Some vaginal discharge is quite common and normal for women of childbearing age. Normally, cervical glands produce a clear mucus secretion that drains downward, mixing with bacteria, discarded vaginal cells, and Bartholin's gland secretions.

These substances may (depending on how much mucus there is) turn the mucus a whitish color (leukorrhea) and the discharge turns yellowish when exposed to air. There are times throughout the menstrual cycle that the cervical glands produce more mucus than others, depending on the amount of estrogen produced. This is normal.

Sexual excitement and emotional stress have both been associated with a normal vaginal discharge. This discharge is a clear, mucus-like secretion.

Disease may be indicated if vaginal discharge is abnormal in color, odor, or consistency, or significantly increased or decreased in amount. Very often, when the abnormal discharge is caused by a sexually transmitted disease (STD), or transmitted through sexual intercourse, the sexual partner(s) may require treatment as well.

• Atrophic vaginitis (common in older women)
• Nonspecific vaginitis
• Foreign bodies (such as a forgotten tampon)
• Monilia (white, cheesy discharge caused by candidiasis), a type of yeast infection
• Trichomonas (green, frothy discharge and intense itch)
• Sexually transmitted disease (if discharge is cheesy, smelly, or bloody)
• Bacterial vaginosis (grayish and smelly discharge, worst after intercourse)
• Drugs (some antibiotics and estrogen-containing drugs)
• Irradiation of the reproductive tract
• Sexual excitement (normal discharge)
• Emotional stress (normal discharge)
• During ovulation

Good hygiene can help prevent some of the causes of abnormal discharge as well as help get rid of it if it occurs. Sometimes a little bit of extra patience is needed.

While many women use a douche to clean themselves after menstrual periods or sexual intercourse, gynecologists discourage such routine cleansing. The vagina is made to cleanse itself, and douching may remove the healthy bacteria lining the vagina (normal flora) that help protect you from infection.

By attempting to treat an abnormal vaginal discharge by douching, you might actually worsen the condition. Depending on the cause of the vaginal discharge, your health care provider might recommend a treatment specifically for the condition.

Do not douche without your health care provider's knowledge when you have an abnormal discharge, and do not douche for 24 hours prior to seeing the doctor.

For yeast infections, medications such as Monistat can now be purchased over-the-counter. Prescription drugs may be necessary for some cases. Use these only if you KNOW that the discharge is caused by a yeast infection (if you have had identical symptoms that were diagnosed by a health care provider as a yeast infection).

If the discharge is caused by a sexually transmitted disease, the sexual partner must also be treated, even if there are no symptoms. Many organisms can harbor themselves without producing symptoms. Failure of the partner(s) to accept treatment can cause continual reinfection which may eventually (if not taken care of) lead to more extensive problems, possibly limiting future fertility and affecting overall health.

• The discharge is associated with abdominal discomfort, pain, or fever.
• The problem occurs in a child who has not reached puberty.
• The discharge may be caused by taking a drug.
• The problem persists for longer than 2 weeks or becomes worse.
• A sexually transmitted disease is suspected.

The medical history will be obtained and a physical examination performed.

Medical history questions documenting the vaginal discharge in detail may include:

• Time pattern
  • When did this begin?
  • Does the discharge remain constant throughout the month?
• Quality
  • What does the discharge look like (color and consistency)?
  • Is there an odor?
  • Is there pain, itching, or burning?
• Aggravating factors
  • Does your sexual partner have a penile discharge?
  • Do you have multiple sexual partners or sexual partners that you do not know very well?
• Relieving factors
  • Is there anything that relieves the discharge?
  • Does frequent bathing help?
  • Have over-the-counter creams been tried?
  • Has douching been tried? What kind?
• Other
  • What other symptoms are present?
    • Abdominal pain?
    • Vaginal itching?
    • Fever?
    • Vaginal bleeding?
    • Rash?
    • Warts?
    • Other lesions?
    • Changes in urination?
    • Difficulty or pain on urination?
    • Blood in urine?
    • Diarrhea?
• Other important information
  • What medications are being taken?
  • What is the frequency of sexual activity?
  • Do you use condoms?
  • Do you have any allergies?
  • Have you changed the detergents or soaps that you use?
  • Do you frequently wear very tight panties or pants?

The physical examination may include a pelvic examination.

Diagnostic tests that may be performed include:

• A culture of the mouth of the womb (cervix) (if venereal disease is suspected)
• Microscopic examination of vaginal discharge specimen

Intervention:
Suppositories or creams may be ordered and antibiotics may be prescribed. Oral medication for fungus or Trichomonas may be used in difficult cases. The sexual partner(s) may also need treatment.