Vaginal health: discharge, thrush, BV and gentle washing

Most questions about vaginal health start with discharge: what is normal, what a change might mean, and whether washing more would help. This guide brings together what the NHS, the WHO and the CDC say about normal discharge, thrush, bacterial vaginosis, gentle washing and vaginal dryness. Where the sources disagree, it says so. It is general information, not medical advice, and it cannot speak to your own situation. For that, a doctor, a nurse, a pharmacist or a sexual health service is the right place to ask.

What normal discharge looks like

Vaginal discharge is normal, and most women and girls have it. The NHS describes it as a fluid or mucus that keeps the vagina clean and moist and protects it from infection. It can appear at any age, and it cannot be prevented, because it is part of how the body works.

According to the NHS, discharge is not usually anything to worry about when it:

• Has no strong or unpleasant smell.
• Is clear or white.
• Is thick and sticky, or slippery and wet.

The amount varies. Discharge is usually heavier during pregnancy, with sexual activity and when using contraception, and it is often clearer, wetter and more noticeable around ovulation, between periods. Contraception methods covers the options themselves.

When discharge changes

A change in smell, colour or texture might be a sign of an infection, the NHS says. It also asks people not to diagnose themselves, and to see a doctor if they are worried. With that warning in mind, here are the possible causes it lists:

Discharge	Possible cause
Smells fishy	Bacterial vaginosis
Thick and white, like cottage cheese	Thrush
Green, yellow or frothy	Trichomoniasis
With pelvic pain or bleeding	Chlamydia or gonorrhoea
With blisters or sores	Genital herpes

Several of these are sexually transmitted infections. The guide to STI testing explains what a test involves. Sexual health services can also help with abnormal discharge, since they treat problems of the genitals and the urinary system.

Thrush

Thrush is a common yeast infection. The NHS says it is usually harmless, but it can be uncomfortable and keep coming back. The WHO adds that vaginal yeast infection affects millions of women worldwide, and the CDC calls it one of the most common fungal infections.

It is caused by Candida, a yeast that normally lives in the body without trouble. The CDC says everyone has some on the skin and in places such as the mouth, throat and vagina, usually with no symptoms. Thrush develops when it grows out of control, in warm, moist conditions, when the natural balance changes.

The NHS describes these symptoms in women:

• White discharge, often like cottage cheese, which does not usually smell.
• Itching and irritation around the vulva and vagina.
• Soreness and stinging during sex or when peeing.

The WHO describes intense itching, redness and soreness of the vulva, and a thick, white, curd like discharge, and notes that thrush is not a typical cause of urinary infections. Sometimes there are no symptoms at all, the NHS says.

The three sources name similar triggers:

• Antibiotics, which can kill the healthy bacteria that keep yeast in check.
• Pregnancy, and hormone changes such as those of the menstrual cycle or the contraceptive pill.
• Diabetes that is not well controlled.
• A weakened immune system.
• Irritated or damaged skin, and hormone replacement therapy, which the NHS adds.

Thrush is not classed as a sexually transmitted infection, but sex can trigger it and, less often, pass it on, the NHS explains. The WHO says the same. Both say partners do not need treatment unless they have symptoms themselves.

Treatment is usually an antifungal medicine, the NHS says: a tablet to swallow, a tablet placed in the vagina (a pessary) or a cream for the irritation. A doctor may ask about symptoms and, if things are not clear, look at the area or take a swab. The NHS adds that a pharmacist can help when thrush has been diagnosed before, and can be asked for a private area to talk. The WHO notes that resistance to some antifungal medicines is spreading, and that home remedies are best discussed with a health professional first. On diet, it says the evidence for strict anti yeast diets is limited.

One practical point from the NHS: antifungal creams can damage condoms and diaphragms, so contraception might not work during treatment. Safer sex basics covers condoms in more detail.

Bacterial vaginosis

Bacterial vaginosis, often shortened to BV, is a change in the natural balance of bacteria in the vagina. The WHO calls it a very common cause of discharge in women of reproductive age and says it can be treated. The exact cause is not fully known, according to all three sources.

The main sign is an unusual discharge with a strong fishy smell, particularly after sex, the NHS says. The discharge may also become greyish white, thin and watery. Many women with BV have no symptoms at all: the NHS says half, while the WHO and the CDC speak of some or many.

On itching, the sources differ. The NHS says BV does not usually cause soreness or itching. The WHO and the CDC, on the other hand, list itching or irritation around the vagina, and burning when peeing, among possible symptoms.

What raises the chances, according to the sources:

• Douching or washing inside the vagina (WHO, CDC), and inserting herbs or other products into it (WHO).
• Sex without a condom, and a new partner or several partners (WHO, CDC).
• An IUD, the contraceptive device, and perfumed products in or around the vagina (NHS).

BV is most often found in people who are sexually active, but it can happen without sex: the NHS and the CDC both say so. It is not classed as a sexually transmitted infection, the NHS says, but sex can trigger it, and it can pass between partners who have a vagina. The CDC adds that it cannot be caught from toilet seats, bedding or swimming pools.

