Evaluation of vaginal discharge

Last reviewed: May 2019

Last updated: August 2018

Summary

Vaginal discharge is one of the most common reasons for gynecological visits in the US, accounting for about 10 million office visits per year. [1]

Physiologic vaginal discharge

Normal vaginal discharge in a reproductive-aged woman, also called physiological leukorrhea, usually consists of 1-4 mL per 24 hours. It is typically transparent, mucousy, and white-to-yellowish. It is typically odorless but can also be slightly malodorous. The character of physiological discharge can vary over time. For instance, it becomes more noticeable with higher estrogen states (e.g., pregnancy, use of estrogen-progestin contraceptives, or at ovulation). Lactobacilli in the normal vaginal flora maintain normal acidity in vaginal discharge by producing hydrogen peroxide and lactic acid. The normal pH of leukorrhea in reproductive women (4.0-4.5) creates a hostile environment for pathogens. In premenarchal and postmenopausal women with low estrogen states, vaginal pH may be 4.7 or more.

Epidemiology

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. [2]

Differentials

Common

Bacterial vaginosis
Trichomoniasis
Vulvovaginal candidiasis
Chlamydia trachomatis infection
Neisseria gonorrhoeae infection
Irritant and allergic vaginitis
Physiological leukorrhea in adults
Foreign body in children
Nonspecific vaginitis
Physiological leukorrhea in children

Full details

Uncommon

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 syndrome
Desquamative inflammatory vaginitis
Erosive lichen planus
Postsurgical
Postradiation
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

Full details

Contributors

Authors VIEW ALL 

Veronica Gomez-Lobo, MD

Professor of Clinical Obstetrics and Gynecology

Clinician Educator Track

Georgetown University

Washington

Disclosures

VGL declares that she has no competing interests.

Acknowledgements

Dr Veronica Gomez-Lobo would like to gratefully acknowledge Dr Isabelle Guichard, a previous contributor to this topic. IG declares that she has no competing interests.

Peer reviewers VIEW ALL 

David Chelmow, MD

Chair

Department of Obstetrics and Gynecology

Virginia Commonwealth University

Richmond

Disclosures

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

London

Disclosures

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.

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Evaluation of vaginal discharge

Summary

Physiologic vaginal discharge

Epidemiology

Differentials

Common

Uncommon

Contributors

Authors VIEW ALL 

Veronica Gomez-Lobo, MD

Disclosures

Acknowledgements

Peer reviewers VIEW ALL 

David Chelmow, MD

Disclosures

Lesley Bacon, FFSRH, MRCGP

Disclosures

Patient leaflets

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