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Some of my patients, who are especially “vaginally aware,” get worried when they see any liquid escaping from their vagina – they are sure it must be a sign of infection. But discharge does not necessarily indicate trouble. In fact, having vaginal discharge is healthy and normal (this is why we wear underwear). Just how much discharge a woman has, and its consistency, depends on several factors, so what’s “normal” varies from woman to woman and can even change over the course of her life.
What is vaginal discharge?
Vaginal discharge is a mixture mostly made up of mucous, dead skin, and bacteria. The vagina is a muscular tube, with the cervix at one the end and the vaginal opening at the other. The cervix has lots of glands that produce mucous, sort of like your nose. This mucousy fluid collects in the top of the vagina and then gravity causes it to flow down the vaginal canal toward the opening, flushing out exfoliated vaginal skin cells. Vaginal discharge also provides a home for the healthy bacteria lactobacillus. Lactobacillus has a symbiotic relationship with your vagina, producing hydrogen peroxide which keeps the vagina acidic, helping to prevent the growth of bad bacteria and yeast.
So, what’s normal?
“Normal” vaginal discharge is usually white, clear or yellow. It shouldn’t smell excessively or cause burning, itching. After the menstrual cycle, discharge is usually watery in consistency. Around ovulation the discharge should become thicker and sticky like an egg white, meant to serve as a nice stream for the sperm to swim through to hopefully meet up with an egg in the fallopian tube.
What is NOT Normal?
It is not normal for discharge to be discolored. Green discharge, especially if it is frothy, can often be a sign of infection. Discharge that is the consistency of cottage cheese, especially if it accompanied by itching, is usually a sign of a yeast infection. A very pungent fishy odor can be a signal of a bacterial infection. Sometimes, vaginal discharge can be a sign of a pelvic infection. A change in discharge after an encounter with a new sexual partner or associated swollen lymph nodes, pelvic pain, or fever should prompt a visit to your doctor right away.
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What affects discharge?
The amount and consistency of discharge a woman produces is mostly determined by the shape of her cervix. Some women have a lot of glands on the outside of the cervix and have more discharge. Occasionally, a woman can produce so much natural discharge that she has to wear a pantyliner.
The cervix, like the rest of the uterus, gets huge during pregnancy. The combination of increased blood, hormonal changes, and bigger cervical glands often result in a lot of discharge during pregnancy. After childbirth, you may find that your new “normal” discharge may be different than it was pre-pregnancy, as the shape of the cervical glands often changes after having a baby.
Hormones also have a big influence on vaginal discharge. While pregnancy increases discharge, alternately, the low estrogen states of menopause and breastfeeding usually lead to minimal discharge. This lower amount of protective discharge can make you more prone to bacterial and yeast infections.
Birth control can also affect discharge. While the pill does affect women differently, most report less discharge – and whatever discharge they do experience won’t have the egg white consistency of mid-cycle ovulation (because the pill prevents ovulation). IUDs that contain progesterone (Mirena, Skyla, Kyleena, and Lilettta) work by thickening the cervical mucous to prevent conception, so they often lead to more than expected discharge.
And, of course, infection can affect discharge. As offending infectious organisms build up in the vagina, they cause the vaginal discharge to increase and thicken in consistency. The body’s immune system then sends in white blood cells and other specialized liquids to attempt to squelch the infection. Discharge caused by infection can be excessive and often has some of the concerning characteristics mentioned above like odor, burning or itching.
Having vaginal discharge is normal and healthy – and necessary. It should really be renamed “vaginal self-cleansing fluid” because that is essentially what it does: it flushes out the old skin and other unneeded fluids (that’s a nice way to say “semen”) and keeps everything in balance. But if your vaginal discharge hurts, burns, persistently itches, or is associated with a new sexual partner, you should visit your provider to make sure you all your vaginal fluids are in balance.
by Heather Rupe, DOBoard-certified OB/GYN
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