Vaginal discharge is a normal, natural part of being a woman. However, changes in discharge color, smell, amount, or consistency could indicate an infection. The most common infections that cause white discharge are yeast infections and bacterial vaginosis.
Yeast Infection
A yeast infection, also known as candidiasis, is a fungal infection caused by an overgrowth of Candida yeast. Candida is a fungus that normally lives in small amounts in the vagina and is kept in balance by the good bacteria in your body.
When something disrupts the balance of bacteria and yeast in the vagina, the yeast can grow out of control, causing an infection. Yeast infections are very common – nearly 75% of women will have one at some point in their lives.
The most common symptom of a yeast infection is thick, white, odorless discharge. It has a cottage cheese-like appearance and texture. The discharge is usually accompanied by itching, redness, and swelling of the vulva and vagina. Pain or discomfort during sex or while urinating can also occur.
Causes
There are several factors that can increase the risk of developing a yeast infection:
- Antibiotics – kill good bacteria along with bad bacteria, allowing yeast to proliferate
- Hormonal changes – fluctuations in estrogen can stimulate yeast growth, occurs during pregnancy, menstruation, etc.
- Weakened immune system – makes it harder to maintain the bacteria/yeast balance
- Diabetes – elevated blood sugar promotes yeast growth
- Douching – disrupts the vagina’s natural pH balance and flora
- Spermicides – can kill good bacteria and alter pH balance
- Tight clothing – prevents ventilation and creates moist environment yeast thrives in
Yeast infections are not considered sexually transmitted, but can occur more often in those who are sexually active. Yeast from a sexual partner’s genitals can be introduced into the vagina.
Diagnosis
Yeast infections can often be diagnosed based on symptoms alone. However, if symptoms are mild, a pelvic exam may be done to inspect the discharge. A sample of the discharge can also be viewed under a microscope to look for yeast.
If diagnosis is unclear, a vaginal culture may be taken to confirm overgrowth of Candida yeast. A DNA probe test that identifies Candida may also be used.
Treatment
Yeast infections can be treated with over-the-counter antifungal medications such as miconazole (Monistat) or prescription antifungals such as fluconazole. These work by stopping the growth of yeast. Treatment is administered as a cream, suppository, or oral pill.
Some tips for treating yeast infections:
- Use the full course of medication, even if symptoms go away sooner
- Avoid sexual intercourse during treatment to prevent reinfection
- Consider probiotics to help restore vaginal flora balance
- Practice good hygiene and wear cotton underwear to help prevent recurrence
Over-the-counter treatments can clear up most yeast infections. See your doctor if symptoms do not go away after treatment. Recurring infections may require longer courses of antifungal medication.
Bacterial Vaginosis
Bacterial vaginosis (BV) is the most common vaginal infection in women of reproductive age. It occurs when there is an overgrowth of bad bacteria in the vagina, crowding out the good bacteria.
The main symptom of bacterial vaginosis is watery, white or gray discharge with a fishy odor. The discharge is usually thin and milky. A strong odor may occur, especially during or after sex. Burning during urination may also be present.
However, many women with BV experience no symptoms at all. BV is not considered an STI, but sexual activity can introduce bacteria that throw off the vaginal flora balance.
Causes
The exact cause of BV is unknown. However, certain factors are associated with developing bacterial vaginosis:
- Multiple or new sexual partners
- Douching
- Using scented soaps or laundry detergents
- Smoking cigarettes
- Natural hormonal changes
BV results from an imbalance between good and harmful bacteria in the vagina. Certain bacteria increase in number and change the vaginal chemistry, causing the discharge and odor.
Diagnosis
BV is diagnosed through a pelvic exam and laboratory analysis of a vaginal discharge sample. The doctor inspects the color and consistency of discharge. A few drops are placed on a slide and examined under a microscope.
The Amsel criteria are also used to diagnose BV if at least 3 of the following are present:
- Thin white/gray discharge
- Elevated pH > 4.5
- Amine or fishy odor when discharge mixed with potassium hydroxide (KOH)
- “Clue cells” visible under microscope (vaginal cells coated with bacteria)
Treatment
Bacterial vaginosis is treated with prescription oral or topical antibiotics. Metronidazole and clindamycin are commonly used. These work to kill off the bad bacteria overgrowth. Probiotic supplements may also be recommended to restore the vagina’s normal bacterial balance.
To prevent recurring BV infections:
- Avoid douching and scented hygiene products
- Use condoms to limit exchange of fluids during sex
- Wear cotton underwear and avoid tight clothes
- Avoid smoking
- Practice proper vaginal hygiene
See your doctor if you experience BV symptoms. Proper treatment can relieve discharge and odor and lower the risk of complications.
Other Causes of White Discharge
While yeast infections and BV are the most likely causes of abnormal white discharge, other conditions can also result in whitish secretions:
- Trichomoniasis – STI caused by a parasite, results in itching, burning, redness, and thin white or yellow discharge
- Chlamydia – bacterial STI, may cause watery or milky white discharge in early stages
- Gonorrhea – bacterial STI resulting in thick, cloudy, yellowish discharge
- Cervicitis – cervical inflammation, can cause whitish discharge mixed with mucus
- Vaginitis – inflammation of the vagina, leads to white, yellow, or green discharge
While less common, other medical conditions may be associated with white discharge as well, such as:
- Pelvic inflammatory disease (PID)
- Endometriosis
- Cervical polyps or cancer
- Urinary tract infection (UTI)
- Sexual abuse
Discharge with a cottage cheese appearance or fishy odor should prompt medical evaluation. But any unusual discharge warrants seeing a doctor, especially when accompanied by itching, burning, or other bothersome symptoms.
When to See a Doctor
See your doctor or gynecologist if you have any of the following:
- Thick, white, clumpy cottage cheese-like discharge
- Gray/white/yellow discharge with fishy odor
- Burning or pain during sex or urination
- Itching, swelling, redness around the vulva/vagina
- Any noticeable change in discharge amount, color, smell
- Discharge along with fever, chills, nausea, vomiting, or abdominal pain
- Bleeding between periods or abnormal periods
- Lower abdominal pain
While yeast and BV are often easily treatable at home, other causes of discharge like STIs require evaluation and prescription medication. Do not attempt to self-treat without seeing a doctor first.
When is White Discharge Normal?
Healthy vaginal discharge is usually:
- White, clear, or off-white
- Smooth, thin consistency
- Mild odor or none
- Amount varies through menstrual cycle
As estrogen levels rise and fall during a woman’s cycle, discharge changes in amount and consistency. Ovulation typically correlates with egg white, slippery discharge that helps sperm travel. Discharge may turn white and thicker after ovulation up until your period.
Normal sweat, bacteria, and fluid secreted from vaginal walls combine to make small amounts of regular discharge. As long as it is odorless and non-irritating, white discharge is nothing to worry about.
Preventing White Discharge Problems
Practicing proper feminine hygiene can help maintain balance in the vagina and prevent issues like yeast infections. Here are some tips:
- Wash the vulva daily with warm water, avoid harsh soaps
- Wipe front to back after going to the bathroom
- Avoid douching, scented sprays, and fragranced products
- Change out of wet swimsuits, exercise clothes soon after use
- Choose cotton underwear and loose clothes
- Limit the number of sexual partners and use protection
- Avoid prolonged antibiotic use if possible
- Take probiotics to support vaginal health
- Manage diabetes if you have it
- Do not smoke and avoid secondhand smoke
If you get more than 4 yeast infections per year, see your doctor. You may need further evaluation or maintenance medication to prevent recurrences.
Conclusion
Most cases of abnormal white vaginal discharge are caused by the fungal infection candidiasis or the bacterial infection bacterial vaginosis. Yeast infections produce a thick, white, cottage cheese-like discharge. BV results in gray/white discharge with fishy odor.
Other causes like STDs, vaginitis, cervical inflammation should also be considered. While some amount of discharge is normal, any changes in color, consistency, or smell should warrant medical evaluation.
Maintaining vaginal health through proper hygiene practices can help prevent imbalance and infections. But see a doctor right away if you experience any unusual discharge to get appropriate treatment.