Vaginal Infections

One of the most common complaints seen daily in any gynaecologist’s clinic is the complaint of having abnormal vaginal discharge. The abnormalities could be the colour, consistency or timing of the discharge with respect to a woman’s menstrual cycle, and whether there are associated symptoms of itch, pain on passing urine or abdominal pains.

Normal Vaginal Discharge

The amount, colour and thickness of the vaginal discharge change during each monthly cycle. The discharge is clear and watery during ovulation and becomes thicker and an opaque white after ovulation has occurred, until the next menses comes along and then the vaginal discharge become minimal again.

What changes may be a sign of a problem?

Changes that may signal a problem include an increase in the amount of discharge, a change in the colour or smell of the discharge, and irritation, itchiness or burning in or around the vagina. A discharge that is stained with blood when not having a period could also be a sign of a problem. If you have any of these signs, you should seek a doctor’s opinion.

These changes can occur if the normal balance of healthy bacteria (germs) in the vagina is upset. Many things can disturb the balance of a healthy vagina, including douching, certain soaps or bubble baths, antibiotics, diabetes, pregnancy or infections.

The chemicals in douches may irritate your vagina and change the normal balance of germs in your vagina. Douching can also spread an infection into the uterus, increasing the risk of getting pelvic inflammatory disease (PID). PID is an infection of the fallopian tubes that can cause infertility.

What is a yeast infection?

Small amounts of yeast fungus are often found in a healthy vagina. But if too much grows, it can cause a yeast infection. They often present as white cottage cheese like discharge and is associated with intense itching, leading to swelling and pain around the vulva region. Needless to say, a huge amount of burning pains are experienced during intercourse.

Yeast infections usually are not caught from a sex partner. One is more likely to get a yeast infection following antibiotic treatment for other ailments. It can also happen during pregnancy, due to diabetes, or when one stays hot and sweaty for long periods.

Yeast infections are usually treated with a medicine inserted into the vagina. The infections can also be treated with oral medicine. Removing sugar and excessive breads during an infection also helps reduce the risk of recurrence.

What is bacterial vaginosis?

Bacterial vaginosis is usually caused by the Gardnerella vaginalis bacteria. Why some women are susceptible to this infection is unclear. The infection is probably not caught from a sex partner. It presents as a white grey or yellowish vaginal discharge and produces a fishy odour which is strongest after sex. It is also associated with burning or itchiness and possible swelling in the vulvovaginal area. Bacterial vaginosis is treated with oral antibiotics or pessaries.

What is trichomoniasis?

Trichomoniasis is caused by an organism called Trichomonas vaginalis. One can be infected but have no signs of the infection for a long time. It presents with a watery yellowish greenish bubbly discharge associated with pain and itching. Trichomoniasis is treated with oral antibiotics and one’s partner should be given the same treatment as well.

Other Vaginal Infections

Two sexually transmitted infections, chlamydia and gonorrhoea, can also cause vaginal discharge. These are infections of the cervix caused by bacteria. Sometimes the only symptom may be an increase of vaginal discharge. Both of these infections can be treated with antibiotic shots or pills.

Hence, vaginal discharge should not be disregarded as a figment of a woman’s mind but treated with respect, in order to help her find the solution to her problem.

Other causes of vaginal discharge

Endocervical or Endometrial Polyps and certain ovarian cysts, as they tend to exude more sticky mucoid to watery discharges. Submucosal fibroids can also lead to excessive vaginal discharge and abnormal bleeding. Hormonal disruptions are also common culprits!


Treatments should include advice on diets - i.e. increase probiotic intake as the correct balance of the good bacteria lactobacillus within the vagina is a key preventive measure against undesirable infections.

The use of boric acid pessaries (available from compounding pharmacies) will also enhance the pH of the vagina and reduce the risk of vulvovaginal candidiasis. Thereafter specific treatment should be rendered to get rid of the offending organism and often the partner should be treated as well to prevent a recurrence.

Dr Ann Tan
Dr Ann Tan, PBM
Obstetrician & Gynaecologist
Dr Ann Tan is the first Singaporean to hold the Diploma of Fetal Medicine from the Fetal Medicine Foundation. She presently serves on the Women’s Health Advisory Committee at the Health Promotion Board. Dr Ann Tan was a Public Service Commission Scholar, and has won several prestigious awards in her field of specialization.
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