Last updated: Oct 10, 2008
“Is this normal?” Thats what women who have vaginal discharge typically ask their gynecologists. The surprise: Discharge usually is normal and healthy. The trick is learning whats your normal, so if something new comes along you can get help, says womens health expert Marie Savard, MD, author of How to Save Your Own Life. Heres a quick guide.


Its normal
How to tell:
In the first half of your menstrual cycle, discharge is thick and sticky and its color is white, clear, or yellow. A few days before ovulation, the amount increases and it becomes more watery, clear, and elastic (what docs refer to as “egg-white discharge”). After ovulation, discharge decreases until the next menstrual cycle begins. You probably wont notice any odor (although you might), especially anything thats bad. “Everyones discharge has its own personality,” says Katharine OConnell, MD, assistant clinical professor of obstetrics and gynecology at Columbia University.

What causes it: Normal discharge is just skin cells; fluid from glands in the vulva, vagina, and cervix; and even bacteria and yeast. “The vagina is a great self-cleaning organ, and discharge is its way of getting rid of dirt and impurities and anything that winds up in there that doesnt belong,” Dr. OConnell explains.

What to do: Nothing! Avoid the impulse to clean whats already clean with perfumed soaps and douches; they increase the risk for developing an infection. “Except for sex, toys, and tampons, stay out,” Dr. OConnell says.



It's yeast
How to tell:
The discharge is thick and white, and it resembles cottage cheese but has no odor. Sometimes its too thick to drip into your underwear, so you may not see it—but youre certain to notice an itch inside your vagina that wont quit.

What causes it: An imbalance of good bacteria and yeast. The bacteria usually keep the yeast, a fungus, in check. But yeast thrives in moist places, so sitting around in a wet bathing suit or sweaty underwear can trigger the infection by allowing yeast cells to multiply. Other culprits: taking antibiotics or birth control pills, douching, or wearing panty liners. (The latter actually trap moisture in the vagina.) More than 70% of women develop at least one yeast infection in their lifetime.

What to do: Try an over-the-counter treatment. If the symptoms don't fade within three days, see a doctor. She may prescribe a different antifungal treatment like Diflucan—or discover that its not a yeast infection. Keep in mind: Women often misdiagnose themselves with yeast infections, according to a recent study. Theres no harm in trying the nonprescription medicine, even if you dont have a yeast infection. If you want an answer right away, though, try a do-it-yourself test like the Vagisil Screening Kit. If yeast is present but the acidity level is normal, you likely have a yeast infection. If acidity is high, call a doc; you may have a different type of infection.



Its bacterial
How to tell:
The discharge is white or gray, and thin, with a strong and unpleasant fishy odor; it isnt quite as irritating or itchy as a yeast infection.

What causes it: Bacterial vaginosis (BV), which is more common than yeast infections, occurs when the pH balance (or acidity level) in your vagina is out of whack, allowing bacteria to grow and upset the usual bacterial balance. Doctors arent sure why this happens, but risks are thought to rise if you have a new sexual partner or multiple partners, or if you douche, which can change the pH balance.

What to do: See a doctor for antibiotics that will get rid of the infection. Pregnant women need to treat BV as early as possible, because the infection increases the likelihood of a premature birth and low birth weight. Also, Pap smears sometimes can pick up BV.



Its an STD
How to tell:
What comes out is frothy and yellowish or greenish with a strong, but not fishy, odor and may lead to some itching.

What causes it: Trichomoniasis, the most common sexually transmitted parasite. An estimated 7.4 million new cases occur each year.

What to do: Your doctor will prescribe the same kind of antibiotic thats used to treat BV—probably metronidazole (Flagyl).

Its an allergy
How to tell:
You have an extra-large amount of normal discharge that may be thicker than usual and even gray or green—plus, a lot of irritation similar to an infection. Theres usually no smell.

What causes it: A new soap or detergent or the perfume in a new personal-hygiene product can cause an allergic reaction and inflammation.

What to do: Ask yourself whether youre doing or using anything new, then stop doing it and see if everything goes back to normal. Dont try fixing the problem with a drugstore remedy. Dr. OConnell says, “Leave your vagina alone. Something else will only make symptoms worse.” If symptoms persist, see a doctor.