Vaginal Discharge

Vaginal discharge is normal and healthy. It is how the vagina cleans and protects itself, and it changes naturally through the menstrual cycle — thin and stretchy around ovulation, thicker and creamier afterwards. It also changes with pregnancy, hormonal contraception and the menopause.

What matters is not whether you have discharge, but whether it has changed from what is usual for you — in amount, colour, consistency or smell — and whether anything else has come with it, such as itching, soreness, pain or bleeding.

One thing worth stating plainly: douching and internal washes make this worse, not better. They strip the healthy bacteria that keep the vaginal environment stable and are a direct cause of bacterial vaginosis. Plain water on the outside is all that is needed.

Normal

• Clear or white, changing in consistency across the cycle, with little or no smell and no itch or soreness
• Increased discharge in pregnancy, on the combined pill, or with a coil

Common causes of a change

• Thrush — thick, white, often described as cottage cheese, with itching and soreness. Usually no strong smell. Not sexually transmitted
• Bacterial vaginosis — thin, grey-white, with a distinctive fishy smell that is often worse after sex. Typically no itch, which is the main thing separating it from thrush. Also not sexually transmitted
• Chlamydia and gonorrhoea — may cause discharge and bleeding between periods, but very often cause no symptoms at all, which is exactly why testing matters
• Trichomonas — frothy, yellow-green, offensive, often with soreness
• A retained tampon or condom — a common and easily solved cause of sudden foul discharge
• Menopausal changes, where reduced oestrogen alters the discharge and causes dryness or irritation

Less common

• Pelvic inflammatory disease
• Cervical polyps or ectropion, which can cause discharge and bleeding after sex
• Skin conditions affecting the vulva, such as lichen sclerosus or eczema
• Rarely, cervical or endometrial cancer — which is why persistent blood-stained or offensive discharge is always assessed

This is an area where people particularly value not sitting in a waiting room. Consultations are confidential and kept separate from your NHS record unless you ask us to share them.

What the consultation covers

• The pattern — colour, consistency, smell, itch, timing in the cycle, and what has changed. That combination distinguishes thrush from bacterial vaginosis reliably enough to treat in most cases
• Whether an STI test is warranted, and arranging screening at an accredited clinic. Chlamydia in particular is frequently silent, so testing is guided by risk rather than by symptoms alone
• Treatment prescribed where the picture is clear — antifungals for thrush, antibiotics for bacterial vaginosis
• Why recurrent thrush and BV keep coming back, which is usually about disturbing the vaginal environment rather than reinfection. Stopping douching, changing washes, and reviewing contraception all help more than repeated courses of treatment
• Vaginal oestrogen where menopausal change is the cause — a treatment that works well and is consistently underused
• Partner treatment advice where relevant

The limits

We cannot perform an internal examination or take a swab, and there are situations where those decide the answer — persistent symptoms, bleeding after sex, an unusual cervix, or suspected pelvic inflammatory disease. In those cases we arrange examination rather than treat blind. We also cannot perform cervical screening, which is a physical procedure and free on the NHS — if you are due one, we will say so.

What counts as normal discharge?

Having discharge is normal — its absence would be abnormal. It changes predictably through the cycle: clear, slippery and stretchy around ovulation; thicker, whiter and less abundant afterwards; and it increases in pregnancy, with the combined pill, and with arousal.

Normal discharge is clear or white, has no strong smell, and does not itch, burn or sting. Change from your own normal is what matters — in smell, colour, volume, or the presence of irritation.

How do I tell thrush from bacterial vaginosis?

By smell and by itch, and it is worth getting right because the treatments are completely different.

• Thrush: thick, white, cottage-cheese-like discharge. Intensely itchy and sore. No particular smell. Treated with antifungals
• Bacterial vaginosis: thin, grey or watery discharge. Distinctly fishy smell, often worse after sex or during a period. Usually not itchy at all. Treated with a specific antibiotic

BV is roughly twice as common as thrush, and is very frequently self-treated as thrush — which does nothing, and can make the irritation worse.

Why does the treatment keep not working?

Three common reasons, in order of frequency:

1. It is not the condition being treated — usually BV being treated as thrush
2. Continued washing, douching or use of perfumed products, which perpetuates the imbalance and is often the actual cause
3. An underlying factor — undiagnosed diabetes, an untreated sexual partner in the case of trichomonas, or a retained tampon

If two courses of treatment have not worked, the diagnosis needs revisiting rather than a third course prescribing.

Do I need an STI test, and where should I go?

Yes if the discharge is new and you are sexually active — chlamydia and gonorrhoea are frequently symptomless, and trichomonas is often mistaken for thrush.

Go to an NHS sexual health service, or order a free postal kit online. They are free, confidential, comprehensive, handle partner notification, and are honestly better resourced for this than private general practice. It is one of the areas where the NHS route is straightforwardly the better one.

Are intimate washes and douching really that harmful?

Douching is genuinely harmful and should not be done at all. It disturbs the protective bacterial population, raises the risk of bacterial vaginosis and pelvic infection, and has no benefit whatsoever.

Perfumed washes, wipes and sprays are the same problem in milder form. They are marketed for odour, and they cause the imbalance that produces odour. The single most effective intervention for many people with recurrent discharge is simply stopping all of it.

I keep getting thrush. Why?

Four or more episodes a year is recurrent thrush, and it deserves investigation rather than repeated treatment. The main things to look for:

• Undiagnosed or poorly controlled diabetes — an HbA1c is essential here
• Repeated antibiotic courses
• Perfumed products, tight synthetic clothing, and over-washing
• A weakened immune system, or steroid use

Recurrent thrush is treated with a longer maintenance course rather than repeated single doses, which is why it is worth having properly assessed.

What if there is bleeding as well as discharge?

That changes things and needs assessing. Bleeding after sex, between periods, or a bloodstained discharge can indicate cervical infection, a cervical polyp, or cervical changes — and it is a reason to check that your smear tests are up to date.

Any bleeding after the menopause requires urgent assessment on a two-week pathway, regardless of how light it is or how easily it might be explained. That one is not a wait-and-see.

Can this be dealt with remotely?

Partly, and it splits fairly cleanly. We can diagnose and treat thrush and bacterial vaginosis from the history in most cases, prescribe the same day, review recurrent cases properly, arrange an HbA1c for recurrent thrush, and advise on the washing habits that are frequently the root of it.

What needs in-person care: STI screening — best done free through sexual health services — suspected pelvic inflammatory disease, any bleeding that needs the cervix examined, pregnancy-related changes, and a retained tampon. We will point you at the right service directly rather than working around it.