Ask Your Family Doctor

Developed by the College of Family Physicians of Canada

Is vaginal discharge normal?

Yes. Glands inside your vagina and cervix (the opening to the uterus, or womb) make small amounts of fluid. This fluid flows out of the vagina each day, carrying out old cells that have lined the vagina. This is your body's way of keeping your vagina healthy and clean. The discharge is usually clear or milky and doesn't smell bad.

The colour and thickness of the discharge changes with your monthly cycle. The discharge is thicker when you ovulate (when one of your ovaries releases an egg), when you breastfeed or when you're sexually excited. During your period, menstrual blood mixes with the discharge.

What changes may be a sign of a problem?

Changes that may signal that something is wrong include an increase in the amount of discharge, a change in the colour or smell of the discharge, and irritation, itchiness or burning in or around your vagina. This is called vaginitis. A discharge that's stained with blood when you're not having your period could also be a sign of a problem. These signs may need to be checked by your doctor.

What may cause these changes?

These changes can occur if the normal balance of healthy bacteria in your vagina is upset. Many things can disturb the balance of a healthy vagina, including douching, feminine hygiene sprays, certain soaps or bubble baths, antibiotics, diabetes, pregnancy, infections, aging and intercourse.

Why is douching harmful?

The chemicals in douches may irritate your vagina and change the normal balance of healthy bacteria in your vagina. Douching can also spread an infection into the uterus, increasing your risk of getting pelvic inflammatory disease (PID). PID is an infection of the fallopian tubes that can cause you to be unable to have children.

Douching isn't needed to be clean. Smells you may notice often come from outside the vagina (vulva). Keeping this area clean with gentle soap and water can prevent smells. See tips on cleanliness.

Tips on cleanliness

	Bathe or shower regularly and pat your genital area dry.
	After using the toilet, always wipe from front to back. This may help prevent getting bacteria from your rectal area into your vagina.
	Avoid feminine hygiene sprays. These sprays may cause allergic reactions. If you feel you must use a spray, limit how often you use it and avoid spraying it into your vagina.
	Don't douche.
	Avoid coloured or perfumed toilet paper, deodorant pads or tampons, and bubble bath.
	Be sure to remove any tampons you use. A forgotten tampon or pieces of a tampon can be irritating.

What is a yeast infection?

Small amounts of yeast fungus are often found in a healthy vagina. But if too much grows, it can cause a yeast infection, or vaginal candidiasis. Possible signs of yeast infections are listed in the box to the right.

Yeast infections usually aren't caught from a sex partner. You may be more likely to get a yeast infection if you use antibiotics, are pregnant, have diabetes, or stay hot and sweaty for long periods. Some women get frequent yeast infections for no obvious reason. Yeast infections aren't harmful, but they can be painful and itchy. Yeast infections are usually treated a cream that you put into your vagina with a special plunger or a pill called a suppository that you insert into your vagina. Medicines in a cream form can be used on your vulva to help relieve the itching on the outside.

Signs of yeast infections

	White, cottage cheese-like discharge, especially inside, on the walls of your vagina
	Swelling and pain outside your vagina, on the vulva
	Intense itching
	Painful intercourse
	Burning when urinating (peeing)

What is bacterial vaginosis?

Bacterial vaginosis is usually caused by Gardnerella vaginalis bacteria. Why some women get this infection isn't clear. It's probably not caught from a sex partner. Sometimes, women with bacterial vaginosis can develop PID or have an abnormal Pap smear. Possible signs are listed below. Bacterial vaginosis is treated with antibiotic medicine, usually a pill, available through a prescription from your doctor.

Signs of bacterial vaginosis

	A white, gray or yellowish vaginal discharge
	A fishy odor that is strongest after sex or after washing with soap
	Itching or burning
	Slight redness and swelling of the vagina or vulva

Signs of trichomoniasis

	A watery, yellowish or greenish bubbly discharge
	An unpleasant odor
	Pain and itching when urinating
	Most apparent after your period

What is trichomoniasis?

Trichomoniasis, also called "trich," is caused by an organism called Trichomonas vaginalis. You can be infected but have no signs for a long time. Men who have trichomoniasis rarely have any signs. Possible signs of trichomoniasis in women are listed above.

Trichomoniasis is usually caught by having sex without a condom with some who has trichomoniasis. It can get into your urinary tract and cause a urinary infection. It's usually treated with antibiotic pills.

What about other infections?

Two sexually transmitted diseases, chlamydia and gonorrhea, can also cause vaginal discharge. These are infections of the cervix caused by bacteria. Sometimes the only symptom in women may be an increase of vaginal discharge. Chlamydia and gonorrhea often cause no symptoms at all in men. Both of these infections can be treated with antibiotic shots or pills.

What about medicine I can buy without a prescription?

If you have yeast infections often and are sure that's what's causing your vaginitis, your doctor may suggest you use a medicine you can buy without a prescription. But if you have any questions about what's causing your vaginitis, talk to your doctor. Many other things besides a yeast infection can cause vaginitis. Getting the right treatment is important so that an infection doesn't get worse.

Tips on preventing vaginitis

	Wear cotton underpants during the day. Cotton allows your genital area to "breathe." Don't wear underpants at night.
	Avoid wearing tight pants, panty hose, swimming suits, biking shorts or leotards for long periods of time.
	Change your laundry soap or stop using fabric softener if you think it may be irritating you.
	The latex in condoms and diaphragms and the sperm-killing gels that are used for birth control can be irritating for some women. If you think one of these things is a problem for you, talk to your doctor about other types of birth control.
	Avoid hot tubs.
	When infected, avoid sex so that you and your partner won't pass the infection back and forth. If you do have sex, use a condom to help prevent the infection from spreading.

Should my sex partner be treated also?

Sometimes. Talk to your doctor if you're sexually active. Some causes of vaginitis can be passed back and forth during sex. You may need to avoid having sex until you've been treated or your partner may need to wear a condom to help prevent him from getting the infection and passing it back to you.

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Revised 2007 The College of Family Physicians of Canada

This information provides a general overview on this topic and may not apply to everyone. To find out if this information applies to you and to get more information on this subject, talk to your family doctor. This health education material has been favorably reviewed by the Patient Education Review Committee of the College of Family Physicians of Canada: Dr Cathy MacLean, Halifax, NS (Scientific Editor) Dr C. Richard Fischer, Pickering, ON Dr Patrice Laplante, Fleurimont, QC Dr Richard Moffatt, Red Deer, AB Dr David Nunn, Kentville, NS Dr Cornelius Woelk, Winkler, MB The College of Family Physicians of Canada, one of the nation's largest medical groups, is committed to promoting and maintaining high standards for family physicians - the doctors who provide ongoing, comprehensive care for people of all ages. This patient education information was developed by The College of Family Physicians of Canada in cooperation with the American Academy of Family Physicians.

Support for this program has been provided by an educational grant to the Research and Education Foundation by Scotiabank.