Vaginal or vulvar (labial) itching and/or discharge is a common issue. Women with vaginal itching or discharge may also have skin irritation, a burning sensation, and painful intercourse.
Many women occasionally have short episodes of vaginal or vulvar itching that resolve without treatment. Itching is considered a problem when it persists, is severe, recurs, or is accompanied by a vaginal discharge.
An odorless, milky white or thin and clear discharge from the vagina occurs normally in most women. It can result from the effects of estrogen. When levels are high, estrogen stimulates the cervix to produce secretions (mucus), and a small amount of mucus may be discharged from the vagina. Estrogen levels are high in the following situations:
In women who still have menstrual periods, a few days before the egg is released (ovulation), usually mid-cycle
During pregnancy
In women who take medications that contain estrogen or that increase estrogen production (such as some fertility medications)
Use of birth control pills (oral contraceptives) and sexual arousal also affect the amount and appearance of vaginal discharge. After menopause, estrogen levels decrease, often reducing the amount of normal discharge.
External Female Reproductive Anatomy
Abnormal discharge
A vaginal discharge is considered abnormal if it is
Heavier than usual
Thicker than usual
White and clumpy (curd-like)
Grayish, greenish, yellowish, or blood-tinged
Foul- or fishy-smelling
Accompanied by itching, burning, a rash, or soreness
Vaginal or vulvar symptoms can occur in females at any age. Itching and discharge during the reproductive years and after menopause are discussed here. (See also Vaginal Itching or Discharge in Children.)
Causes of Genital Itching and Discharge
An abnormal vaginal discharge is usually caused by vaginitis, which results from an infection or inflammation (such as from irritation by a chemical).
Infections
Vaginitis may be due to an infection or a change in the balance of bacteria or other organisms that normally live in the vagina (vaginal microbiome). The vagina usually has many different types of bacteria that keep the acidity of the vagina in the normal range; one of the major types is lactobacilli. When acidity in the vagina decreases, the number of normal bacteria decreases, and the number of harmful bacteria increases.
The growth of harmful bacteria is made more likely by:
Use of antibiotics (because they may reduce the number of normal bacteria)
Menstrual blood or semen in the vagina (because they reduce the acidity of the vagina)
Douching (because it can reduce the acidity of the vagina)
Pregnancy
Diabetes
A foreign object, such as a forgotten tampon (because tampons provide a warm, moist environment where bacteria can thrive)
The most common types of vaginitis caused by organisms include:
Candidiasis (a yeast infection)
Trichomoniasis (an infection with an organism called a protozoa), which is usually sexually transmitted
Other sexually transmitted infections (such as gonorrhea and chlamydia) can cause a discharge. If these infections spread to the uterus or into the pelvic area, they may develop into pelvic inflammatory disease. Genital herpes sometimes causes vaginal itching, tingling, or burning.
Other causes
Chemicals that come in contact with the vagina or genital area can cause an allergic reaction or inflammation, which can result in discharge, irritation, or itching. Such chemicals may be present in laundry detergents, bleach, fabric softeners, bubble bath, soaps, feminine hygiene sprays, douches, vaginal creams, menstrual pads, synthetic fabric underwear, fabric dyes, toilet tissue, condoms, diaphragms, and spermicides.
Skin disorders, such as psoriasis, lichen simplex chronicus, lichen planus, and lichen sclerosus, can cause genital itching. Lichen sclerosus can cause thin or thick white areas on the vulva around the opening of the vagina. If untreated, lichen sclerosus can cause scarring and may increase the risk of cancer of the vulva.
After menopause, some women have a vaginal discharge due to the decrease in estrogen levels, which causes the vaginal tissue to thin and a change in the vaginal pH. This can result in vaginal inflammation and itching or a discharge. Symptoms that affect the vagina and urinary tract after menopause are called genitourinary syndrome of menopause. These symptoms may include vaginal dryness, pain during sexual intercourse, urinary urgency, and urinary tract infections.
In women with limited mobility due to prolonged injury or illness, urine or stool may irritate the area around the genitals and anus, resulting in a vaginal discharge. Such irritation may occur when women are incontinent (involuntarily pass urine or stool) or bedbound.
Fistulas (abnormal connections between the vagina and the bladder or rectum) can cause a discharge from the vagina. This discharge sometimes contains stool or urine. Fistulas can occur during traumatic injuries to the genital tract during childbirth, but rarely occur in women who receive adequate medical care during childbirth. Fistulas can occur after hysterectomy, pelvic radiation, or pelvic surgery. In areas where women have limited access to medical care during childbirth, fistulas due to obstructed labor are more common.
