitted infections — those need a separate test, and it is worth asking for it outright.
When you should be seen the same day
There are combinations where waiting for a convenient appointment is not an option.
- Discharge with blood, pain low in the abdomen and a fever together: that is how inflammation of the womb and the tubes shows itself, and without quick treatment it leaves consequences.
- Pus-like discharge with severe pain and a high fever, shivering and nausea.
- Any bleeding with pain in pregnancy, and any suspicion that the waters are leaking: a watery discharge that does not stop.
- Foul-smelling discharge after childbirth, a miscarriage, a termination or an operation on the pelvic organs.
- A forgotten tampon. After a few days it produces a very foul discharge. If you cannot get it out yourself, be seen the same day, and do not try to flush it out. A sudden high fever, a rash, vomiting or confusion while a tampon or cup is in place calls for an ambulance: this is a rare but dangerous complication.
Girls before puberty and the years after the menopause
At these two ages the rule is the opposite: there, discharge is not a normality to get used to but a reason to be examined.
In a girl who has not yet entered puberty there is little oestrogen and there should be no appreciable discharge. Any persistent discharge, all the more so with a smell, blood or itching, calls for examination. Most often it turns out to be irritation from soap and bubble baths, or bowel microbes carried across while wiping; less often a small object placed in the vagina, or threadworms. Examination is needed for another reason too: faced with discharge in a child, a doctor is obliged to consider possible abuse. This is done calmly and without assumptions about the family, but the step cannot be skipped.
After the menopause the lining becomes thinner and drier, and ordinary discharge nearly disappears. So its return, and all the more a discharge with blood or a pink tinge, always calls for examination, even if the blood amounted to a single drop. In most cases dryness and thinning of the lining are to blame, but cancer of the body of the womb can present in exactly this way, and it responds well when found early. There is nothing to wait for here.
Care that does not get in the way
Half of all consultations about discharge have nothing to do with infection and everything to do with efforts to get thoroughly clean.
Douching is harmful and should not be done in any form. Washing out the inside flushes away the lactobacilli that keep the environment in order, which is why bacterial vaginosis occurs more often after douching, not less. It can also carry microbes higher up, towards the neck and the cavity of the womb, and mute the signs of an infection, so that the diagnosis is made later.
Soap and "intimate gels" do more harm than good. They strip the protective film and shift the acidity, and from there the circle closes: dryness and irritation are taken for infection and the washing becomes more thorough still. Warm water once or twice a day, and on the outside only, is enough; if you would rather not do without a cleanser, use the plainest one, with no fragrance and no colouring. Deodorants, scented wipes and pads, sprays and powders for the area are not needed at all.
- Wear underwear made of natural fabrics and change it daily; sleep without it if you are prone to itching.
- Change tampons and pads often, and prefer a pad overnight.
- Do not wear panty liners continuously: it is damp and warm underneath them.
- Change the washing powder or the fabric conditioner if the irritation is recent.
- Wipe from front to back — a simple measure against carrying bowel microbes across.
- Do not buy antifungal pessaries "just in case" every time the discharge changes: in vaginosis and trichomoniasis they do nothing.
Online consultation
Discharge is an awkward thing to ask about, and because of that it gets carried for months or treated on the strength of something read online. An online appointment removes exactly that barrier. From your account a doctor can say what the picture resembles, whether you need to be seen the same day or can book without hurry, and which tests are worth doing from the outset so that you are not sent round in circles: a swab for flora, a separate test for sexually transmitted infections and, where relevant, a check of your blood sugar. They will go through results you already have and help you see why an earlier treatment failed, or why everything came back at once. They will also suggest how to raise testing with your partner — without that, treatment often turns out to be wasted.
This material is for information only and does not replace medical advice.
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