Vaginal Discharge: Normal vs Abnormal

What normal discharge looks like

Healthy discharge, called physiological leukorrhea, is made of mucus from the cervix, fluid from the vaginal walls, shed cells and the normal bacteria (mainly Lactobacillus) that keep the vagina mildly acidic. A typical amount is about half to one teaspoon a day.

Normal changes through the menstrual cycle:

Discharge also increases in pregnancy, with hormonal birth control, during sexual arousal and in newborn girls, who may have a little white or bloody discharge from their mother's hormones.

Discharge color and what it means

Causes of abnormal vaginal discharge

Bacterial vaginosis

The most common cause of abnormal discharge in women of reproductive age. Normal lactobacilli are replaced by other bacteria. It is not an STI, but it is more common with new or multiple partners and with douching. It raises the risk of catching STIs and of preterm birth in pregnancy.

Yeast infection (candidiasis)

Overgrowth of Candida. Itching and soreness are the main symptoms. Discharge may be thick and white or minimal. Triggers include antibiotics, pregnancy, uncontrolled diabetes and a weakened immune system.

Sexually transmitted infections

Trichomoniasis, chlamydia and gonorrhea can change discharge, though chlamydia and gonorrhea often cause no symptoms. Untreated, they can spread to the uterus and fallopian tubes and cause pelvic inflammatory disease and infertility.

Other causes

• Low estrogen after menopause, while breastfeeding or with some medicines causes thin, sometimes watery or yellowish discharge with dryness. See vaginal atrophy.
• Irritation or allergy from soaps, douches, bubble baths, spermicides or condoms.
• Cervical ectropion, a harmless patch of delicate cells on the cervix, can increase discharge and cause spotting after sex.
• Cervical polyps and, rarely, cervical or uterine cancer, which may cause watery, bloody or foul discharge.

Sudden reduction in discharge

Less discharge is often normal right after a period, with age, while breastfeeding or on some hormonal contraceptives. A noticeable drop with dryness, itching or painful sex often points to low estrogen around menopause. Antihistamines, some antidepressants and cancer treatments can also reduce it. Stress and dehydration rarely cause a large change by themselves.

How doctors diagnose the cause

A doctor or nurse will ask about color, smell, itching, timing in your cycle, sexual partners and contraception, then examine the vulva and vagina with a speculum. A swab of discharge is tested for pH (above 4.5 suggests bacterial vaginosis or trichomoniasis), examined under a microscope, and sent for yeast culture or STI tests (NAAT). A urine test or self-taken swab can screen for chlamydia and gonorrhea.

Treatment

• Bacterial vaginosis: prescription antibiotic tablets or vaginal gel.
• Yeast infection: antifungal creams or pessaries available over the counter, or a single prescription tablet. Do not use the oral tablet during pregnancy without medical advice.
• Trichomoniasis, chlamydia and gonorrhea: prescription antibiotics, and partners must be treated too. Avoid sex until treatment is complete.
• Vaginal atrophy: moisturizers, lubricants and low-dose vaginal estrogen.

Self-treat for yeast only if you have had a confirmed yeast infection before and the symptoms are the same. Many women who think they have a yeast infection actually have bacterial vaginosis.

Keeping discharge healthy

• Do not douche. It disrupts healthy bacteria and is linked to bacterial vaginosis and pelvic infections.
• Wash the vulva with water or a mild unscented cleanser. The vagina cleans itself.
• Wear breathable cotton underwear and change out of wet swimwear promptly.
• Use condoms with new partners and get regular STI screening.
• Change tampons at least every 8 hours.

Frequently asked questions

What does normal vaginal discharge look like?

Normal discharge is clear or white, has little or no smell, and does not cause itching or burning. It becomes clear, slippery and stretchy around ovulation and thicker and creamier afterward. The amount varies from day to day and increases in pregnancy.

What is benign leukorrhea?

Benign or physiological leukorrhea is the normal, healthy white or clear discharge that keeps the vagina clean and moist. It increases around ovulation, in pregnancy and with hormonal contraception. It needs no treatment as long as there is no odor, itching or change in color.

Why is my discharge suddenly less than usual?

Lower discharge is common just after a period, while breastfeeding, during perimenopause and with some birth control pills or medicines such as antihistamines. If it comes with dryness, itching or pain during sex, low estrogen is a likely cause and treatment can help.

Is yellow discharge normal?

Pale yellow discharge without odor or itching can be normal, as discharge dries slightly yellow in underwear. Darker yellow or green discharge, especially with a smell, itching or pelvic pain, suggests an infection such as trichomoniasis, chlamydia or gonorrhea and should be tested.

Can stress change vaginal discharge?

Stress can indirectly affect discharge by altering your cycle and making yeast infections more likely. It does not usually cause a major change by itself. New odor, color or itching points to an infection rather than stress.