Some Causes of Vaginal Itching or Discharge
Cause | Common Features* | Diagnostic Approach |
|---|---|---|
During the childbearing years | ||
A thin, yellow-green or gray frothy discharge with a fishy odor Sometimes vaginal or vulvar irritation | Examination of the discharge under a microscope and analysis of a sample of the discharge | |
Irritation, itching, redness, and swelling of the vulva or vagina A thick, white, curd-like vaginal discharge Sometimes worsening of symptoms after intercourse and before menstrual periods Sometimes diabetes or recent use of antibiotics | Examination of the discharge under a microscope and analysis of a sample of the discharge | |
Trichomoniasis (an infection caused by protozoa) | A yellow-green, frothy discharge (often in large amounts) with a fishy odor Irritation, redness, and swelling of the vulva or vagina Sometimes pain during sexual intercourse or urination | Examination of the discharge under a microscope and analysis of a sample of the discharge |
Pelvic or abdominal pain A yellow-green discharge that sometimes has a foul odor Sometimes pain during sexual intercourse or urination Sometimes fever or chills | Tests to detect sexually transmitted infections using a sample from the urine, vagina, or cervix Sometimes pelvic ultrasound | |
A foreign object (such as a forgotten tampon) in the vagina | A discharge (often in large amounts) with a foul odor | A doctor's evaluation |
After menopause | ||
Thinning of the tissue of the vagina | A scant white or pale yellow discharge, sometimes with blood Vaginal dryness and/or pain during sexual intercourse | Examination of the discharge under a microscope and analysis of a sample of the discharge |
At any age | ||
Chemical irritation (such as that due to soaps, bubble baths, feminine hygiene sprays, or vaginal creams) | Irritation, itching, redness, and swelling of the vulva or vagina | A doctor's evaluation |
An abnormal connection (fistula) between the intestine and genital tract, which may result from
| A discharge with a foul odor Presence of stool or urine in the vagina or in the vaginal discharge | A doctor's evaluation |
Inflammation due to
| Recent treatment of a disorder affecting the pelvis A scant white or pale yellow discharge Sometimes pain during sexual intercourse Sometimes itching, redness, burning pain, and mild bleeding | A doctor's evaluation Usually examination of the discharge under a microscope and analysis of a sample of the discharge |
Skin disorders such as psoriasis, lichen sclerosus, lichen simplex chronicus, and lichen planus (due to an autoimmune reaction, when the body attacks its own tissues) | Rashes, itching, or other symptoms, depending on the disorder | Usually a doctor's evaluation alone Sometime a biopsy |
Irritation caused by urine or stool | Limited mobility due to injury or illness, sometimes bedbound General redness in the area around the genitals and anus | A doctor's evaluation |
*Features include symptoms and results of the doctor's examination. Features mentioned are typical but not always present. | ||
Evaluation of Genital Itching or Discharge
Vaginal discharge that is heavy, persistent, a color other than white or clear, or is accompanied by other bothersome symptoms should be evaluated by a doctor. Doctors can usually determine the cause by asking about symptoms, the woman's medical history, and by examining the vulva and vagina.
Warning signs
In women with an abnormal vaginal discharge, certain characteristics are cause for concern:
Fever
Pelvic pain
A bloody discharge, especially after menopause
Stool in the vaginal discharge
Vulvar itching accompanied by masses or lesions of the vulva is concerning.
When to see a doctor
Women with most warning signs should see a doctor within a day.
Women should see a doctor if itching or discharge lasts more than a few days or is severe or if other symptoms suggesting an infection (such as pain or fever) develop.
If women recognize the symptoms of a vaginal yeast infection, are confident that what they have is a yeast infection based on previous experience (when the yeast infection was confirmed by a doctor), and have no other symptoms, they may use a nonprescription vaginal treatment if that is available. A discharge caused by a yeast infection is usually distinctive. It is thick, white, and often clumpy or curd-like. If the discharge persists or symptoms return after treatment, women should see a doctor.
What the doctor does
Doctors first ask a woman about her symptoms, particularly whether she has any symptoms of infection, and about her medical history.
If there is vaginal discharge, doctors ask
What it looks and smells like
When it occurs in relation to menstrual periods and sexual intercourse
Whether other symptoms (such as itching, bleeding, or fever) are present
Doctors also ask about other symptoms, such as abdominal or pelvic pain and pain during urination or sexual intercourse.
Other questions include whether women use hygiene sprays or other products that may irritate the genital area and whether women have any conditions that can increase the risk of having a vaginal discharge (such as taking antibiotics frequently or having diabetes). Doctors also ask about possible exposure to sexually transmitted infections.
Doctors then do a physical examination, which focuses on the pelvic examination. The information from the history and physical examination often suggests a cause and additional tests that may be needed (see table Some Causes of Vaginal Itching or Discharge).
If women have a discharge, unless the cause is obvious (such as a foreign object or an allergic reaction), doctors use a cotton swab to take a sample of the discharge from the vagina or cervix. They examine the sample under a microscope to check for the microorganisms that can cause yeast infections, bacterial vaginosis, and trichomonal vaginitis. They usually also send a sample to the laboratory to test for gonorrhea and chlamydia.
A complete blood count and pelvic imaging are sometimes done if a widespread infection, such as pelvic inflammatory disease, is suspected.
Treatment of Genital Itching or Discharge
If the condition causing vaginal or vulvar itching or discharge is identified, it is treated. General measures can also help relieve symptoms.
General measures
General measures that can help avoid vulvar or vaginal irritation include
Wearing underwear made of cotton instead of synthetic fabrics
Allowing vulva and groin area to dry completely after bathing, before putting on clothing
Changing clothing, tampons, or pads if they are wet for a prolonged period of time
Using unscented soaps, laundry detergents, and toilet paper
Not using feminine hygiene products or douches
Improved hygiene is particularly useful if the cause is being incontinent or bedbound.
Douching may cause irritation of the vulva or vagina and increase the risk of pelvic inflammatory disease.
Placing ice packs on the genital area or sitting in a warm sitz bath may reduce soreness and itching. A sitz bath is taken in the sitting position with water covering only the genital area. Sitz baths can be taken in the bathtub or in a large basin. Flushing the genital area with lukewarm water squeezed from a water bottle may also provide relief. Women should be cautious about applying too much cold or heat to the area, to avoid injury.
If prescription products cause irritation, women should talk to their doctor before stopping use of these products.
Medications
If symptoms are moderate or severe or do not respond to general measures, medications may be needed.
For severe itching, an antihistamine taken by mouth may help temporarily. Antihistamines also cause drowsiness and may be useful if symptoms interfere with sleep.
Vaginal infections, such as bacterial vaginosis, a yeast infection, or trichomonal vaginitis, that cause itching or discharge require antibiotics or antifungal medications taken by mouth or inserted into the vagina.
For lichen sclerosus
Essentials for Older Women: Vaginal Itching or Discharge
After menopause, estrogen levels decrease markedly. As a result, the amount of normal discharge usually decreases. However, the decrease in estrogen causes the lining of the vagina to thin and become drier and fragile. The thin, dry vagina is more likely to become irritated, sometimes resulting in an abnormal discharge from the vagina. This discharge may be thin and white or pale yellow. Vaginal dryness may make sexual intercourse painful. Vaginal dryness, pain during sexual intercourse, urinary urgency, and urinary tract infections are symptoms of the genitourinary syndrome of menopause. Low-dose vaginal estrogen or dehydroepiandrosterone therapy may be used to treat this syndrome.
Thinning also makes certain vaginal infections more likely to develop, such as bacterial vaginosis or yeast infections. The thin, dry vaginal tissues are more easily damaged, allowing usually harmless bacteria from the skin to enter tissues under the skin and cause infection there. Such infections are usually not serious but can cause discomfort.
Limited mobility due to prolonged illness or injury may occur at any age. For people who are incontinent or bedbound, good hygiene may be difficult. Poor hygiene can result in chronic inflammation of the genital area due to irritation by urine or stool.
Older women should see a doctor promptly if they have a discharge, particularly if the discharge contains blood or is brown or pink (possibly indicating a small amount of blood). Any vaginal bleeding after menopause can be a warning sign of a precancerous disorder (such as thickening of the lining of the uterus) or cancer and should not be ignored.
Key Points
Genital itching is a problem when it persists, is severe, recurs, or is accompanied by pain or by a discharge that looks or smells abnormal, suggesting an infection.
Causes of genital itching and discharge vary depending on the person’s age.
Any discharge that occurs after menopause requires prompt evaluation by a doctor.
Usually, doctors examine a sample of the discharge to check for microorganisms that can cause infections.
Treatment depends on the cause, but applying cold packs or sitting in a warm sitz bath can help relieve symptoms.
If a vaginal infection causes itching and a discharge, women are treated with antibiotics or antifungal medications taken by mouth or inserted into the vagina.
