Vaginal Discharge and Vaginal Bleeding
Vaginal discharge and vaginal bleeding are common for most women. Most of the time these symptoms are part of a normal cycle of monthly changes for women. Common causes of abnormal discharge and abnormal bleeding are given below.
What are the common causes of vaginal discharge?
This refers to the changes in your discharge associated with your normal monthly period (menstrual cycle). After you have produced an egg (around day 14), you may notice that you seem to have a lot more mucus in your vagina. This usually continues until your period starts. This is normal and is caused by the hormones in your body. This type of discharge is usually clear and has no nasty smell.
Similarly, when you are pregnant, you have a lot of this same hormone in your body. Many women notice they have a heavy normal discharge during pregnancy. Some contraceptives with hormones in them can make your discharge heavier too.
Some women are aware that they get a discharge for a day or two after sex. If the man 'comes' (ejaculates) inside the vagina, most of his semen will leave the vagina as a vaginal discharge unless he used a condom. There will also be fluid that the glands of the vagina make during sex.
In small baby girls, discharge (and sometimes bleeding) can be caused by the effect of their mothers' hormones. This only occurs in newborn babies, as the hormones affect the baby whilst they are in the womb (uterus).
This is anything in the vagina that isn't normally there. Young children sometimes put small toys there and then can't get them out. In women the most common foreign body is a forgotten tampon.
Non-sexually transmitted infections
These are types of discharge that are caused by infections. Neither is transmitted during sex.
- Bacterial vaginosis (BV): this is a common cause and makes a discharge, often with a noticeable fishy smell that may be worse after sex or after a period. BV is NOT a sexually transmitted infection (STI). It is caused by an overgrowth of normal germs (bacteria) in the vagina. Symptoms are often mild and BV may clear without treatment. Other cases can be treated with antibiotics. See separate leaflet called Bacterial Vaginosis for more details.
- Thrush (candida): this is the second most common cause of a vaginal discharge. (The most common cause of vaginal discharge is BV - above.) The discharge from thrush is usually creamy white and quite thick but is sometimes watery. It can cause itch, redness, discomfort or pain around the outside of the vagina. The discharge from thrush does not usually smell. Some women can have some pain or discomfort whilst having sex or whilst passing urine if they have thrush. See separate leaflet called Vaginal Thrush for more details.
Sexually transmitted infections
Symptoms of STIs can vary. The following are possible symptoms to look out for:
- Vaginal discharge.
- Abnormal vaginal bleeding.
- A sore, ulcer, rash, or lump that appears around the vagina, vulva or anus.
- Pain when you have sex or pain when you pass urine.
The most common infections causing vaginal discharge are chlamydia, gonorrhoea and trichomonas. See separate leaflet called Sexually Transmitted Infections for more details.
Other rare causes of discharge
Sometimes polyps on the neck of the womb (cervix) can cause a discharge. A polyp is a small fleshy lump. They can usually be seen when your doctor or nurse examines you. They are easily removed (this may need to be done in hospital) and are very rarely cancerous. Sometimes the covering of the neck of the womb changes and becomes more fragile and produces more discharge. This is called ectopy (or ectropion). It is not serious and often doesn't need any treatment. See separate leaflet called Common Problems of the Cervix for more details.
Some cancers such as cancer of the womb and cancer of the cervix can also cause a discharge. There are usually other symptoms and it would be very unusual to have discharge as the main symptom of these cancers.
Some skin conditions such as dermatitis and lichen planus can also cause a vaginal discharge. They also have other symptoms with them. The most common is itch. Your doctor may examine you to reassure you about these rarer causes.
What happens during a period?
For several days, approximately every month, there is bleeding from the vagina. This is called a period (menstruation). The amount of blood loss varies from period to period and from woman to woman. Some women have a dark scanty loss and some have a heavier loss which is a brighter red. Sometimes clots are passed, especially if the loss is heavy. Sometimes there are small flaky fragments in with the menstrual blood. A normal amount of blood loss during each period is between 20 and 60 ml. (This is about 4 to 12 teaspoonfuls). Bleeding can last up to eight days but five days is the average. The bleeding is usually heaviest on the first two days. Some period pain - in the lower tummy (abdomen) - is common and normal.
Starting to have periods is part of growing up for girls. Periods usually start to occur around the same time as other changes happen to the body, such as starting to develop breasts or to grow pubic hair. The average age to start periods is 13. However, it is normal to start at any time between the ages of 11 and 15. A small number of girls may start before or after this. Periods continue until the menopause, which is usually between the ages of 45 and 55. See separate leaflet called Periods and Some Period Problems for more details.
This is common. It is difficult to measure blood loss accurately. Periods are considered heavy if they cause such things as:
- The need for double sanitary protection.
- Soaking of bedclothes.
- Passing clots.
- Restriction to your normal lifestyle because of heavy bleeding.
