Vaginal discharge is one of the most common reasons for gynecological visits in the US, accounting for about 10 million office visits per year.
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 vaginal acidity by producing hydrogen peroxide and lactic acid. The acidic 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.
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 leukorrhea in adults
- Foreign body in children
- Nonspecific vaginitis
- Physiological leukorrhea 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 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
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.
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