Vaginal discharge: what is normal, causes, red flags and when to seek help

The NHS describes vaginal discharge as a fluid or mucus that keeps the vagina clean and moist and protects it from infection, and says you can get it at any age. The amount varies, and you usually get heavier discharge during pregnancy, if you are sexually active or if you are using birth control. Around ovulation it is often clearer, wetter and more noticeable.

In other words, a cycle of change is normal. Discharge that is thick and white just before a period, stretchy and egg-white-like at mid-cycle, or heavier in pregnancy needs no treatment. What matters is a change from your own usual pattern.

The NHS links discharge that smells fishy with bacterial vaginosis, thick white discharge like cottage cheese with thrush, green, yellow or frothy discharge with trichomoniasis, discharge with pelvic pain or bleeding with chlamydia or gonorrhoea, and discharge with blisters or sores with genital herpes. It says that if your discharge changes in smell, colour or texture it might be a sign of infection, but not to self-diagnose.

The NHS says bacterial vaginosis is caused by an imbalance of bacteria in the vagina, is not classed as an STI although sexual activity can trigger or pass it on, and causes an unusual discharge with a strong fishy smell, particularly after sex, or a change to a greyish-white, thin and watery discharge. It does not usually cause soreness or itching. It says you are more likely to get it if you are sexually active, have had a change of partner, have an IUD or use perfumed products around the vagina, and that it is treated with antibiotic tablets, gels or creams. It is common for it to come back, and if you get it more than 4 times in a year you may be given an antibiotic gel to use for a few months. In pregnancy there is a small chance of complications, so speak to a GP or midwife if discharge changes.

The NHS describes thrush as a common yeast infection that is usually harmless but can be uncomfortable and keep coming back, and is not classed as an STI. In women it causes white discharge, often like cottage cheese, that does not usually smell, itching and irritation around the vulva and vagina, and soreness and stinging during sex or when you pee. It says treatment is an antifungal tablet, pessary or cream, that it should clear up within 7 to 14 days, and that you can buy antifungal medicine from a pharmacy if thrush has been diagnosed in the past and you know the symptoms. It advises seeing a GP if it is your first time, you are under 16 or over 60, it keeps coming back (more than 4 times in 12 months), treatment has not worked, you are pregnant or breastfeeding, or you have a weakened immune system.

The NHS says to get help from NHS 111 if your vaginal discharge changes colour, smell or texture, you produce more discharge than usual, you feel itchy or sore, you bleed between periods or after sex, you get pain when peeing, or you get pelvic pain in the area between the tummy and thighs. It notes that sexual health clinics treat problems with the genitals and urinary system, that many offer walk-in services and that they often get results back faster than GP surgeries.

Pelvic pain with discharge, fever, pain during sex or bleeding may signal pelvic inflammatory disease, which needs prompt treatment to protect fertility. Severe lower abdominal pain, fever and feeling unwell with discharge needs same-day assessment. Bleeding after sex, between periods or after menopause with discharge should be reviewed to exclude cervical or womb causes.

Discharge in a girl who has not started periods, or in a pregnant woman, should always be assessed. Any possibility of an STI means testing and treating partners as advised.

The NHS bacterial vaginosis page says a GP or sexual health clinic will want to confirm the diagnosis and rule out an STI, will ask about your symptoms, and a doctor or nurse may look at your vagina and wipe a cotton bud over the discharge inside to test for bacterial vaginosis and other infections.

Expect questions about timing, smell, colour, itching, pain, bleeding, sexual partners and protection, contraception, recent antibiotics, pregnancy and previous infections. Swabs for BV, thrush, trichomonas, chlamydia and gonorrhoea may be taken, and a urine sample can test for chlamydia and gonorrhoea. Some clinics can look at the sample under a microscope while you wait.

The NHS says you cannot prevent vaginal discharge, but to help avoid irritation, soreness or dryness you should wash the skin around the vagina gently with warm water and mild, non-perfumed soap, and avoid perfumed soaps and gels, deodorants, scented hygiene wipes and washing inside the vagina (douching). For BV it adds showers instead of baths, not using bubble bath or antiseptic liquids in the bath, using water and plain soap and not smoking. For thrush it suggests an emollient instead of soap, drying properly, cotton underwear and avoiding tight underwear or tights, and notes that antifungal creams can damage condoms and diaphragms.