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Vaginal discharge is normal and its purpose is to protect and clean the vagina. It consists of discharge from the vaginal and cervical mucosa and includes cells detached as a result of constant regeneration of the mucosa. Rod-shaped bacteria that produce lactic acid form the main microbiota of the vagina, which makes the vaginal discharge acidic.

Female sex hormones, particularly estrogen, regulate the amount and composition of vaginal discharge. This is why its amount varies according to the woman’s age and stage of the menstrual cycle. The amount of vaginal discharge increases at the beginning of the menstrual cycle and is at its heaviest for a few days around the middle of the cycle before ovulation. This is when clear and loose cervical mucus is excreted. At the end of the cycle after ovulation, the discharge becomes thicker and its amount decreases. For women on the pill, there’s usually less vaginal discharge, whereas during pregnancy there’s more of it.

Increased vaginal discharge, itching and burning are common symptoms that may be caused by a vulvar or vaginal infection, but there are many other causes too. Good genital hygiene is important, but excessive washing particularly with soap dries the skin and mucosa. Scents and other chemicals, tight, chafing clothes, and continuous use of pantyliners may cause symptoms. Long-term use of combined contraceptives may cause vaginal and vulvar dryness. Vulvar symptoms are more common among women with atopic skin. Allergies and skin conditions may also cause long-term vulvar itching. Suppositories and creams used to treat the symptoms may cause contact allergy. Symptoms may also be due to psychological reasons.

Self-care

If you have genital itching and dryness that disrupts your life, you should first consider changing your washing routines or other routines of intimate care. Itching caused by dryness of the skin and mucosa can usually be reduced by applying oils. You should use thin skin care oils for the vulvar region. If the symptoms don’t disappear within 2 to 3 weeks of treatment, contact a healthcare professional.

If you have clear symptoms of a yeast infection and you have had such symptoms before, you can use over-the-counter products obtained from a pharmacy. The primary choice is topical treatment: use suppositories for 1 to 3 days and if necessary vulvar cream for 1 to 2 weeks. Another treatment option for yeast infections is fluconazole (150 mg by mouth).

When should you seek treatment?

You should seek treatment if you have symptoms of infection, particularly if you suspect a sexually transmitted infection. Examinations are also required if vaginal discharge is accompanied by bloody discharge, urinary problems, abdominal pain or systemic symptoms.

If your vaginal discharge is heavy and has changed in colour or composition or smells bad or involves vulvar itching or burning, you may have a vaginal infection, the most common being yeast infection. If there’s blood in your vaginal discharge and you also have lower abdominal pain, urinary problems, frequent urination, burning when urinating or bleeding outside your period, you should see a healthcare professional.

Bacterial vaginosis is another common cause of abnormal vaginal discharge. Its typical symptom is increased, foul-smelling, greyish, continuous vaginal discharge that may be accompanied by itching and mucosal irritation. Bacterial vaginosis is not actually an infection but an imbalance of the vaginal microbiota caused by overgrowth of vaginal bacteria in which the normal lactic acid microbiota has been replaced with anaerobic bacteria. Symptomatic bacterial vaginosis can be treated with topical medication or medication taken by mouth.

Information sources: The Finnish Medical Society Duodecim: Terveysportti, Lääkärin tietokanta database

FSHS General Practitioner / 09 January 2020

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