We’ve all had it. That moment of shock and awe (horror, even) accompanied with the question of “how can this possibly be normal?” … in the bathroom. Discharge, while not always pleasant or convenient, is indeed normal and actually required for a healthy vagina. The amount, color, and consistency various among women. And throughout a woman’s life it changes depending on her age, menstrual cycles (or lack thereof), and if she is pregnant. Knowing what’s normal may help alleviate moments of panic or, alternatively, prompt you to seek treatment.
Understanding vaginal discharge also requires some understanding of the female anatomy. “Discharge” is mucus and fluid made by the cells of the vagina and cervix (on the inside), but is usually not noticed until it exits the vagina to the vulva and labia (on the outside). This steady production of fluid is important to protect the fragile, specialized cells of the vaginal and urinary tracts, prevent infection, and provide lubrication to the very sensitive vaginal tissues. The amount of discharge and its consistency are under the direct influence of the female hormones, estrogen and progesterone (i.e. increase in hormones = increase in discharge). So you can rationalize how the increased hormonal state of pregnancy may cause copious amounts of vaginal discharge and how perimenopause/menopause commonly causes vaginal dryness – both normal.
And now for the interesting part, for a healthy vagina there is a delicate balance of cells, mucus, and bacteria. Yes, bacteria. Bacteria seem to get a bad rap, but there are several examples where our bodies work in conjunction with bacteria, and the vagina epitomizes this symbiotic relationship. The “good” bacteria of the vagina are a genus known of lactobacillus. Lactobacilli use glycogen (sugar) from the sloughed vaginal cells (a normal process) for energy as part of their survival. In this process, the bacterium creates lactic acid and hydrogen peroxide. It is the production of the lactic acid by the lactobacilli that help maintain the vagina’s acidic pH (and gives vaginal discharge its faint odor). The acidic nature of the vagina and the production of hydrogen peroxide prevent overgrowth of other bacteria (and sometimes yeast) that are naturally present in the vagina.
The complex, yet balanced environment of a healthy and normal vagina has byproducts, the dreaded discharge. So what’s normal? Women who have not yet reached menopause produce about 2 to 5 milliliters of discharge per 24 hours (one-half to one teaspoon). Normal discharge is clear to white and mostly odorless. The amount and consistency of the discharge depends largely on hormones. Overall, vaginal discharge may become more noticeable during pregnancy, with use of hormonal birth control, near ovulation, and in the week before the menstrual period.
This beautifully complex microenvironment naturally harbored in the vagina is very delicate. Perhaps now you can understand and appreciate how small changes in the vagina can lead to a disruption resulting in increased discharge and possibly even infection. The most common things that cause abnormal vaginal discharge and lead to vaginitis include:
- Changes in the pH of the acidic vagina, commonly from menstrual blood and semen (both are basic in their pH) or menopause
- Mechanisms that decrease lactobacilli in the vagina, like with douching (washes them away) and antibiotics (doing their job by killing bacteria – both good and bad)
- Reactions to a foreign body or substance: tampons, condoms, spermicides, soaps, perfumes, etc.
Abnormal amount, consistency, or color of vaginal discharge should prompt you to visit your health care provider. Further evaluation is especially needed if you have any symptoms:
- Itching of the vulva, vaginal opening, or labia
- Redness, burning, soreness, or swelling
- Foamy, green, or yellow discharge
- Foul odor
- Pain with intercourse or urination
- Abdominal or pelvic pain
The most common causes of vaginal discharge/vaginitis are bacterial vaginosis, vaginal candidiasis (yeast infection), and changes related to menopause. In about 20 percent of the cases, a specific cause of the vaginitis is not identified. Sexually transmitted infections (STI) like gonorrhea, chlamydia, and trichomoniasis, also commonly cause vaginitis and have similar symptoms. If you suspect an STI, you should be evaluated and tested immediately, as there can be serious consequences if diagnosis is delayed. And if you’re thinking, “Well, I know I don’t have an STI and there are plenty of over the counter (OTC) products I can do at home without telling anyone about my panty pandemonium.” True, but women’s self-diagnosis of vaginitis is correct in only about a third of the time. If you choose to treat yourself, be advised you could be spending money unnecessarily and delaying the correct diagnosis and treatment.
Want to prevent vaginitis? Don’t we all. To date, the research studies are [unfortunately] not showing much evidence for probiotics and vaginal health (For the gut, yes. The vagina, no). More clinical trials are needed that are well-designed and include a larger study population. There also seems to be a more complex relationship between the pH and lactobacilli than just inserting a tablet of bacteria into the vagina (or taking it orally). Furthermore, there are several species of lactobacilli and no certainty which [if any] help. Lastly, probiotics are typically considered a supplement and therefore the probiotic industry is not held to the same standards as other medications for treatment (i.e. not regulated by the FDA) so the strength, activity, species, quantity, safety, and efficacy may vary considerably. This also means you can stop making 10 p.m. runs to the grocery store for yogurt to cure your ailments. There is no evidence that consuming yogurt (buttermilk, cream, etc.) or inserting it vaginally helps treat or prevent vaginitis, including yeast infections.
I know desperate times call for desperate measures, but before you add insult to injury consider making an appointment with your health care provider. It may save you time, money, … and laundry.