Common Vaginal and Vulval Conditions

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What Is A Normal Vaginal Discharge?

All women have a vaginal discharge. The amount varies from woman to woman. It is sometimes heavier, sometimes lighter, and sometimes you won’t notice it at all.
Menopausal women often notice that they have less vaginal discharge. It also depends on where a woman is in her menstrual cycle and whether she is using hormonal contraception. The discharge keeps the vagina healthy, but sometimes it changes in a way that causes problems.

How Would I Know If I Had A Vaginal Infection?

You might notice:
• itching, burning or soreness around the vaginal area
• an increase in the amount of vaginal discharge or an unusual or unpleasant smell
• pain on passing urine
• painful intercourse

If you have any of these symptoms you could have one of the vaginal conditions described below:

Bacterial Vaginosis

This is sometimes called BV or Gardnerella, and is caused by an imbalance in the bacteria that keep the vagina healthy. When this happens, the normal acidity of the vagina changes and some women will notice an unpleasant strong, fishy smell and a white or grey watery discharge.
Women who get bacterial vaginosis often notice the symptoms can come and go or can be associated with their periods. Even with treatment the symptoms can recur.

If a woman is pregnant and has bacterial vaginosis it is very important for her to be treated. This is because having this condition during pregnancy is associated with premature birth of the baby.

Bacterial vaginosis is generally not considered to be a sexually transmissible infection in heterosexual couples.  Male sexual partners do not need to be treated for bacterial vaginosis. Bacterial vaginosis seems to be more common in women who have sex with women and there is some thought that it might be passed from one female partner to another.

Treatment

There are several different treatment options using either oral antibiotic tablets or vaginal antibiotic cream or gel. You may need to avoid alcohol when you are taking the antibiotics as this combination may cause severe nausea and vomiting.

Aci-Jel Therapeutic Vaginal Jelly® is an acidic jelly for the vagina, which is available from chemists without a prescription. It can be used to help correct the acid balance of the vagina. Some women find it useful in reducing the recurrence of this infection.

Douching should be avoided. 

Vaginal thrush (candida)

Thrush is very common and more than 50% of women will have at least one episode in their lifetime. Thrush is caused by yeast that is found in the vagina, mouth and bowel. The yeast usually causes no problems because it is kept in balance by other organisms that live normally in the body and on the skin. If this natural balance is upset, overgrowth of the yeast can result in symptoms.  This can be caused by pregnancy, diabetes, and some medications such as antibiotics and steroids.

Some women using the contraceptive pill, vaginal ring or hormone replacement therapy may develop symptoms of thrush. Thrush is not a sexually transmitted infection (STI). Thrush symptoms include a cheesy, thick, white discharge that smells yeasty but not unpleasant. The area around the vagina is often red, itchy and sore, and sex can be very uncomfortable..

Treatment

The most common treatments for thrush are vaginal creams or pessaries that can be bought from the chemist without a prescription. Women who find that their symptoms don’t settle with this simple treatment should see their doctor for further advice.
The doctor will check that the symptoms are in fact due to thrush and not some other infection or condition. They may also suggest an oral antifungal treatment, also available without a script from the chemist. Some women get recurrent thrush and may need a longer course of treatment.

Avoid tight fitting clothes such as jeans as this creates a moist, warm environment that encourages the overgrowth of yeast. There is no evidence that changing your diet can reduce the chance of getting thrush.

Trichomoniasis

This infection is caused by a small parasite called Trichomonas vaginalis. It can be carried by both men and women and is almost always sexually transmitted. It may also be possible to pick it up from objects contaminated with semen or vaginal discharge such as shared sex toys. Most men and about half the women who carry this infection have no symptoms at all.

When women have symptoms they may notice a thin, frothy vaginal discharge, with an unpleasant fishy smell. The vagina may be sore and itchy, and some women notice a burning sensation when they pass urine. The infection is diagnosed by a special swab test or by looking for the parasites under a microscope.

Treatment

Trichomonas is treated with a short course of antibiotic tablets prescribed by a doctor. It is important that all sexual partners are treated at the same time to avoid re-infection. You should avoid alcohol while you are being treated since it can cause severe nausea or vomiting when combined with this treatment.

Vulval Dermatitis

Dermatitis is a very common cause for irritation around the vaginal entrance. The main symptom is usually itching, but if a woman scratches the area the skin can tear or split and this can cause burning and stinging as well.

Dermatitis can be caused by anything that irritates the sensitive skin around the entrance to the vagina such as the detergents used to wash underwear, panty liners, perfumed toilet papers and pads, soaps, perfumes, bubble baths, shower gels, vaginal deodorants, lubricants and spermicides. Dermatitis can also be caused by an allergy, perhaps to the latex in some condoms, to tea-tree oil, or to one of the ingredients in vaginal creams or pessaries. Often the woman will have had other allergic conditions like asthma, hay fever or eczema.

Treatment

A gentle moisturiser like aqueous cream may be advised by your doctor to stop any splits in the skin and soap substitutes are usually recommended.

A weak steroid ointment is often used to treat mild symptoms. Ointments are a bit messier to use than creams but they cause less irritation than creams or lotions, and are longer lasting. Sometimes stronger steroid preparations are needed for a short time when symptoms are more severe.

Cold compresses can help to relieve the symptoms and antihistamine tablets can be useful when the cause is an allergy.

What Can I Do To Keep My Vagina And Vulva Healthy?

There are a number of simple things you can do:
• Wear cotton or silk underwear rather than synthetics and change daily. Wear tights or stockings for as short a time as possible
• Wash underwear in hot water and pure soap and double rinse to make sure any irritants are removed before you wear them
• Change out of damp swimming costumes or sports clothes as soon as possible after swimming or exercise
• Use tampons instead of sanitary pads or panty liners. If using pads, change them regularly and avoid perfumed or deodorised pads and tampons
• Avoid tight fitting clothes such as jeans as this creates a moist, warm environment that encourages the overgrowth of bacteria and yeasts
• Never douche - except if it is specifically prescribed by a doctor to treat an infection. Douching increases your risk of vaginal irritation. A healthy vagina does not need a vaginal deodorant
• Avoid using soaps, bubble baths, bath salts, perfumes and perfumed talcs around the vaginal area. And never ever use anything harsh such as disinfectants - even diluted, near your vagina
• A gentle moisturiser like aqueous cream may be advised. Use water or soap substitutes to wash the area
• Always wipe from the front to the back after going to the toilet since this stops bowel organisms being swept into the vagina. Don’t use perfumed toilet paper because it can cause irritation.

Sometimes vaginal and vulval symptoms can be due to other more serious causes so if your symptoms do not get better make sure you see your doctor for a check up.

For Further Information

• Contact the Family Planning NSW Talkline on 1300 658 886 or go to www.fpnsw.org.au/talkline
• NRS (for deaf) 133 677
• Or visit your nearest Family Planning clinic

The information in this Factsheet has been provided for educational purposes only. FPNSW has taken every care to ensure that the information is accurate and up-to-date at the time of publication. Individuals concerned about any personal reproductive or sexual health issue are encouraged to seek advice and assistance from their health care provider or visit a Family Planning clinic.

Reviewed: May 2013   |   FPNSW 05/13