It matters for two reasons. All three sources say BV raises the risk of other sexually transmitted infections, including HIV. The NHS suggests this may be because BV makes the vagina less acidic and lowers its natural defences. BV is also linked to problems in pregnancy, such as an early birth. The NHS says the chance of complications is small and that BV causes no problems in most pregnancies, while the CDC says treating it during pregnancy is very important.

Treatment is usually antibiotic tablets, gels or creams prescribed by a doctor or a sexual health service, the NHS says. A doctor or a nurse may ask about symptoms, look at the vagina and take a swab, to confirm BV and rule out an STI. A female partner may need treatment too. BV sometimes clears up without treatment, the CDC notes, but treatment helps to avoid the risks above. It often comes back, usually within a few months, and a doctor can help identify a trigger such as sex or periods.

On prevention, the CDC is candid: scientists do not fully understand how BV spreads or how best to prevent it. The steps it lists include not douching and using a condom correctly every time.

Gentle washing and clothing

On this point the sources agree. Discharge already keeps the vagina clean, the NHS says, and its advice to avoid irritation, soreness or dryness is about gentle washing of the skin around it.

Habits the NHS and the WHO describe

• Washing the skin around the vagina gently with warm water and a mild, unperfumed soap. With thrush, the NHS suggests water and an emollient instead of soap.
• Drying properly after washing.
• Showers rather than baths, which the NHS suggests for BV.
• Cotton underwear and loose clothing, and changing quickly out of sweaty sports clothes or a wet swimsuit.

And what they advise leaving aside:

• Washing inside the vagina, known as douching, which the WHO and the CDC link to BV.
• Perfumed soaps, gels, bubble bath, vaginal deodorants and scented wipes.
• Antiseptic liquids in the bath, and strong detergents for underwear.
• Creams, lotions or moisturisers not made for the vagina, which can cause more irritation or an infection.

The WHO adds that avoiding scented or harsh products helps to prevent irritation and lowers the risk of thrush. The NHS also lists not smoking among the habits that help with BV.

Vaginal dryness

Dryness has many possible causes, the NHS explains. It can show as soreness or itching in and around the vagina, pain or discomfort during sex, unusual discharge or spotting, needing to pee more often, or repeated urinary infections, which have their own guide.

It often follows a change in hormone levels: the menopause, pregnancy or breastfeeding, a hysterectomy, cancer treatment, or certain medicines such as hormonal contraception or some antidepressants. It can also come from not being aroused during sex, from perfumed products, or from a condition such as diabetes.

The NHS suggests trying a few things first, most of them available without a prescription:

• A water based lubricant before sex, in and around the vagina, on a partner or on a toy.
• A vaginal moisturiser, made to be used inside the vagina.
• Unperfumed soaps and washes.
• Different kinds of foreplay, to find what helps arousal.

Sex toy safety explains which lubricants suit which materials. When dryness comes from hormone changes, a doctor may suggest hormone treatments, and the NHS notes they are not suitable for everyone. Changes in desire, which can go together with dryness, are covered in changes in sex drive.

When to get help

The NHS suggests getting advice in these situations:

• Discharge that changes colour, smell or texture, or is heavier than usual.
• Itching or soreness, pain when peeing, or pain between the tummy and the thighs.
• Bleeding between periods, after sex or after the menopause.
• Thrush symptoms for the first time, thrush that keeps coming back, or treatment that has not worked.
• Thrush during pregnancy or breastfeeding, or with a weakened immune system.
• A change in discharge during pregnancy, to discuss with a doctor or a midwife.
• Dryness that lasts a few weeks despite what you have tried, or that affects daily life.

Unusual bleeding or discharge should not wait for a routine test either: cervical screening and HPV explains why. A doctor, a nurse, a pharmacist or a sexual health service can say what applies to you.

Questions about vaginal health

Is it normal to have discharge every day?

Yes. The NHS says discharge is normal, that most women and girls have it, and that the amount varies with the cycle, pregnancy, sexual activity and contraception.

What colour should normal discharge be?

Clear or white, according to the NHS, thick and sticky or slippery and wet, with no strong or unpleasant smell.

Is thrush a sexually transmitted infection?

No. The NHS and the WHO say it is not classed as one, although sex can trigger it and, less often, pass it on.

Is bacterial vaginosis a sexually transmitted infection?

The NHS says it is not classed as one, but sex can trigger it and it can pass between partners who have a vagina. The CDC says it cannot be caught from toilet seats, bedding or swimming pools.

Should I wash inside my vagina?

The sources say no. The NHS lists washing inside the vagina among the things not to do, and the WHO and the CDC link douching to a higher risk of BV.

Can bacterial vaginosis go away without treatment?

Sometimes, the CDC says, but treatment helps to avoid the risks linked to BV, such as other infections and problems in pregnancy. A doctor or a sexual health service can advise.