Vaginal Discharge

The elusive messaging that our bodies send to us through our vaginal discharge is often confusing and straight up frustrating for many women.  A high proportion of visits to healthcare providers is related to changes in vaginal discharge, odor, or irritation “down there”.  Figuring out the exact cause and treatment plan can be just as frustrating and often requires multiple follow up visits.  Why is it so difficult? I must admit that I didn’t fully understand my own body until sitting in some of my women’s health classes in nurse practitioner school.  Things started making sense and I was baffled at how much the average population is not taught about common things.  Speaking about vaginal discharge is now part of my daily life in the office.  I love educating patients and “breaking the code” for usable everyday medical information.  So here goes….

First off, what is “normal” vaginal discharge?

A woman’s body is meant to conceive, whether you want it to or not.  Therefore, every month your vaginal discharge changes based on where you are in your menstrual cycle.  The period of time after your menstrual cycle, but before ovulation (when there is no egg to fertilize), your vaginal discharge is thick and sometimes white.  It is your bodies’ way of creating a barrier to unwanted sperm and infections.  Once you ovulate and there is an egg to be fertilized, your vaginal discharge changes to a very clear, stringy discharge often compared to egg yolk.  This discharge is easy to penetrate and allows sperm to fertilize an egg.  Your body is saying “come on in, we have an egg for you!”.    If the egg is not fertilized after about a week or two, your menstrual cycle will occur and the cycle starts over.  Here’s the biggest nugget of information; only compare your vaginal discharge to yourself, not anyone else’s.  What is normal for you, may not be normal for the next woman.  

So then what is “abnormal” vaginal discharge? 

To answer this question, let’s dive a little more microscopically into the microbiome of the vagina.  I know, this may be getting a little scientific, but knowing this is the key to knowing your vagina.  Our vaginas have healthy bacteria that maintain its homeostasis, pH balance, and ward off infections.   There are multiple different strains and types of bacteria that are found in vaginas and not all women have the same strains; mind blown!  You don’t need to know or care about the specific strains in your vagina, just know that some require oxygen and some don’t.  When an imbalance occurs, meaning one type of bacteria grows more than it should, is when you will notice changes.  

There are way too many causes of abnormal discharge to list here.  Since this is a blog and not a textbook, I will hit the most common ones:

Bacterial Vaginosis, a common imbalance, is caused by an overgrowth of the bacteria that do not require oxygen. This is commonly caused by sex with new partners, condom use, douching, or use of fragranced soap.  Symptoms are usually a thin watery grayish clear discharge with a fishy odor.

Aerobic Vaginosis, another imbalance, is caused by an overgrowth of the bacteria that require oxygen.  This is usually caused by specific bacteria that originate from the colon or urinary tract and cross into the vagina.  Symptoms are usually a thick discolored discharge with burning and irritation to the skin.  Sometimes pelvic pain can occur as well.  

Vulvovaginal Candidiasis, otherwise known as a yeast infection, is caused by an overgrowth of yeast.  This may occur secondary to antibiotic use for an infection elsewhere in the body.  Other common reasons are from creating a dark, hot, moist environment where overgrowth can occur—i.e., the long wear of wet swimsuits or sweaty gym clothes, and not providing good airflow to vaginal tissues.  The wear of cotton panties is essential, you do not want to wear fabrics that prevent air flow, and sorry ladies—skinny jeans are not our vagina’s friend.  Loose fitting pants are best.   Symptoms are usually thick white, often clumpy discharge with a “raw” feeling.

Last, but not least, is sexually transmitted infections.  Yes ladies, if your vaginal discharge is abnormal—I want you to consider STIs.  The issue is, if it is an STI and it goes untreated, it can cause infertility later in life.  Common STIs that cause vaginal discharge changes are Chlamydia, Gonorrhea and Trichomoniasis.  A high percentage of women that have STIs do not have symptoms or changes in their vaginal discharge.  Hence, you need to rule this out if there is any reason to suspect it.  

So what do I want readers to take away from this? 

Know your normal, so you can identify your abnormality.  Probiotics that have lactobacillus acidophilus and lactobacillus rhamnosus will help to maintain the “good” bacteria in your vagina to help ward off changes.  Don’t use bath bombs or scented soap on your vagina.  I also extend this to your sexual partner—if they are using scented soaps on their genitals and it now enters your genitals, well…you know what happens.  Wear cotton undies or perhaps no undies at all to maximize air flow.  As our grandmothers told all of us; don’t douche—it wipes away the good bacteria along with the bad.  Change out of wet clothes quickly.   See a healthcare provider when your discharge is abnormal.  Technology has advanced to now test vaginal discharge and see what your microbiome looks like and if there is an overgrowth or perhaps an infection.  Finally, live your best life.  We shouldn’t have to live our lives around what our vagina is doing, but knowledge is power and hopefully this blog will help you in some shape or form.