Abnormal Vaginal Discharge (Vaginitis)

During puberty, an adolescent’s body begins to change. Along with outward physical differences, an adolescent may notice a discharge from their vagina and become concerned. It is normal and healthy for young people’s bodies to produce clear or white discharge from the vagina. The mucus is produced normally from the cervix (see illustration).

Healthy discharge varies throughout the menstrual cycle, and may be slightly brown towards the end of the period, but does not have a strong smell or color.

Any change in the amount, color or smell of vaginal discharge — or other symptoms like itching, pain or unexpected bleeding — could indicate a vaginal infection (vaginitis) and should be promptly assessed by an adolescent medicine specialist.

Vaginitis refers to any inflammation or infection of the vagina. It’s a common problem found in people of all ages.

While a number of factors may cause abnormal vaginal discharge, it is usually an infection that upsets the natural balance of yeast and bacteria in the vagina.

Other causes may include:

• Chemicals in creams or sprays
• Clothing
• Overall health of the young person
• Changes in personal hygiene or hormone levels
• Overall health of the young person’s sexual partners
• Organisms passed between sexual partners

Any disturbance in any of these factors can cause abnormal vaginal discharge.

The color, consistency and smell of abnormal vaginal discharge can help identify what may be causing the condition. However, it is important not to self-diagnose and self-treat any gynecological condition.

More than one type of infection may be present in the vagina at one time — with or without symptoms — and many of the conditions have similar symptoms. Any adolescent or young person with abnormal vaginal discharge should be examined and treated by a healthcare professional.

Watery or white vaginal discharge with intense itchiness

Thick, white, cottage cheese-like vaginal discharge that is watery and usually odorless, may be a symptom of a vaginal candida infection, commonly known as a yeast infection. Yeast infections are very common and may cause itching and redness of the vulva and vagina. These infections are caused by a disruption in the balance of healthy bacteria and yeast that is present in the vagina. For example, taking an antibiotic to treat an infection in another part of her body, can affect the bacteria that normally protect and balance the yeast in the vagina. When the yeast overgrows, it causes an infection.

Gray or white discharge with fishy smell

Vaginal discharge that is thin and milky, or gray and heavy, and has a fishy smell, may be a symptom of bacterial vaginosis. While yeast infections are the most commonly discussed vaginal infections, bacterial vaginosis is actually the most common type of vaginitis in people of reproductive age. This infection is caused by bacteria, not yeast, and occurs when certain species of normal vaginal bacteria grow out of control and trigger inflammation.

Frothy, green or yellow discharge

A frothy, musty-smelling, greenish-yellow vaginal discharge, may be a symptom of trichomoniasis (also known as trich). One of the most common sexually transmitted infections (STI), trich is caused by a one-celled parasite called trichomonas vaginalis and is spread through unprotected sex with an infected partner.

Abnormal discharge with bleeding or pain

Increased vaginal discharge as well as pelvic pain, pain when urinating or bleeding between periods, may be symptoms of chlamydia or gonorrhea, two of the most common sexually transmitted infections in the United States.  If left untreated, gonorrhea and chlamydia can lead to pelvic inflammatory disease, a serious infection that can increase a person’s risk of infertility.

Abnormal discharge with warts or blisters around the genitals

Abnormal discharge, along with pain, lesions or sores in the vaginal area, may be symptoms of viral vaginitis. The two most common viruses are the herpes simplex virus (HSV) and the human papillomavirus (HPV).

Increased vaginal discharge with itching and burning

In some cases, vaginal discharge, itching and burning may occur without an infection being present. This is called noninfectious vaginitis. Most often, noninfectious vaginitis is caused by an allergic reaction to, or irritation from, vaginal sprays, douches, or spermicidal products. It may also be caused by sensitivity to perfumed soaps, detergents, or fabric softeners. The symptoms of noninfectious vaginitis may resemble other conditions so it’s important to consult a healthcare professional for a formal diagnosis.

Adolescents with abnormal vaginal discharge should be referred to clinicians who have expertise in Adolescent Medicine. At Children’s Hospital of Philadelphia (CHOP), these young people are evaluated by our Adolescent Medicine specialists.  

At CHOP, we welcome parents and caregivers as key partners in supporting a young person’s care during and after treatment for abnormal vaginal discharge.

To help young people develop the skills needed to be responsible for their own health, clinicians typically ask to spend time alone with patients during each visit. This helps young people become comfortable talking with their healthcare providers about their concerns and allows patients to ask questions that may be more difficult to say in front of their parents and caregivers.

At Children’s Hospital of Philadelphia, we respect the privacy and confidentiality of our young patients, while ensuring that young people are safe and connected to the appropriate services and resources they need.

An Adolescent Medicine specialist performs the initial evaluation, asking a series of questions about the patient’s overall medical history, menstrual cycle, and any sexual activity. The clinician will also ask specific questions about the vaginal discharge — whether there’s been a change in color or consistency, a sudden bad smell, unusually large amount of discharge, and other symptoms such as itching or unexpected bleeding.

A physical examination will follow the interview, along with a pelvic examination if appropriate.  A sample of the discharge will be collected for examination.  

Depending on what clinicians find during the initial assessment, additional tests may be ordered including:

• Pregnancy test

• Blood tests
• Urine tests
• Microscope evaluation
• Genital swab tests

These routine tests can confirm or rule out certain infections, including sexually transmitted infections, allowing the specialist to recommend the best treatment.

Treatment for abnormal vaginal discharge will be recommended by our Adolescent Medicine specialist based on:

• The cause of the condition
• The severity of other symptoms

• The adolescent’s age, overall health and medical history
• The adolescent's tolerance for specific medications, procedures or therapies
• Expectations for the course of the condition
• The adolescent's opinion or preference