If you have a vagina, chances are you've freaked out at some point about some weird discharge. Vaginal fluids likely aren't among the most breezy, casual topics in your conversational repertoire. Plus, we all know symptom-related Google searches inevitably point to certain death and some images you'll never be able to unsee. So gather round, friends, for the talk we all should have had when we were pre-teens. We'll journey through what's normal and not, how discharge changes with menstruation, birth control, and transitioning—and when you should see a doctor. (Of course, this guide is not a substitute for a medical checkup, so when in doubt, cough up that copay.)
The basics: What is vaginal discharge?
Discharge comes from glands nested in your vaginal walls and cervix. These glands make a natural infection-resistant fluid that flushes out dead cells, and protects your vagina from unwanted bacteria. Depending on a person's hormonal state, vaginal fluids are also designed to stop sperm from entering the uterus. (Medical journals literally call that a "hostile vaginal environment" for that reason, but that's a story for another time.)
There are two things to know about vaginas: They're acidic, and they're filled with healthy bacteria. These bacteria are kept in a fine balance, and disruptions in that balance can lead to changes in your vaginal discharge, and could be a sign of infection, which we'll get into.
"Not all discharge is bad, and not all discharge is an infection," says Mark Yudin, gynecologist and professor of obstetrics and gynecology at the University of Toronto. Daily discharge can be normal. It's typically clear or milky, but color and consistency can also vary over time. In general, hormones like estrogen and progesterone are responsible for those variations, whether you're menstruating, taking birth control, breastfeeding, or transitioning.
If you have a menstrual cycle, you may have noticed regular changes in your vaginal fluids over the course of the month. (If you're curious, try documenting your fluid's consistency with a period tracking app to keep tabs—it's weirdly fun?) Right after a period, discharge tends to be absent, or thick, clear, and sticky. As estrogen levels rise leading up to ovulation, discharge might become creamy and slightly white or yellow.
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Most of the time, when you're not ovulating, cervical mucus forms a thick plug to block sperm from traveling into the uterus. But around ovulation, the cervix makes thinner mucus that lets in sperm and protects them from the vagina's acidic conditions.
Those who are taking hormonal birth control don't actually ovulate. As a result, they're less likely to see cyclical variations in their fluid, or experience the "egg white" fluid of the body's fertile phase.
What's not normal?
"Discharge by itself might not be an issue, but if you have discharge plus other symptoms, it's more likely to be something that may need to be treated or could potentially be treatable," Yudin says. If you notice an abrupt change in smell or start experiencing burning or irritation around your vagina, Yudin explains, it could be a sign that something else is up—possibly an infection. Remember the delicate balance of vaginal bacteria? Disturbances to that balance can lead to vaginal irritation, a "fishy" odor, painful pee, uncomfortable sex and changes in discharge. Bacterial vaginosis, or BV, is one of the most common causes of abnormal discharge that lead people to seek medical care. It's associated with gray or white fluid, usually with a fishy smell that's worse after sex or washing with soap.
For trans men, the beginning of a hormonal transition is a common time to get BV, because the shift in hormones can alter the vagina's bacterial makeup. Other contributors to BV include prolonged bleeding—which can be a side effect from a newly inserted IUD. Because of this, hormonal contraceptives are protective against BV.
Vaginas usually contain some yeast, but when that yeast proliferates, things get uncomfortable. Yeast infections produce an odorless, thick, white, and chunky fluid—the infamous "cottage cheese" discharge. They're usually associated with intense itchiness of the vulva, along with redness, swelling, and burning urine. As for treatment: "There are over-the-counter treatments for yeast that you can buy without a prescription," Yudin says. "If you have a lot of discharge, and you think it might be a yeast infection, it's reasonable to try to treat it yourself. But if that doesn't work—if you you still have symptoms—then you need to get checked out." And you know a talk on vaginal discharge wouldn't be complete without the talk. The common STI-related causes of abnormal discharge include a parasitic infection called trichomoniasis—which is known for watery or frothy foul-smelling yellow-grey discharge, burning urine, and pain with sex.
Chlamydia and gonorrhea are both bacterial infections that can present with few to no symptoms, though some people report increased odorless discharge that looks like mucus. These may seem like NBD because they can be nixed with an antibiotic, but they're important to get tested for, since both infections can lead to pelvic inflammatory disease—a condition that untreated, could lead to chronic pelvic pain and infertility.
Keeping your vagina healthy
We'll leave you with some parting wisdom on ways to keep your juicebox in excellent condition. The American Academy of Family Physicians recommends you let your vagina "breathe" (their words, not mine). That means wearing cotton underwear during the day, and sleeping without underwear at night. That's right, doctors recommend you sleep commando. Next, you can save some cash by skipping the probiotics. "There's actually very little evidence that probiotics work in terms of vaginal health," Yudin says. "I'm not opposed to people using probiotics, because there's no real evidence that they're harmful either." Also, avoid using perfumed soaps, sprays, pads, or tampons around your vagina—they're more likely to irritate and mess with your bacteria.
Another one: A "douche" is a fun, evergreen insult, not a legitimate grooming product. "The vagina is like a self-cleaning oven. You don't actually need to do anything to clean it, it takes care of itself," Yudin says. Douching is not good for you, and can increase your risk of developing BV. He adds, "there are all these new products that they're marketing for vaginal health—tablets, or things you can put into the vagina that are supposed to keep the pH balance normal. There's really no compelling evidence in studies, at all, that any of these things are necessary, or even that they work."
The same goes for natural products and foods. Yudin says, "I have patients that have come to me with histories of infections, saying 'I'm putting garlic; I'm putting yogurt,' because they read online that that might help. And that's not a good idea. Don't put things into your vagina."
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