Normal vaginal secretions

The amount of mucus that a women normally produces in the vagina varies from person to person. If the amount produced is sufficient it becomes noticeable by staining underwear and giving off an odour. Normal vaginal discharge is usually white in colour and varies in consistency during the cycle, becoming more wet, thin and profuse around the middle of the cycle when you ovulate and relatively less and thicker at other times. Normal discharge can increase in the middle of the cycle, if you are taking the combined oral contraceptive and during pregnancy. These are all caused by an increase in the amount of female hormone (oestrogen) in your body and this is normal. The amount of vaginal mucus is also increased when you are sexually excited and increased mucus from the uterus (womb) before your period can also increase the amount of normal discharge. These conditions do not need treatment. Avoid getting too hot, take a frequent shower but avoid douches (pushing water into the vagina to clean it) and deodorants since these can irritate the vagina and contribute to the increased production of mucus. Cotton underclothes may be more comfortable.

Abnormal discharge

Increased vaginal discharge together with other symptoms like itching, abdominal or pelvic pain and pain during sex may indicate a problem that requires treatment. There are a number of infections that can cause vaginal discharge symptoms and if you feel that you fit into one of the groups described below then it will be appropriate to consider treatment. The type of vaginal discharge may give you a clue as to its cause. Don't forget that discharge is not always caused by infection; consider irritation from douches and deodorants, bath salts, allergy to latex condoms, and occasionally if the discharge is offensive it may be due to something left inside (e.g. a forgotten tampon).

Bacterial vaginosis (BV)

The vagina normally contains harmless bacteria which help to crowd out unwanted germs and keep you healthy. If these usually harmless bacteria increase in numbers and change the usual composition of bacteria in the vagina a condition known as bacterial vaginosis can result. This can cause a discharge which is often thin, grey, and has a fishy or unpleasant smell. This may be accompanied by irritation, although it is not usually itchy. BV is sensitive to changes in the acidity of the vagina and you may notice that symptoms are worse after sex and after your period. BV is fairly common. It is not a sexually transmitted disease and not related to poor hygiene. In fact too frequent washing or douching can contribute to disrupting the usual balance of healthy bacteria there. BV does not spread to your womb, tubes or pelvis. Mild BV may settle without treatment. There are antibiotics that can be taken by mouth (metronidazole; don't drink alcohol with these) or applied into the vagina as a cream (clindamycin) and these will clear the condition, but it is frequently recurrent so sometimes may need to be retreated after a few months. BV in pregnancy is a risk factor for premature delivery (infections in general are) and is something your obstetrician will consider if you have a history of premature delivery.

Candida (thrush)

Another common organism that hangs around the human body is a yeast called Candida. In small numbers it is harmless and usually crowded out the normal bacteria that live in the vagina. However, if it is allowed to multiply and increase in numbers it can cause symptoms. Like BV, vaginal symptoms due to candida are common, can be a nuisance but are not usually serious. Infection with candida usually causes a creamy white or cheesy discharge. It does not smell but tends to stick to the walls of the vagina and when removed leaves a sore red patch. Candida can causing itching around the vagina and discomfort inside. Candida infection does not normally spread. Candida is more likely to develop when the balance of usual bacteria that crowd it out is changed. Changes to the normal secretions in the vagina can also trigger thrush. Women at risk include those who have recently taken antibiotics that deplete the vagina of its usual protective bacteria. In addition thrush is more common in pregnancy, women with diabetes mellitus, those who douche and clean the vagina excessively and those that use tampons.

Candida can be treated with pessaries, creams or tablets containing anti-yeast drugs. Typical examples are clotrimazole (Canesten) and miconazole (Daktarin) creams and pessaries and fluconazole (Diflucan) capsules by mouth and they are usually very effective. They can be bought at pharmacies without a prescription. Unfortunately, candida infection can often be recurrent but can be helped by the following.

The next three infections are sexually transmitted. If you have one of these it is important that your partner is also treated properly and you may wish to be checked by a genito-urinary specialist for other infections. There is a genito-urinary clinic at Northwick Park Hospital and Watford General Hospital. You can make an appointment by phoning them direct. Remember, condoms protect you from catching sexually transmitted diseases.

Chlamydia

Chlamydia infection is being diagnosed increasingly commonly. In part, this may be due to better detection techniques. It is particularly common in young, sexually active people. As well as a vaginal discharge chlamydia can cause pelvic infection which may present with abdominal pain, fever and vaginal bleeding. Chlamydia infection can be silent and about half of women infected do not have symptoms. To find chlamydia, your doctor needs to wipe a specimen from the neck of your womb (a cervical swab) and send it for analysis. Chlamydia infection needs to be treated because spread to the fallopian tubes and pelvis can cause pain, scarring and infertility problems in the future. In pregnancy, chlamydia can affect the baby causing eye infection and pneumonia. The usual treatment is by antibiotics like doxycycline, azithromycin or erythromycin by mouth. The duration of the course varies between antibiotics but can be up to 2 weeks. Your partner needs to be screened and treated as well so that you are not re-infected and you need to avoid sex until you are both clear.

Trichomonas

Trichomonas most commonly occurs between the ages of 18 and 35. It is usually, but not always, acquired sexually and the infection takes between 4 and 21 days to become apparent. Trichomonas infection usually involves the vagina, causing a thin, yellow-green, frothy discharge that smells unpleasant or fishy. There may also be irritation or pain in the vagina, pain during sex or pain when passing urine. You may notice redness around the vagina and the doctor may notice this inside as well and can check for infection by taking a swab from the vagina. It does not normally spread to the womb or pelvis. Trichomonas is treated with an antibiotic called  metronidazole; you cannot drink alcohol with this particular antibiotic. Your partner may not have symptoms and trichomonas usually disappears in men without treatment over the course of a couple of weeks, so he may not require treatment if you have avoided sex during that time.

Gonorrhoea

Gonorrhoea is a sexually transmitted disease that is also on the increase. 40% of infected women will not have symptoms but most men will develop pain when they pass urine and a discharge from the penis within 3-5 days of infection. In women, gonorrhoea can cause vaginal discharge containing pus, increased frequency of passing urine and pain in and around the anus and rectum. If the infection spreads it can cause fever, muscle pains, a rash with pustules and inflamed joints. It can spread to the womb and fallopian tubes in the pelvis and this can cause longer term problems with fertility as with chlamydia infection. To diagnose gonorrhoea, the doctor will usually take swabs from the neck of the womb, your urethra (where you pass urine from) and from your anus. Gonorrhoea is treated with antibiotics by mouth and your partner requires treatment too. Gonorrhoea in pregnancy can cause infection of the baby's eye and perhaps other problems like premature delivery, growth retardation and infection after delivery.

Vaginal discharge in children

This is not an uncommon problem and the cause is not necessarily sinister. Usually, poor hygiene is responsible, particularly after children go to the toilet to open their bowels. In this situation the discharge will often settle when parents go back to helping their child with toileting and teaching them to wipe from front to back. Other causes in children include threadworms and sometimes a object put into the vagina. If a foreign object is suspected or the discharge is persistent, your child will usually be referred to a hospital specialist who can, if necessary perform an examination under anaesthetic. Suspected infection with any of the sexually transmitted organisms above, whilst less likely, clearly needs investigation, appropriate treatment, and follow up to determine the cause.