Leukorrhea (Normal Vaginal Discharge)

What leukorrhea is

The word comes from Greek words meaning "white flow". Normal discharge is a mix of mucus from the cervix, fluid that seeps through the vaginal walls, shed skin cells and helpful bacteria, mainly Lactobacillus species. These bacteria make lactic acid that keeps the vagina mildly acidic (pH about 3.8 to 4.5), which stops harmful germs from growing.

Discharge does several jobs: it moistens and cleans the vagina, protects against infection, and around ovulation helps sperm travel through the cervix. It is a sign that hormones are working normally, and it is not a sign of poor hygiene.

What normal discharge looks like

How discharge changes through the menstrual cycle

1. After a period: little discharge, the vagina may feel dry.
2. Days before ovulation: discharge becomes creamy or sticky and white.
3. Around ovulation (mid-cycle): more discharge, clear, slippery and stretchy like egg white. This is when you are most fertile.
4. After ovulation: progesterone makes it thicker, cloudier and less in amount.
5. Just before a period: it may turn thicker and white, sometimes brownish as the period starts.

Common reasons for more discharge

• Ovulation
• Pregnancy: higher estrogen and blood flow increase discharge, which is thin, white and mild-smelling. This is often called leukorrhea of pregnancy and can increase toward the end of pregnancy. Before labor, the mucus plug may come away as thick, sometimes blood-tinged mucus.
• Hormonal contraception, including the pill and hormonal IUD.
• Sexual arousal.
• Puberty: girls often notice white discharge 6 to 12 months before their first period.
• Newborn babies: baby girls can have white or slightly bloody discharge in the first weeks because of the mother's hormones.
• A cervical ectropion, where the softer glandular cells from inside the cervix sit on the outside. It is common with the pill and in pregnancy and can cause extra discharge.

Discharge usually decreases after menopause as estrogen falls, which can lead to dryness and irritation (vaginal atrophy).

When discharge is not normal

Bacterial vaginosis

The commonest cause of abnormal discharge. Bacterial vaginosis gives a thin gray-white discharge with a fishy smell, often stronger after sex or a period. Usually little itching.

Yeast infection

A vaginal yeast infection causes thick, white, cottage-cheese-like discharge with intense itching, soreness and burning. It usually has little smell.

Trichomoniasis

A sexually transmitted infection causing frothy yellow-green discharge, a strong smell, itching and pain on urination. See trichomoniasis.

Chlamydia and gonorrhea

These infections of the cervix (cervicitis) often cause no symptoms but can produce increased or yellow discharge, bleeding after sex and pelvic pain. Untreated, they can damage fertility.

Other causes

• A forgotten tampon, which causes a very foul discharge.
• Cervical polyps or, rarely, cervical cancer, which can cause watery or blood-stained discharge.
• Irritation from soaps, douches, bubble baths or latex.

How doctors check discharge

If your discharge has changed, a doctor or nurse will ask about color, smell, itching, sexual history, contraception and pregnancy. They may examine the vulva and vagina with a speculum and take swabs. Simple tests include the pH of the discharge and looking at a sample under the microscope. Swabs or a urine test check for chlamydia, gonorrhea and trichomoniasis. A Pap test or HPV test may be due as part of cervical screening.

Caring for normal discharge

• Wash the vulva with plain water or a mild, unscented cleanser. The vagina cleans itself.
• Avoid douching, which upsets the healthy bacteria and increases infection risk.
• Avoid scented soaps, sprays, wipes and bubble baths.
• Wear breathable cotton underwear, and change out of wet swimwear or gym clothes promptly.
• Use unscented panty liners if needed, changing them often.
• Use condoms with new partners.
• Get to know your usual pattern, so you notice changes.

Frequently asked questions

Is white discharge normal?

Yes. White or clear discharge without a strong smell, itching or pain is normal and is called leukorrhea. It varies through the menstrual cycle. Thick, lumpy white discharge with itching suggests a yeast infection, and gray discharge with a fishy smell suggests bacterial vaginosis.

What is leukorrhea in pregnancy?

It is the normal increase in thin, white, mild-smelling discharge during pregnancy, caused by higher estrogen and blood flow to the vagina. It needs no treatment. Contact your provider if discharge becomes watery and continuous, bloody, foul-smelling or itchy.

How much discharge is normal per day?

Most people produce roughly 1 to 4 ml a day, about half to one teaspoon. This can double around ovulation and in pregnancy. A sudden large increase, especially with a change in smell or color, is worth checking.

Why does my discharge stain my underwear yellow?

Normal clear or white discharge often dries to a pale yellow on fabric because it is exposed to air. This is not a sign of infection. Discharge that is yellow-green while still wet, or comes with smell or itching, should be checked.

Can stress change vaginal discharge?

Stress can affect hormones and ovulation, which can change discharge patterns and delay periods. It can also make yeast infections more likely in some people. A change in discharge with itching, odor or pain still needs checking for infection.