Vaginal discharge is one of those topics that can sometimes be difficult for women to speak about. But it is completely normal and an important part of a healthy functioning female reproductive system. Vaginal fluid, which can vary in odor and color, provides lubrication and keeps the vagina clean and healthy by removing dead cells and bacteria. 

There are times, however, when vaginal discharge may appear abnormal and can signal an infection. Here’s what’s normal and when to be concerned.

Typically, you don’t need to be alarmed by vaginal discharge. The amount, consistency, color and odor can change with your menstrual cycle and other female occurrences such as when you’re ovulating, breastfeeding, pregnant or sexually aroused. 

For example, the color may vary from clear to a milky whitish depending on the stage of your menstrual cycle. In the days approaching ovulation, you may have up to 30 times more mucus and it may be creamier in appearance. During ovulation, vaginal discharge is usually an egg white color and consistency. After ovulation and before you menstruate, discharge will lessen and have a thicker consistency. 

You’ll also experience more discharge when you are breastfeeding or sexually aroused. It may also smell different during pregnancy and after intercourse. 

These are all completely normal and nothing to be concerned about. Unusual changes in color that are more yellow or greenish, a strong odor or unusual consistency; however, may need further investigation. If these changes are accompanied by vaginal itching, burning, pelvic pain or bleeding, it could signal an infection or other problem.

Some women do not feel comfortable with what medical providers consider “normal” and have tried using non-prescription remedies such as drinking cranberry juice, eating yogurt, taking probiotics and vitamin C. Women have also used coconut oil, tea tree oil, hydrogen peroxide or apple cider vinegar baths. None of these home remedies have been effective in research studies.  

Infections occur when the balance of the healthy lactobacillus bacteria is disrupted by an overgrowth of bad bacteria called anaerobic bacteria. Some of the most common instigators of infection include:

• Use of tobacco products
• Douching, using scented soaps or lotions and bubble baths
• Antibiotic or steroid use
• Birth control pills
• Unmanaged diabetes
• Multiple sexual partners and unprotected sex even with one infected partner
• Pelvic infection after surgery

You can help reduce the risk of infection or irritation in the vaginal area by practicing healthy feminine hygiene. Contrary to what is often thought, when it comes to vaginal hygiene, less is often better. Practice these tips to stay healthy and infection-free:

• The skin around the vulva is very delicate. Wash gently 
• Do not wash inside the vagina
• Avoid harsh antibacterial soaps, scented soaps and lotions and taking bubble baths
• Use hands to wash in this area rather than washcloths and scrubbing puffs, which can irritate the skin
• Limit your time in wet bathing suits or workout clothes. This creates a warm, moist environment for bacteria to grow   
• Avoid frequent washing in this area. If you need to wash more than once in a day, use water only the second time 
• Do not wash clothes with scented detergents or use other scented washing products 
• Practice safe sex habits by using protection and limiting partners
• Do not smoke

 Some of the most common infections or conditions include:

Bacterial vaginitis (BV) – More than one third of women will be diagnosed with bacterial vaginitis in their lifetime. This is an inflammatory response that is typically accompanied by an increase in discharge, a fishy odor and irritation, burning and/or itching. The condition occurs when there is an overgrowth of anaerobic bacteria that upsets the balance of healthy lactobacillus bacteria. Common causes include new or multiple sex partners, douching and smoking. The condition may be more common after your menstrual cycle. Antibiotics will typically clear up BV. This infection unfortunately has a high rate of recurrence in the months after treatment but is unlikely to be seen as a recurrent problem for most patients. There are special longer term treatment protocols that use boric acid vaginal suppositories and antibiotics when BV becomes a persistent problem. 

Yeast infection – This type of infection is associated with a thicker, clumpier discharge and may include itching, irritation and rawness on the inside of the vagina and outside on the vulva. If there is an odor, it is typically a yeasty type smell. Common risk factors for this condition include antibiotic use (which can wipe out the good bacteria), unmanaged diabetes, over aggressive use of feminine products and immunosuppression. Treatment with an antifungal medication will usually clear the infection.  

Trichomoniasis – This is a sexually transmitted infection (STI) that produces a more abundant, green and frothy discharge that may cause irritation, a mild odor and pain with intercourse. It is often caused by having multiple sex partners and failure to use protection, even with one infected partner. The condition can be treated with an antibiotic prescription medication. If you are diagnosed with an STI it is worth considering being tested for a wider range of STIs, which typically includes blood testing in addition to urine or vaginal swab tests. Many STIs do not have significant symptoms in male partners so it is always worth considering screening for these infections at your well woman care visits.  

Gonorrhea and chlamydia – These are both STIs often caused by unprotected sex with an infected partner(s). They are both associated with a yellow, greenish discharge, pelvic pain, burning when urinating and spotting after intercourse. Both can be treated with antibiotics. If left untreated, your risk of infertility, chronic pain and ectopic pregnancy increases. 

Vaginal atrophy (atrophic vaginitis) – This is a thinning and drying of the vaginal walls that often occurs in post-menopausal women due to a drop in estrogen levels. The condition can cause more sloughing of the vaginal cells, which may result in increased vaginal discharge. Localized vaginal estrogen can help improve the condition.

In most cases, if you follow healthy feminine practices, vaginal discharge is completely normal and should not raise concern. If you are uncertain, it is always safer to seek medical advice to ensure there is not a larger problem.