Let’s be honest- vaginal discharge can feel like one of those things no one really explains properly. Is it normal? Is it weird? Why does it change? And what’s the deal when it suddenly smells funny?
To get real answers, we spoke with Dr Deborah Lee, an expert from Dr Fox Online Pharmacy, who’s worked in Sexual Health for over 30 years. Her no-nonsense, deeply informed approach helps break down the science behind discharge - and why understanding what’s happening down there is not just normal, but essential.
Let’s start with the basics - what actually is vaginal discharge, and why does it happen?
Before you can understand what’s normal or not, you’ve got to know what discharge is in the first place. Dr Lee gives us a proper breakdown of what your body is doing - and why it’s totally natural.
Dr Deborah Lee explains:
“Vaginal discharge is a perfectly normal part of being female. It usually starts around 6–12 months before you have your first period. You start to get it because your hormone levels are changing. Oestrogen levels are rising and you are going to start ovulating.
"Think of the vagina just as a muscular tube that runs from your vulva up to your cervix. The cervix is the lower end of the uterus (womb). The vaginal wall does not have any glands, so it doesn’t secrete anything by itself, but it does have a rich network of tiny blood vessels called capillaries. Fluid leaks from these capillaries into the vagina. This vaginal fluid bathes the vaginal walls and provides vaginal lubrication. The force of your blood pressure physically pushes this tissue fluid through the capillary walls. This is the basis of normal vaginal discharge.
"Normal vaginal discharge is made up of vaginal fluid mixed with dead epithelial cells. The epithelial calls are the cells found throughout the body at mucosal surfaces. They have a lifecycle and are always being renewed and replaced. Dead epithelial cells are continually being shed from the vaginal walls, the cervix, and the uterus.
"The discharge also contains water, mucous produced by the cervix, and leucocytes (white blood cells). The healthy vagina contains large numbers of bacteria, mostly lactobacilli, which produce lactic acid. They keep the vaginal pH acidic. The fact that the healthy vagina is acidic (not alkaline) means it is not a suitable environment for the growth of other microorganisms.
"Normal vaginal discharge is white, clear, or sometimes cloudy, has no specific smell, is not blood-stained, and has an acidic pH between 3.8–4.4. The amount of discharge you have, can vary considerably, from half to one teaspoon or more per day. Around the time of ovulation, vaginal discharge becomes thinner, stringy and stretchy. Women can be taught to recognise this as a sign of ovulation.
"As life progresses, women generally get to know what vaginal discharge is normal for them and they are the first to notice if something has changed.
"Things that can increase vaginal discharge include sexual arousal, pregnancy and the contraceptive pill. Local allergic reactions to hygiene products can cause vaginal discharge. Other causes include Infections such as thrush (candidiasis), bacterial vaginosis (BV) and STIs such as chlamydia and gonorrhoea.
"Things that can reduce vaginal discharge - cause vaginal dryness - include stress, anxiety and depression, childbirth, breastfeeding, smoking, chemotherapy and menopause. Progestogens in contraceptives can thicken or reduce vaginal discharge."
How can someone tell the difference between daily discharge, spotting, and the start of their period?
Ever been unsure whether your period's starting - or if it’s just spotting? Dr Lee shares exactly what to look for (and when it’s time to take note).
Dr Deborah Lee says:
"Vaginal discharge should not be brown, red or blood stained. If you have bleeding in between your periods or after sex you must go to the Sexual Health Clinic or see your GP."Having said that, it’s quite normal to have spotting, as in light bleeding/brownish discharge, a day or two before your period starts. It’s a good idea to keep a note of the first day of each period, so you start to see a pattern, and can recognise your menstrual cycle. At first this can be very irregular, but should settle to a regular monthly bleed.
"We time the period from the first day of proper bleeding to the next first day of proper bleeding. The average cycle length is a bleed every 28 days, but this varies considerably, usually between 21 and 35 days. Some people have few, light periods. Others have frequent heavy periods. A period may last just a few days or over a week. The key is to try and recognise your cycle and get to know what is normal for you.
"Menstrual fluid often smells slightly metallic as it has iron in it, and may be acidic. Normal vaginal discharge does not smell. It has an alkaline pH of around 7.4.
"Breakthrough bleeding is also common on almost all types of contraception. Generally, it occurs in the first few months after starting a new method, and settles with time. But if this is not the case, don’t stop taking your contraception, but you must go back to the clinic or see your GP."
Is it normal for discharge to change colour, consistency or smell throughout your cycle?
The short answer? Yes - but it depends. Dr Lee explains how to spot the difference between normal changes and signs of infection.
Dr Deborah Lee says:
"It’s absolutely natural for vaginal discharge to change throughout the cycle. The important thing is to take notice of it and get to know what is normal for you. If something breaks from the normal pattern, you need to seek medical help."Infective discharge can be heavier than normal, thick and lumpy, or thin and watery. It can also be yellow, green, brown or blood stained. It may have a foul smell. BV (which is not an STI), for example, often smells like rotting fish. However, do remember than the majority of those with an STI have no symptoms at all. If you have been at risk, especially if you are aged 25 or under, and have never been screened, you should make an appointment at the Sexual Health Clinic or the GP surgery to be checked.
"Common causes of vaginal discharge are thrush and BV. In young people, it is not uncommon in those with chlamydia and gonorrhoea. Other frequently seen causes of vaginal discharge are due to genital irritation from hygiene products – do not use wet wipes or vaginal douches in the genital area. The vagina is self-cleaning and only needs a gentle wash on the outside with warm water, no perfumed soap or other products, once a day. A forgotten tampon can cause a foul-smelling discharge and is not uncommon in the Sexual Health Clinic. It is very rare for vaginal discharge to be due to cancer in the genital area, especially in young people, but it can happen."
When should someone actually worry about their discharge or speak to a doctor?
It’s not always easy to know when to get checked. Here’s Dr Lee’s clear list of when to take things seriously and reach out for help.
Dr Deborah Lee says:
"You should worry about vaginal discharge if you have any of the following:
- The discharge is brown or bloodstained
- The discharge is heavier than normal, or has changed in colour or consistency - infective discharge can be yellow, green, or red/brown
- You have symptoms such as vaginal soreness, itching or irritation, painful sex, pelvic pain, pain passing urine or bleeding in between your periods or after sex
- You have blisters/ulcers or lumps down below
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You have been at risk of an STI - This could mean any of the following and applies even if you used a condom:
– You’ve had sex with a new partner in the past 3 months
– You’ve had sex with more than one partner in the past 3 months
– Your partner has been unfaithful
– Your partner has been diagnosed with an STI
– You are aged 25 and under
– You’ve had sex, but never been tested
– You’ve had sex with a gay or bisexual partner
– You are an IV drug user, or have had sex with an IV drug user
– You’ve had sex on holiday, including a holiday abroad
– You’ve paid for sex, or been paid for sex
Why do so many people feel embarrassed about discharge - and how can we change that?
Let’s be real - talking about discharge can feel awkward. But Dr Lee wants you to know: there is nothing to be ashamed of.
Dr Deborah Lee says:
"Having anything wrong down below can feel overwhelming and make you feel very anxious and upset. But ... it won’t get better unless you have the professional help and the tests you need. As you get older, you will continue to need pelvic and genital exams, so somehow you need to come to terms with this."Having worked in Sexual Health for over 30 years, I want to stress that however awful you feel, you won’t have anything down below we haven’t seen before! Even the Queen sits on the toilet! Try and normalise the episode - this is just a part of your body, like any other part of your body.
"The staff in the clinic are trained and will do all they can to put you at your ease and be non judgemental. The consultation is confidential and your GP does not need to be informed. In many cases, you will be simply asked to go the toilet and do your own swab, and may not need to be examined.
"You can ask for a doctor or nurse of the sex of your choice. You can take a friend or relative with you. The examination will be done as quickly as possible, with all efforts made to maintain your dignity. If at any stage, you want them to stop you just have to say so. You are in charge.
"Things you can do before your visit to ease anxiety:
- Check you know the date and time of your appointment and how to get to the clinic in plenty of time
- Take a friend with you
- Write down any questions so you won’t forget to ask
- Practice deep breathing exercises in the waiting room to calm your nerves
- Get informed. Read up on the clinic so you know what to expect when you get there
- You might like to watch a video of a female STI screen – click here
- You can put your headphones on and listen to music during the examination if you want to
Final Thoughts
Discharge is normal. Talking about it should be too. Understanding what’s happening with your body - and knowing when something’s not quite right - is one of the most powerful things you can do for your health. Thanks to Dr Deborah Lee for helping us ditch the shame and make vaginal health something we can actually talk about.
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