It’s difficult to feel your best if your vagina isn’t healthy. As a Nurse Midwife, I am always a little surprised by the gap in knowledge between my patients and I. It saddens me that no one has taken the time during their health care experiences to provide basic education about vaginal health. I have some women who come in all the time, convinced something is wrong because they see discharge. Not all discharge is bad, but these women have the misconception that it should never be present. I have diagnosed and treated women for a sexually transmitted infection that they have never even heard of. It’s difficult to ask for a test if you don’t even know it exists. Pretty much everyone knows about gonorrhea and chlamydia, but hasn’t heard of the third infamous culprit. Almost every week, I have someone come in who is convinced she has a yeast infection, but when I ask about symptoms, they do not match up. She may have used Monistat over the counter, not realizing that an antifungal is not the treatment for a pH imbalance. This guide will address the difference between normal and abnormal discharge, different infections, and tips for keeping your vagina happy.
So all discharge isn’t bad?
Discharge can be completely normal and will change during different times in your menstrual cycle. Immediately after your period, the vagina will be drier, and then mucus will develop over time. During ovulation, your discharge will be visible and appear clear and slippery, imitating egg whites. I have many women who will come in when this appears and state they have issues every month before the period. However, the cultures are repeatedly negative. They are simply experiencing normal discharge that occurs when your body is trying to conceive. So how exactly do you tell the difference between normal and abnormal discharge? I have laid out the differences in the chart below. However, if you are ever concerned, it is best to be evaluated by a health care professional to prevent delay in necessary treatment.
So what are symptoms of a yeast infection?
The main symptom associated with a yeast infection is very annoying itching! It would be extremely difficult to ignore this symptom. You would also notice clumpy yellow or white discharge resembling a cottage cheese appearance. Some people also experience burning and generalized irritation. A yeast infection is basically a fungal infection in your vagina, so it feeds off of moist, dark environments. Here are the top ways to prevent it:
Wear looser fitting clothing - If clothes are really tight, the vagina will be even more moist throughout the day, which causes the fungi to grow
Wear cotton underwear
Change pad, panty liner, tampon often
Avoid soaps with a fragrance - I recommend Dove unscented, as some women’s bodies are too sensitive to the chemical that is used to provide the fragrance. Also, please don’t stick your whole finger inside your vagina to put soap there, this will cause an immediate burning sensation and make the vagina too basic.
Shower after the gym, pool, beach immediately
Consume less sugars and carbs
NEVER douche - This only makes your symptoms worse by knocking off your natural pH balance
Take probiotics - May consume yogurt to get it naturally. Alternatively, take probiotic capsules daily which are found in the vitamin section of the store or order here:
If you are experiencing recurrent yeast infections, please ask your provider to screen for diabetes as this can often be a sign. This is another reason why it is important to decrease the sugar and carbs in your diet, to prevent diabetes that could be developing. In terms of treatment, I recommend Monistat 3 day or the generic Miconazole. Trust me, the generic works just fine and is more affordable. I would prefer a woman does this if she has to wait a few weeks to meet with her healthcare provider. Sometimes my patients cannot get in right away, and I always feel bad that they suffered through the itching so long. I often prescribe a 1-day antifungal pill called Diflucan or 3 day antifungal vaginal suppository treatment called Terazol.
So what is bacterial vaginosis?
Bacterial vaginosis (BV) is an overgrowth of harmful bacteria in the vagina, which changes your natural pH balance. This change in pH gives the vagina a fishy smell and often produces gray or white, watery discharge. When a woman comes in saying she has an excess of discharge with a smell that’s not right, it’s almost always BV. You can prevent BV similar to how you prevent a yeast infection, such as using probiotics, not douching, and using unscented soaps. Although BV is not a STI, you can develop it if you have a new or multiple sexual partners. When your body is introduced to bacteria that it is not used to or various, different bacteria at once, this changes your pH. For BV that occurs sporadically, it can be treated with a course of antibiotics, administered either orally or vaginally. The most common pill is called Flagyl and the vaginal suppository is either Clindesse or Nuvessa. Some of my patients follow all the prevention methods, including daily probiotics. Unfortunately, they still experience recurrent BV every month. For these women, I recommend switching to vaginal probiotic suppositories. These are placed in the vagina, so it provides targeted rebalancing and can be used weekly. Another treatment I advise is boric acid suppositories. These can be made in special pharmacies, so check with your healthcare provider. You can also try these here.
A few women have asked me about more natural methods, such as inserting Greek yogurt. This makes sense to me since the yogurt has probiotics; however I am not trained in natural medicine and haven’t been able to find evidence-based research on this practice.
So do I have a STI?
The two infections mentioned above are not sexually transmitted. The 3 STI’s that can be diagnosed through a vaginal culture are gonorrhea, chlamydia, and trichomoniasis (Trich). Gonorrhea and chlamydia can often occur together, with chlamydia being the most commonly reported STI in the United States. Trich is less known; however, in my particular practice, it is the one I diagnose the most. It is basically a parasite and can be seen under microscope rapidly moving around. Ironically, the more serious infections often do not manifest symptoms in many women. This is why it is so important to get tested regularly! If you are in a monogamous relationship, I recommend once a year (I have diagnosed many women in long term relationships). If you have multiple partners, I recommend at least every 6 months for blood work and 3 months for vaginal cultures. Occasionally, symptoms will be present, especially if left untreated for a few weeks.
Symptoms of STI
Discomfort during sex
Bleeding after sex
Spotting in between periods
Abnormal discharge - Foul odor, yellow, gray, green, dark brown
Burning/pain when urinating
It is extremely important to be treated immediately as all of these can lead to infertility if it progresses to the reproductive organs. Chlamydia is treated with Azithromycin, which is an antibiotic. Gonorrhea also requires antibiotics, one of which is administered as an injection (Ceftriaxone). Trich is treated with the same antibiotic that treats BV, which is Flagyl. Sometimes I will treat my patients and when they repeat the cultures, they are positive again. You must remember to have your sexual partners treated as well and wait at least 7 days after you BOTH are treated to engage in sexual activity again. Prevention is key and can only be done by utilizing condoms, limiting sexual partners, and knowing their status.
The purpose of this guide was to provide basic information about what constitutes as abnormal discharge and to educate on the most common vaginal infections. Unfortunately, there are many more infections that would have been too much to discuss in this blog post, such as HPV, genital warts, mycoplasma, and ureaplasma. However, if you are able to identify when something is wrong, you know when it is time to see your health care provider in order to be properly diagnosed. Education is truly power; the more you know, the more you can advocate for yourself and incorporate best practices for vaginal health.
xoxo, Global Midwife
Link for YouTube video!