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Vaginal Discharge: The Good, The Bad, and The Ugly

Posted Oct 19 2010 3:39pm

One of my patients’ most common gynecologic complaints is about vaginal discharge.   It’s not something most womenwant to talk about.  I mean, if you watch enough commercials for “feminine hygeine products” you start to think that vaginal discharge will make you a social outcast who wears loose, flowy clothing  in varying shades of mauve and gray. 

But what causes vaginal discharge?  When is it normal? What can you treat at home?   And when do you need to see a gynecologist?  Those are some of the questions I’d like to address in this post.

First of all, vaginal discharge is one of the symptoms of a medical condition gynecologists call “vaginitis.”  Literally, it means inflammation of the vagina.  (And you thought taking Latin in high school would never come in handy.)

They key to vaginitis is the vaginal flora.  Vaginal flora aren’t roses and peonies blooming in your nether-regions.  They are microscopic organisms, like bacteria and yeast, who normally live in the vagina and are beneficial.  They need a certain level of moisture, acidity, and estrogen in order to function properly.  When the balance of normal vaginal flora is upset, vaginitis can result.

Normal vaginal discharge is often clear, white or yellow.  It can be thin and watery, creamy or similar to mucus in character.  Normal vaginal discharge may lack an odor or may smell musky (as opposed to abnormal discharge, which often smells foul and unpleasant).   When the vagina is in a healthy balance, it shouldn’t smell bad, burn/itch or hurt. 

The normal balance of vaginal flora may be upset by activities such as douching and tampon use.  Both can worsen the symptoms of vaginitis and should be avoided while symptoms persist.

One of the most common causes of vaginitis is a yeast infection.  These are caused by a fungus called candida which is normally found in small amounts in the vagina.  When candida overgrows, the symptoms of a yeast infection may occur.  These include itching and burning of both the vagina (inside) and the vulva (the outside skin near the vagina).  Symptoms may be worse after urination or intercourse. Some (but not all) women notice thick white discharge which may be odorless.    

Risk factors for developing a yeast infection include pregnancy, diabetes mellitus, recent antibiotic use, human immunodeficiency virus and oral contraceptive use.  Treatment is available by prescription or over-the-counter.  It usually involves antifungal medication (cream or suppository)  inserted in the vagina for 1 to 7 days.  Oral treament with a pill may also be offered, but is available by prescription only.  Longer courses of treatment may be necessary  Sexual partners do not require treatment. 

Bacterial vaginosis (BV) is caused by an overgrowth of certain vaginal bacteria, particularly gardnerella.  The main symptom of BV is increased discharge can be copious (a large quantity)and may be white, gray or even greenish in color.  A strong, fishy vaginal odor is often present.  The odor may increase after a mesntrual period or after sexual intercourse.   Itching may also occur.

Treatment is by prescription antibiotics.  Metronidazole (Flagyl) gel or oral capsules are prescribed for 5 days.  Oral metronidazole can not be taken in combination with alcohol or severe nausea/vomiting may occur.  Clindamycin suppositories or cream can be used for 3 to 7 days.   Longer courses of treatment are sometimes necessary. Sexual partners do not require treatment.

Vaginal discharge may also be a symptom of trichomoniasis.  This is a condition caused by the microscopic parasite Trichomonas vaginalis. It is a sexually transmitted disease (STD). Signs of trichomoniasis may include a yellow-gray or green vaginal discharge.  The discharge may have a fishy odor, which may lead one to confuse it with bacterial vaginosis. Burning, irritation, redness and swelling of the genitals may occur.  Pain may occur during urination. 

Trichomoniasis is usually treated with metronidazole (flagyl) by mouth.  Women who have trichomoniasis are at an increased risk of infection with other STDs, so they should be screened accordingly.  Sexual partners must be treated to avoid re-infection.  Sexual intercourse shoudl be avoided until both partners have received treatment.

Vaginal discharge may also be a sign of atrophic vaginitis.  This condition can occur when the level of estrogen in the body drops, as usually happens during breastfeeding or menopause.  Symptoms include dryness, itching and burning of the vagina.  Discharge may be present and pain may occur during sexual intercourse.  Treatment is usually aimed at restoring estrogen to the vagina through topical medications.  Water-based lubricant can also be helpful, especially during intercourse.

In summary, vaginitis and discharge are common conditions which may require special diagnostic tests and/or treatment by a gynecologist.  If you are experiencing bothersome symptoms, especially if over-the-counter treatments have failed, it is time to talk to your doctor.


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