Monique Rainford

One of the most common reasons why a woman comes into my office is because of an abnormal vaginal discharge. She may report burning, itching, a bad odour or heavier-than-usual discharge, among other things.

Occasionally, women have no symptoms but wonder if their discharge is normal. Normal vaginal discharge is acidic, white and has no odour. It consists of surface cells of the cervix (the neck of the womb) and the vagina, water, normal bacteria and other chemicals. She may notice an increase in discharge with stress or the days after she ovulates. The bacteria that is important to maintain the normal balance in the vagina is called lactobacillus acidophilus. It produces hydrogen peroxide which helps to keep the vagina healthy.

Bacterial vaginosis

Three of the most common causes of abnormal vaginal discharge include bacterial vaginosis, trichomoniasis and yeast or candida vaginitis. Bacterial vaginosis is the most common cause of abnormal vaginal discharge. It occurs when the vagina has high concentrations of certain types of bacteria which replace the normal lactobacillus. It is not usually considered a sexually transmitted infection but women with multiple sexual partners are more at risk for this condition.

However, it is also common in women who are not sexually active. Other risk factors include not using a condom with intercourse, douching and past antibiotic use. The discharge is thin and grey-white and has a fishy odour which is often most noticeable after intercourse. The discharge is frothy in about 10 per cent of women. It is uncommon for a woman to have any irritation or itching with this condition. Treatment may either consist of oral or vaginal medications.

Trichomoniasis

Trichomoniasis is another common cause of abnormal vaginal discharge. It is caused by trichomonas vaginalis which is a sexually transmitted and very contagious parasite. Symptoms usually occur between four to 28 days after the infection is transmitted. A woman may or may not have any signs or symptoms of infection.

The amount of vaginal discharge associated with this infection is usually more than the other common vaginal infections. It may be white, grey, yellow or green in colour. It may be frothy and have an odour. She may experience redness and swelling in the genital area. She may also have itching in the genital area. Other symptoms include, pain with or without bleeding after intercourse, burning with urination or pain in the lower abdominal region. Treatment usually consists of oral antibiotics. Treatment of the woman's partner lowers her risk of re-infection.

Yeast vaginitis

Yeast vaginitis is the other common cause of vaginal infections. It affects about 75 per cent of women during their lifetime. It is usually caused by the fungus candida albicans. Yeast is found normally in the vagina of about 25 per cent of women. Women are more likely to have this infection in pregnancy, immediately before or after their menses, with antibiotic or steroid use. The oral contraceptives currently used do not increase a woman's risk of yeast infections. Women with certain health problems such as diabetes, HIV and obesity are also more likely to have this infection.

Symptoms include genital itching, burning, soreness, irritation and sometimes pain with intercourse. A woman may also notice redness, swelling and small cuts in the genital area. The discharge is white or yellow and has an appearance like cottage cheese. Treatment is either oral or topical medications.

Avoid douching

Wearing cotton underwear, avoiding panty liners, douching and scented vaginal products may help to reduce a woman's chances of developing a yeast infection. There are a number of other infectious and non-infectious causes of vaginal discharge which I will address in future articles.

Dr. Monique Rainford is a consulting obstetrician and gynaecologist; email: yourhealth@gleanerjm.com.