Vaginal discharge is one of the most common reasons for gynaecological visits. In the US alone, it accounts for about 10 million office visits per year.
Physiological vaginal discharge
Normal vaginal discharge in a reproductive-aged woman, also called physiological leucorrhoea, usually consists of 1-4 mL per 24 hours. It is typically transparent, mucousy, and white-to-yellowish. It is typically odourless but can also be slightly malodorous. The character of physiological discharge can vary over time. For instance, it becomes more noticeable with higher oestrogen states (e.g., during pregnancy, or when using oestrogen-progestin contraceptives, or at ovulation). Lactobacilli in the normal vaginal flora maintain normal vaginal acidity by producing hydrogen peroxide and lactic acid. The acidic pH of leucorrhoea in reproductive women (4.0-4.5) creates a hostile environment for pathogens. In premenarchal and postmenopausal women with low oestrogen states, vaginal pH may be 4.7 or more.
The true prevalence of this condition is uncertain because vaginitis, which encompasses the symptom vaginal discharge, is often asymptomatic, self-diagnosed, and self-treated. A telephone survey revealed that 8% of white women and 18% of black women had at least 1 episode of vaginal symptoms in the previous year.
- Bacterial vaginosis
- Vulvovaginal candidiasis
- Chlamydia trachomatis infection
- Neisseria gonorrhoeae infection
- Mycoplasma genitalium
- Irritant and allergic vaginitis
- Physiological leucorrhoea in adults
- Foreign body in children
- Non-specific vaginitis
- Physiological leucorrhoea in children
- Herpes simplex virus (HSV) infection
- Streptococcal vaginitis in adults
- Genital schistosomiasis
- Entamoeba gingivalis plus intrauterine device (IUD)
- Inadequate hygiene
- Foreign body in adults
- Contraceptive vaginal ring-related
- Atrophic vaginitis
- Postpuerperal atrophic vaginitis; lochia
- Behcet's syndrome
- Desquamative inflammatory vaginitis
- Erosive lichen planus
- Cervical cancer
- Carcinoma of the fallopian tube
- Pinworm infection
- Streptococcal vaginitis in children
- Sexual abuse
- Transmitted maternal birth canal infection
- Prolapsing fibroid
- Vaginal fistula
- Lymphoma of genital tract
Jenell S. Coleman, MD, MPH, FACOG
Associate Professor Division Director, Gynecologic Specialties Medical Director
JHOC Women’s Health Center Director
JHOC Resident Continuity Clinic Co-Director
JHOC Colposcopy Clinic
Department of Gynecology & Obstetrics
Johns Hopkins University School of Medicine
JC is an author of a reference cited in this topic.
Dr Jenell Coleman would like to gratefully acknowledge Dr Veronica Gomez-Lobo and Dr Isabelle Guichard, previous contributors to this topic. VGL and IG declare that they have no competing interests.
David Chelmow, MD
Department of Obstetrics and Gynecology
Virginia Commonwealth University
DC declares that he has no competing interests.
Lesley Bacon, FFSRH, MRCGP
Consultant in Sexual and Reproductive Health
Lewisham Primary Care Trust
Waldron Health Centre
LB was a member of the group that produced the 2006 Faculty of Sexual and Reproductive Health guidance on the management of women with vaginal discharge presenting in non-GU setting.
- British Association for Sexual Health and HIV national guideline for the management of vulvovaginal candidiasis (2019)
- Sexually Transmitted Infections Treatment Guidelines, 2021
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