Understanding the Vagina: Normal vs. Abnormal Vaginal Discharge & Infections

In short: Normal vaginal discharge is clear or white, with no smell or itching, and is part of vaginal health. Abnormal discharge differs with the cause: white and curd-like with itching (thrush), yellow or green (bacteria), or frothy with a smell (trichomonas). For an accurate diagnosis and the right treatment, have the discharge examined under the microscope or cultured by the doctor.

The vagina is a remarkable organ, and understanding how it works can help you recognize what’s healthy and when to seek care. It develops from the embryonal Mullerian duct and consists of fibromuscular tissue extending from the vulva to the uterus, with its opening protected by the labia. The vagina is lined with stratified squamous epithelium, and its inner surface has a folded texture that creates gentle friction during intercourse. Beneath this lining is a layer of smooth muscle that contracts during labor and also during sexual activity. In women of childbearing age, the vagina typically measures about 6.0 to 7.5 cm along its front wall and around 9 cm along its back wall, and it naturally expands in size during sexual arousal.

The vaginal wall doesn’t contain glands, but its membrane still produces secretions that keep the area moist and healthy. The Bartholin glands, located on either side of the vaginal opening, also contribute to natural lubrication. Around ovulation, the cervix produces alkaline mucus that helps create a friendlier environment for sperm survival. As women get older, vaginal lubrication naturally decreases, and after menopause, lower estrogen levels can lead to thinning of the vaginal walls — a completely normal part of aging that your doctor can help you manage if it becomes uncomfortable.

The hymen is a thin membrane that partially covers the external vaginal opening. Its response to sexual intercourse varies from person to person — depending on its elasticity, it may return to its original shape, stretch gradually, or change after repeated penetration.

Functions of the vagina:

• It is a path for passage of uterine secretions such as menstrual blood, to exit the body.
• The vagina stretches during child birth due to its elasticity and this creates a channel for the passage of the newborn outside the uterus. That is why the vagina is called the birth canal.
• It receive the penis during sexual intercourse.
• • The lower third of the vagina, especially near the opening, contains nerve endings that cause the pleasure sensation during sexual intercourse. However, the other parts of the vagina have insufficient nerve endings to make the childbirth less painful.
• When arousal sensations have been achieved, lubrication will be produced in the walls of the vagina that will reduce the friction that may happen during intercourse. And with arousal, the vagina expands especially its last 2/3rd in length and width, and the vagina will stretch to accommodate the size of the penis. This will stimulate the penis to result in orgasm and ejaculation which hopefully leads to fertilization.
• G-spot (Grafenberg spot) is described as an area on the front wall of the vagina, about 5 centimeters from the entrance. Many women find stimulation of this area pleasurable, but studies have not found a distinct anatomical structure there; the sensitivity is thought to come from the nearby inner parts of the clitoris and the urethra.

Erogenous Zones Video | Male reproductive system Video | Response To a Sexual Stimulus Video | Female reproductive system Video

Types of Vaginal Discharge:

Normal Vaginal Discharge:

Most vaginal discharge is a natural, healthy part of your menstrual cycle. Cyclic discharge occurring at the beginning and end of the cycle is normal and usually thick, white, and odorless, while a clear, stretchy discharge is common around the time of ovulation — this is simply your body’s way of supporting reproductive health.

The vagina naturally hosts beneficial bacteria such as L. acidophilus and L. doderlein, which produce lactic acid from glycogen. This is what helps maintain the vagina’s healthy acidity.

The Bartholin glands, located on both sides of the vaginal opening, secrete mucus that helps keep the vaginal entrance naturally lubricated.

Abnormal Vaginal Discharge:

If you notice a change in your discharge that concerns you, it’s always worth having it checked by a doctor. Some signs to be aware of include:

• Thick, white and clumpy discharge is caused by fungal infection (candidiasis) and it is associated with itching, swelling, and pain.
• Bloody or brown discharge can occur just before or after a period, but if it happens between periods, after intercourse, during pregnancy or after menopause it should be checked by a doctor, as it may be due to infection, a polyp, or less commonly a precancerous or cancerous change.
• Yellow or cloudy discharge may be caused by a sexually transmitted infection such as gonorrhea or chlamydia and may be associated with burning on urination, pelvic pain or bleeding between periods; however, these infections often cause no symptoms at all.
• Trichomoniasis is associated with frothy, yellow and greenish discharge with a very bad smell and it is associated with itchiness and painful urination. Bacterial vaginosis

• Bacterial vaginosis is associated with a thin, gray or white discharge with a fishy odor, often more noticeable after intercourse or a period. It usually does not cause itching or redness, and many women have no symptoms.

• Vesicovaginal fistula (an abnormal opening between the bladder and the vagina) causes passage of urine from the vagina.
• Abnormal vaginal bleeding may be caused by:
• • Dysfunction of hypothalamus, pituitary gland, thyroid gland or the ovaries.
• Postmenopausal bleeding, most often due to thinning of the vaginal or uterine lining, but which may be caused by endometrial hyperplasia, polyps or endometrial cancer - any bleeding after menopause should be checked by a doctor promptly.
• Bleeding disorders.
• Chronic, severe inflammation.
• Benign and malignant tumors.
• Stress.
• Vitamin deficiencies.
• Puberty.
• Vaginal injuries by chemicals or foreign bodies.

Factors which increase risk of Vaginal Infection:

• Vaginal douching or washing inside the vagina.
• Sexually transmitted diseases (trichomoniasis, syphilis, gonorrhea).
• Poor hygiene.
• Recurrent urinary tract infections.
• Prolonged use of antibiotics and exposure to chemotherapy.

Uncontrolled diabetes or weakened immunity.

Types of Vaginal Inflammation (Vaginitis):

• Vaginal and urinary tract infection. It is usually transmitted by sexual intercourse (gonorrhea, bacteria, trichomoniasis, etc)
• Atrophic vaginitis: Caused by the decrease of estrogen which happens in post menopausal women and will lead to thinning and atrophy of vaginal tissues, and to dryness. This will cause symptoms such as itching, burning, whitish discharge, and painful sexual intercourse.
• Fungal infection: This increases in pregnant women, in diabetics, in users of combined oral contraceptive pills and it increases after taking an antibiotic which will kill the vaginal bacteria that transform glycogen to acids.
• Inflammation of vaginal erosions that may result from injuries by foreign bodies or chemicals or by ulcers that is associated with Behçet’s disease.

Diagnoses of Vaginal Infection:

If you’re experiencing unusual discharge or discomfort, the best step is to see your doctor, who can check the vaginal pH and take a swab for examination under the microscope, PCR testing or culture to identify the cause accurately. Cervical screening (an HPV test or Pap smear) does not diagnose vaginal infections, but your doctor may check whether it is due.

Tips to avoid Vaginal Infections:

• Gently wash the outside area once a day with plain water or a soap substitute (avoid perfumed soaps and washing inside the vagina), then pat the area dry.
• Use the cream that is prescribed by the doctor after washing the infected area and keep it exposed for 30 minutes.
• When using the vaginal ovules, you have to insert it as far as you can inside the vagina and it is preferred to be used before going to sleep.
• Avoid nylon underwear. Cotton underwear is preferred.

If you notice persistent or concerning vaginal symptoms, don’t hesitate to reach out to Dr. Najeeb Layyous’s clinic for a thorough evaluation and personalized guidance — early attention can help you feel comfortable and confident about your health again.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist