Notes from a Doctor's Practice

"Is it normal to have . . .?" It's a question I often hear in the office. Vagina talk starts with this question: has the quantity or quality (color, odor, and amount) of your vaginal discharge changed? If so, here is a breakdown of some of the causes of vaginal discharge and what it will look like. Here we go ladies:

• Bacterial vaginosis: This is the most common cause of vaginal discharge in premenopausal women and can give you a thin, grayish-white or off-white discharge that is "fishy smelling" and more noticeable after intercourse. This is not sexually transmitted and easily treated with 5 nights of a prescription vaginal antibacterial cream.
• Vaginal Candidiasis "Yeast Infection": This will give you a thick, white, "cottage cheese-like" discharge usually accompanied by vaginal itching. This is also not sexually transmitted and easily treated. Over-the-counter antifungal vaginal cream preparations are available for treatment. There is a single dose pill for treatment (Diflucan) which requires a prescription from your physician.
• Trichomoniasis: Classically associated with a greenish-yellow, smelly, purulent discharge and you should notice vaginal burning, burning during urination and even mild bleeding after intercourse. This is sexually transmitted and is easily treated with an oral antibiotic.
• Normal Discharge "Physiological leucorrhea": This can be thick white or yellowish vaginal discharge that does not smell and is not accompanied by other symptoms (itching, burning, pain or irritation). Physiological leukorrhea is usually due to estrogen induced changes in cervicovaginal secretions. Treatment is unnecessary. This is normal vaginal discharge.
• "Fertile mucus" or Ovulation mucus: This occurs mid-cycle and is thin, stretchy, clear, jelly-like discharge also described as being like egg whites. This is normal.
• Chlamydia and Gonorrhea: Both of these STDs cause a red inflamed cervix that you won't see and 50% of women have no symptoms. If you do, greenish/yellowish discharge, burning with urination and during sex, and abdominal pain is what you will notice. These are sexually transmitted and easily treated with a course of antibiotics.
• Atrophic vaginitis: This is dryness or inflammation of the vagina in postmenopausal women caused by lack of estrogen. If you have symptoms from atrophic vaginitis you will have dryness, itching and you may have yellow malodorous (smelly) discharge and a feeling of pressure. This is also easily remedied with hormones (vaginal or oral preparations).
• Spotting between periods "Breakthrough bleeding": This is usually brownish/reddish discharge that can look like dried blood and occurs between periods. If you are on oral contraceptives this is known as "breakthrough bleeding" and you should mention it to your doctor because it may mean you need a higher dose estrogen pill.

Visti your doctor for an exam if you have any hesitation about what's normal and what's not.

Dr O.