Some degree of odourless vaginal discharge is normal in all women. The problem arises when the discharge is offensive, excessive, irritating or all three. Abnormal vaginal discharge is usually caused by problems within the vagina itself but can be caused by problems further up the genital tract such as disease of the cervix or uterus. Most vaginal conditions that cause discharge are the result of infection. The commonest infections are Candida (thrush), bacterial vaginosis (BV) or trichomonas vaginitis (TV). Candida is caused by a yeast. It is not normally considered a sexually transmitted disease (STD). Candida grows when there is a reduction in number of the normal bacterial inhabitant of the vagina, lactobacillus, such as might happen following a course of broad spectrum antibiotic, given to the woman for a chest infection. Many women are aware of this problem of thrush following antibiotics. Candida is also common in association with any condition that can reduce the body's immunity, including treatments that involve immunosuppression. The discharge in Candida infection is thick, white and irritating. Bacterial vaginosis is caused by a variety of microbes, sometimes several at once. It is not usually considered an STD but in recurrent cases, treating both partners may be helpful. 50% of women with BV have no symptoms but the rest complain of a grey/white, non-irritant discharge with a musty odour. Trichomonas vaginitis is usually considered an STD and both partners should always be treated. There is a yellow greenish, frothy, irritant, offensive discharge, often associated with dyspareunia (pain on intercourse). Other vaginal infections include the STDs gonorrhoea and chlamydia and any woman suspecting she has an STD should see a doctor. Non-infective causes of vaginal discharge include chemical and allergic vaginitis which may be caused by douches, feminine hygiene products etc. Atrophic vaginitis is a drying, and susceptibility to infection, of the vagina brought on by the fall in oestrogen, as a woman becomes older. An extremely offensive, profuse vaginal discharge can result from a forgotten, retained tampon. Vaginal discharge, blood stained and offensive, can result from infection and malignancy in the cervix and uterus. Cervical erosions, extremely common, can produce an excess of non-irritant vaginal discharge.

Consultation with a doctor is advised, essential if the condition is thought to be an STD or if there is any blood staining or pain. The doctor will examine the patient and take vaginal swabs to determine the nature of the infection. Candida can be treated with anti-fungal preparations such as clotrimozole, usually in pessary form, available over the counter from the pharmacy. Women prone to vaginitis are advised not to wear tights and cotton underwear is preferred to synthetic material. Highly scented soaps and sprays should be avoided. Bacterial vaginosis and trichimonas are usually treated with metronidazole, available from the doctor. (Note. When the doctor says that no alcohol should be taken with this medication he means it. It can make you very ill indeed!). Other causes of chronic vaginal discharge need to be investigated by the doctor and referred to the gynaecologist as necessary. Atrophic vaginitis very often improves on HRT and can also be helped with locally applied oestrogens.