A women’s health expert explains common infections and how to keep your vagina healthy.
“Is my discharge normal?” This is a common concern for most women and a question I am asked often in the course of my day. When it comes to vaginal discharge, it is important (and comforting) to understand what normal discharge looks like, how to identify common infections, and when to seek medical treatment.
A women’s vagina makes discharge that ranges from clear and watery to cloudy and sticky depending on the time of the month. Normal discharge does not have an odor, and it shouldn’t itch or cause irritation. The amount can vary. Factors affecting discharge include pregnancy, age, menopausal status, and birth control like oral contraceptive pills or the IUD. Vaginal discharge is a healthy bodily function. It is how the vagina cleans and protects itself.
Abnormal discharge can be a sign of infection or suboptimal vaginal health. The healthy vagina is a balanced “ecosystem” with good bacteria called lactobacilli that create a protective environment. Abnormal discharge can happen when this ecosystem gets out of balance. The amount of good bacteria decreases and is replaced by unfriendly bacteria. This imbalance can lead to common vaginal infections.
What causes vaginal imbalance?
Anything that disrupts the vaginal ecosystem: douching, over washing, sex, medications, prolonged or irregular menstrual bleeding. Other causes include changes in hormones during pregnancy, breastfeeding and menopause. Smoking, diet and chronic diseases such as diabetes also may affect vaginal health.
Abnormal vaginal discharge can also be caused by sexually transmitted infections. Rarely, vaginal discharge can be a sign of something more serious like cervical cancer. That’s why it is so important to stay up to date on your pap smears. Current guidelines recommend a pap smear every 3 years starting at age 21; and a pap plus co-testing for the human papilloma virus every 5 years between ages 30-65.
What are the signs of a vaginal infection?
You might suspect a vaginal infection if:
- Your discharge is thick and clumpy, or unusually thin and runny.
- The color is grey, yellow or green.
- It has a foul smell.
- Your vulva or vagina is itchy, irritated or raw.
- Sex is painful.
Common vaginal infections
Bacterial vaginosis: This is the most common vaginal infection. It produces a fishy odor and increased thin white to grey discharge. It sometimes causes mild itching or burning. Odor is usually worse after sex or after menses. Though not considered a sexually transmitted infection, women with new sex partners are at greater risk of developing this infection.
Yeast vaginitis: The classic sign of yeast infection is a thick “cottage cheese” discharge, but this is not always present. This infection usually causes intense itching, but can also burn or hurt. There is no odor or you may notice a slight sweet odor (like baking bread).
Aerobic vaginitis: This vaginal infection is similar to bacterial vaginosis but caused by different bacteria. It is less common and often under-diagnosed. Signs of this infection include profuse yellow discharge, vaginal burning and irritation, and a foul non-fishy odor.
Trichomonisis: This sexually transmitted infection causes a yellow-greenish discharge that is usually frothy in consistency. You may notice a fishy odor and itching, burning or pain with urination or intercourse.
Atrophic vaginitis: After menopause, the ovaries no longer make estrogen. Vaginal tissue may become thin, dry and fragile. Estrogen plays a key role in promoting lactobacilli (the good bacteria). Without estrogen, the vagina loses its ability to protect itself. Bacteria that normally lives around the rectum may colonize and grow in the vagina or urethra. This type of vaginitis may cause a yellow discharge, vaginal burning and itching, pain with intercourse and increased risk for bladder infections.
Chlamydia and gonorrhea: These sexually transmitted infections can cause yellow discharge and pain with intercourse, but sometimes there are no symptoms. They are technically infections of the cervix, not vaginal infections. The U.S. Centers for Disease Control and Prevention recommends yearly screening for all women under the age of 25 and with any new sexual partner.
How can I keep my vagina healthy?
- Don’t douche. Douching washes away the vagina’s natural protection and may contain chemicals that irritate the vaginal tissue.
- Use water and gentle cleansing with fingertips to wash the vulva. There is no need for harsh soaps or perfumes in this area.
- Always use condoms with new or untested sex partners.
- Don’t smoke.
- Eat a balanced diet, get adequate sleep and manage stress to promote a healthy immune system.
I have symptoms….now what?
If you suspect yeast, it is reasonable to try an over-the-counter cream like miconazole first. If symptoms don’t resolve within one week, contact your healthcare provider.
For other symptoms, it’s best to make an appointment for evaluation. Untreated infections can lead to pelvic inflammatory infections, and complications in pregnancy including miscarriage and preterm birth. Treatment consists of antibiotic or antifungal vaginal creams, gels or oral medication. In the case of atrophic vaginitis, topical estrogen may be prescribed. Treatment is safe, effective and well tolerated.
This post was written by Lisa Milam, MSN, WHNP-BC, a Women’s Health Nurse Practitioner in the department of Obstetrics and Gynecology at Vanderbilt University Medical Center. Milam works alongside Melinda New, M.D., in the Vanderbilt Center for Vulvar and Vaginal Disorders. Milam’s clinical interests include vulvovaginal disorders and abnormal bleeding/pelvic pain. She earned her undergraduate degree from Bethel University and her Masters of Nursing from Vanderbilt School of Nursing in 1996.
Lisa Milam, A.P.N, M.S.N, is an instructor of clinical obstetrics and gynecology at Vanderbilt University Medical Center. Her areas of expertise include abnormal uterine bleeding, vulvar dermatoses, chronic vaginal infections, sexual pain and dysfunction, menopause and menopausal hormone therapy, and pre-cancerous changes of the vulva, vagina and cervix.
Melinda New, M.D., is associate professor of clinical obstetrics and gynecology at Vanderbilt University Medical Center. Her areas of expertise include general gynecology and gynecologic surgery, cervical vulvar and vagina dysplasia, menopausal symptoms, painful intercourse, recurrent vaginal infection, and vulvar disorders.