See your doctor if your periods change and become heavier than previously. There are various causes of heavy periods. However, in most women, the cause is unclear and there is no abnormality of the womb (uterus) or hormones. See separate leaflet called Heavy Periods (Menorrhagia) for more details.
Bleeding at abnormal times
If you have vaginal bleeding at times apart from your expected periods, you should see a doctor. This includes if bleeding occurs after you have sex, or after the menopause.
Bleeding after sex is also called postcoital bleeding. It may be because the neck of the womb (cervix) is sore and inflamed. This can make it more likely to bleed after sex. The most common reasons for this are infections - such as chlamydia - and hormonal changes.
Bleeding in between your periods (intermenstrual bleeding) can also occur. This has several causes. They include infections or polyps. Polyps are small fleshy lumps that can occur on the neck of the womb or inside the cavity of the womb.
Breakthrough bleeds are small bleeds that occur in the first few months after starting the contraceptive pill. They usually settle over a few months.
The interval between periods can vary in some women. Irregular periods may indicate that you do not ovulate every month and the balance of the female hormones may be upset. See a doctor if your periods become irregular in your younger years, especially if you are having fewer than four periods a year. However, irregular periods are common in the few years leading up to the menopause.
Periods which stop (amenorrhoea)
Pregnancy is the most common reason for periods to stop if you are aged under 50 years. If you have vaginal bleeding in your pregnancy, you should see your doctor.
However, it is not uncommon to miss the odd period for no apparent reason. However, it is unusual to miss several periods unless you are pregnant. Apart from pregnancy, other causes of periods stopping include:
- Losing weight.
- Exercising too much (long-distance runners, etc).
- Hormone problems, such as polycystic ovary syndrome (a common cause of irregular periods).
- The menopause.
As a rule, it is best to see a doctor if your periods stop for several months without explanation. Also, see a doctor if your periods have not started at all by the age of 16.
The menopause is your last period. It occurs because, as you get older, your ovaries stop producing eggs. They also make less of the main female hormone called oestrogen. It usually occurs around 51 years of age in the UK. A premature menopause is one that happens before the age of 45 years but this is uncommon. There are other symptoms that many women may have when they are going through the menopause. The most common is hot flushes. See separate leaflet called Menopause and HRT for more details.
Note: if you have any bleeding after you have had your menopause, you should see your doctor.
What should I do If I have abnormal bleeding or vaginal discharge?
You should go to see your doctor. They will ask you about the pattern of your bleeding. They will want to know how you used to bleed and how it has changed.
They will ask about how heavy the bleeding is. If you have heavy bleeding they will ask about clots and flooding. 'Flooding' refers to the feeling you may have of a gush of blood coming down. You may sometimes bleed on to your clothes or the bedsheets at night. Your doctor will want to know about this.
They will want to know if you are taking any medications - this includes ones you may have bought in a health or herbal shop. Sometimes these can interact with prescribed medicines such as the contraceptive pill.
They may ask about your sex life. This is to try to predict how likely it is that you may have an infection. They will ask about contraception and if you use condoms. Condom use is protective against STIs.
For many conditions the doctor will have a good idea of what is wrong just by talking to you, so examination isn't necessary. Otherwise they may ask to examine you. You are entitled to ask for a chaperone whilst you are being examined - even if it is a female doctor. They will ask you to remove your clothing from the waist down. If you wear a loose skirt, you may only need to remove your knickers. You will be asked to lie on your back on the examination couch. They may examine you with two fingers inside your vagina. This can tell them how big your womb is and if the womb is tender.
Sometimes the doctor may also use an instrument called a speculum. This goes into your vagina. This gently opens the vagina and allows the cervix to be seen (at the top of the vagina). They will be able to see any discharge and take a sample with a swab. This can be sent to the laboratory to tell them if any infection has caused the discharge. They will also be able to see any sore areas or polyps on the neck of the womb.
When the doctor has all the results, they will discuss with you whether you need any more investigations such as an ultrasound scan, or whether you need to see a specialist - a gynaecologist.
Often, reassurance may be enough.
Further reading & references
- Vaginal discharge; NICE CKS, May 2013 (UK access only)
- Bacterial vaginosis; NICE CKS, May 2013 (UK access only)
- Heavy menstrual bleeding; NICE Clinical Guideline (January 2007)
- Management of Unscheduled Bleeding in Women Using Hormonal Contraception; Faculty of Sexual and Reproductive Healthcare (2009)
- Management of bacterial vaginosis; British Association for Sexual Health and HIV (May 2012)
- Management of Vaginal Discharge in Non-Genitourinary Medicine Settings; Faculty of Sexual and Reproductive Healthcare (Feb 2012)
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Patient Platform Limited has used all reasonable care in compiling the information but makes no warranty as to its accuracy. Consult a doctor or other healthcare professional for diagnosis and treatment of medical conditions. For details see our conditions.
Dr Jacqueline Payne
Dr John Cox