What normal vaginal discharge looks like

Healthy vaginal discharge is typically clear to white, may be thin or slightly sticky, and usually has a mild scent rather than a strong odour. The amount and texture shift through the menstrual cycle: discharge is often clearer and more stretchy around ovulation (due to “egg white cervical mucus”), and thicker at other times.

Pregnancy, hormonal contraception and approaching menopause can all alter the vaginal flora and hence affect the type of discharge you experience.

Common infections that change discharge

Several common conditions alter discharge, and each tends to have its own pattern:

• Vaginal thrush (yeast infection): Often causes thick, white discharge with itching and irritation around the vulva.
• Bacterial vaginosis: Typically produces a thin, greyish discharge with a noticeable fishy odour, and may cause little itching.
• Trichomoniasis: A sexually transmitted infection that can cause frothy, greenish-yellow discharge, soreness and irritation.
• Sexually transmitted infections such as chlamydia or gonorrhoea: May change discharge, though they can also cause few or no symptoms.

Because these conditions overlap in how they present, a proper diagnosis often needs an examination and sometimes a swab. Self-treating without knowing the cause can delay effective care, so persistent or recurrent symptoms are best assessed. Routine preventive care and health screening can also form part of looking after vaginal health.

Irritation and itching without infection

Not every case of itching or irritation is due to infection. The skin the vulvar and vaginal region is particularly sensitive, and hence can be irritated by contact with seemingly common everyday products.

Common triggers include:

• Perfumed soaps, washes, bubble baths and feminine sprays
• Tight or non-breathable underwear and prolonged wear of damp clothing
• Certain laundry detergents or fabric softeners
• Excessive washing or douching, which disturbs the vagina’s natural bacteria

Simple measures such as gently washing the external area with water or a plain, unperfumed cleanser, avoiding douching, and wearing breathable cotton underwear can reduce irritation. If symptoms persist despite these steps, do consider seeking medical help. 

Hormonal changes and vaginal health

Hormones strongly influence vaginal health. Falling oestrogen levels around menopause can lead to vaginal dryness, thinning of the tissues and irritation, sometimes with a change in discharge. This can cause discomfort during daily activities or intercourse.

Hormonal fluctuations also occur with the menstrual cycle, pregnancy and some contraceptives. Where menopause-related symptoms are troublesome, they can be discussed as part of menopause care and hormone health. Broader hormonal issues, such as those linked to hormone imbalance and PCOS, can also affect cycles and vaginal comfort and may warrant assessment.

What are the risks of leaving a vaginal infection untreated?

The severity of lower genital tract infections can vary.  Some infections may spontaneously resolve with improved perineal hygiene practices and/or probiotics.  Persistent and/or recurrent infections require specialized treatment which targets the microbe responsible for the symptoms.   

Abnormal, and especially bloody, vaginal discharge can at times indicate a more serious underlying problem – such as polyps of the womb / cervix, and cancers of the genital tract.  A gynaecological examination would be useful in excluding sinister conditions, and follow-up is important to ensure that the symptoms clear with prescribed treatment.

Certain infections such as Chlamydia can also ascend the genital tract and lead to pelvic inflammatory disease (PID).  Pelvic inflammatory disease is one of the main causes of subfertility, and can lead to chronic pelvic pain and increase the risk of ectopic pregnancies.  Prompt and appropriate treatment for suspected and confirmed cases of pelvic inflammatory disease can help to avoid unwanted long-term consequences and preserve a woman’s fertility.  

When to see a gynaecologist

It is reasonable to see a doctor or gynaecologist in Singapore if you notice:

• Discharge that is green, grey, frothy or has a strong or unpleasant odour
• Persistent itching, burning, soreness or swelling
• Pain when passing urine or during intercourse
• Bleeding between periods or after intercourse
• Symptoms that keep returning or do not settle with simple measures

These symptoms are common and usually treatable once the cause is identified. A gynaecologist can examine, arrange any necessary tests such as swabs or a Pap smear and gynaecological screening, and discuss appropriate management. Seeking timely advice is particularly important for any unexpected bleeding.