As a trained and experienced sexual health nurse/ Cytology sampler (that’s a smear taker if your wondering) I have had a fair share of unusual questions and concerns from those that have come under my care. Most of these questions come from women and are heavily focused on their vaginal discharge. Yes, that’s right- ladies are very concerned with what it looks like and even what it smells like. I get asked everything from “Nurse, does it smell funny to you?” (whilst in-between legs of said questioner) or “nurse, is it meant to look like that?” “is it too white?” “is it too sticky?” “how can I produce less of it? “does everyone have it like me?” “does it mean I have an infection?” “why does it smell more after my period” “why does it smell differently after sex” …
Women are curious about their vaginal discharge. And why shouldn’t they be? This is a rather taboo subject; I am not sure how many of you sit down on a Friday night and compare vaginal discharge stories with your “Gal Pals” but this for sure has never been my experience- and I have some pretty weird friends. The truth is vaginal discharge is very seldom talked about (unless you have a similar role to mine).
Your vagina is rather impressive (assuming you have one), it has this rather complex relationship with the communities of bacteria’s that live in it (like tiny little villages of microbes!). We often term this microflora, imagine it to be an ecosystem, that when undisturbed, is beneficial to the health of the vagina. Bacteria that is healthy for our vagina sounds as if I just totally made it up, but its true! Our resident microflora helps us from being made home to other less friendly bacteria by competing for territory.
Vaginal discharge plays an important role in this, as it helps to keep you clean. The mucus that the vagina produces comes from various glands, which remove any debris and old cells being shed. Ultimately every woman is unique and so is her discharge. I’ve often considered what does it mean to be “normal” when explaining this to women, some women have it every day and others don’t, and not to mention that vaginal discharge changes throughout the menstrual cycle. Discharge production is linked by our sex hormones, oestrogen, and progesterone. This controls the “type” of vaginal discharge by altering in response to the rise and fall of hormonal levels, as we work our way through the monthly cycle.
For most of this cycle, progesterone is the dominant hormone, creating thick and creamy mucus, a bit like Diarylea triangles (bet you will never eat them again!). This type of discharge is designed by the body to try and stop you from becoming pregnant, by hindering the sperms movement towards the egg, like trying to swim through treacle. It’s the bodies way of saying its not ready to get pregnant yet, so back off spermys!
If you have a 28-day cycle, somewhere around day 14, ovulation occurs (when an egg is released) at this point it is likely the discharge will become clearer, wetter, and if you fancied to take some in your hand (likely you don’t) but you would be able to stretch this out like some sort of strange kids slime putty toy…And this is entirely normal. We can blame this on rises in Oestrogen, it has the complete opposite effect of the Progesterone hormone, it is allowing the sperm to move easily and even assist it in reaching the egg that is now available to be fertilised! Your body is ready to get pregnant.
In terms of smell, vaginal discharge is not meant to smell like DOVE soap, it more resembles an attic that has not been opened for a while- musky! A strong foul smell, like gone off steak sitting in the fridge too long, are often a sign that things are a bit off balance. Odours do differ from women to women, we all have our unique smell. You may notice a slightly different smell to discharge following a period, this is because there will be some endometrial (womb) lining mixed in with the discharge, this is entirely normal and will resolve itself as you move through the cycle. Sometimes, semen interacts with vaginal fluid, along with sweat that is produced during intercourse, so again, it is entirely normal for it to smell differently after sex, and even up to 5 days later if he has ejaculated inside you.
If you are using artificial hormones such as contraceptive pills, implants, injections and coils, your levels of hormones are relatively consistent, this is because the contraceptive is tricking your body into thinking its already pregnant, so the discharge tends to be thick and creamy all the time as there is a consistent level of progesterone being delivered to the body.
When you are sexually aroused you become “wet”, this is different from vaginal discharge, and is known as transudate, that’s basically there to save you from the discomfort of friction burn during intercourse and gives the sperm an idea of which direction they should be heading. (“its this way lads, follow the slippery road”
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What about when its not normal?
One of the most common issues that changes the vaginal discharge are caused by imbalances in the vaginal microflora. When there is a sudden strong and foul smell, a change in colour or consistency, this may be our vaginal discharge trying to tell us something.
This may be a fungal infection known in the medical community as Candida (Albicans), you probably know this better as “Thrush”. It is pretty normal to have the fungus candida, a type of yeast, living in and around the vagina on any given day. When this grows out of control, because something has changed in the environment to encourage it to multiply, this will result in an infection. If you’re experiencing this or have had this in the past, you’re not alone- 70% of women have also experienced it, with either mild or severe symptoms.
Thrush causes some rather unpleasant symptoms of itching and burning of the genitals, they become very sore and red, and discharge will often look thick and white and lumpy (like cottage cheese) The good news is that it is easily treated, in most cases you can self-treat by buying “over the counter” (no prescription needed!)
If your self-treating, I would recommend both using a pessary (inserted into the vagina) such as clotrimazole and to use oral medicine such as fluconazole alongside it for the higher chance of cure, especially if it’s been particularly tricky to get rid of.
If your having symptoms of the outer vagina, chuck in some clotrimazole cream to treat that area too. These days you can get the pessary and the cream in a duo pack, but the cream is known to make the burning sensation worse in the beginning of the treatment, which you may not enjoy, so it’s perfectly fine to stick to the oral treatment instead- the end result is usually the same and either way you are less likely to get treatment failure.
Another problem that is often seen is known as “Bacterial Vaginosis” or just BV for short. This is another example an overgrowth of bacteria leading to infection. There is usually a reduction in the careful balance of how acidic the vaginal environment is, this allows those microbes the take over the territory once owned by other bacteria, and they then become the dominant strain, pushing everything out of balance. Typical symptoms are a strong unpleasant odour- I would describe it as smelling fishy- discharge is usually greyish white colour, and it may cause itching, soreness, or other discomfort. This is easily treated with antibiotics, generally Metronidazole is used, although it’s not superior to any other treatments, we just like it. Not every case will need treatment, as the vagina is able to self-correct the problem and get back the fine balance.
You may have heard it before but over washing does upset the vagina, you only need to wash the external vulva and meatus – nothing needs to go inside the vagina to clean it. Doing so can cause the imbalances I have described. Your vaginal discharge is there for a reason, so trying to eliminate it by washing it away leaves your vagina vulnerable and open to infections.
Another message your vaginal discharge may be trying to tell you, is that you have a sexually transmitted disease. This may present as pain, unusual bleeding, unpleasant smells, and yellow green frothy discharge. Sometimes there are no symptoms at all. No matter how much washing you do, or how clever your vagina is, this is not going to go away. Left untreated can cause serious damage, such as infertility. I know it takes away some of the pleasure, but everyone should consider using condoms when having sex with new or “open” partners, don’t let anyone pressure you into thinking otherwise.
What I would like to end on is some caution, as most issues with vaginal discharge can be easily treated, we do not need to worry too much about this, just get to know what’s normal for you. Post-menopausal women and girls before puberty should not be having issues with vaginal discharge, you should not have vaginal discharge at all, this is because they don’t have much oestrogen and progesterone floating around to really be producing it. Therefore, if you’re no longer having a menstrual cycle, or too young to have started one, you need to see a doctor if you are experiencing issues with vaginal discharge, it is very likely to be caused by infection, but sometimes it can be something far more serious.
Growing Nurses 