Vaginal itching and discharge - adult and adolescent
Vaginal discharge refers to secretions from the vagina. The discharge may be:
- Thick, pasty, or thin
- Clear, cloudy, bloody, white, yellow, or green
- Odorless or have a bad odor
Itching of the skin of the vagina and the surrounding area (vulva) may be present along with vaginal discharge. It can also occur on its own.
Causes
Glands in the cervix and the walls of the vagina normally produce clear mucus. This is very common among women of childbearing age.
- These secretions may turn white or yellow when exposed to the air.
- The amount of mucus produced varies during the menstrual cycle. This happens due to the change in hormone levels in the body.
The following factors can increase the amount of normal vaginal discharge:
- Ovulation (the release of an egg from your ovary in the middle of menstrual cycle)
- Pregnancy
- Sexual excitement
Different types of infections may cause itching or an abnormal discharge in the vagina. Abnormal discharge means abnormal color (brown, green), and odor. It is associated with itching or irritation.
These include:
- Infections spread during sexual contact. These include chlamydia, gonorrhea (GC), and trichomoniasis.
- Vaginal yeast infection, caused by a fungus.
- Normal bacteria that live in the vagina overgrow and cause a gray discharge and fishy odor. This is called bacterial vaginosis (BV). BV is not spread through sexual contact.
Other causes of vaginal discharge and itching may be:
- Menopause and low estrogen levels. This may lead to vaginal dryness and other symptoms (atrophic vaginitis).
- Forgotten tampon or foreign body. This may cause a foul odor.
- Chemicals found in detergents, fabric softeners, feminine sprays, ointments, creams, douches, and contraceptive foams or jellies or creams. This may irritate the vagina or the skin around the vagina.
Less common causes include:
- Cancer of the vulva, cervix, vagina, uterus, or fallopian tubes
- Skin conditions, such as desquamative vaginitis and lichen planus
Home Care
Keep your genital area clean and dry when you have vaginitis. Make sure to seek help from health care provider for the best treatment.
- Avoid soap and just rinse with water to clean yourself. Using a spray bottle to wash with water after urination may be helpful.
- Soaking in a warm but not hot bath may help your symptoms. Dry thoroughly afterward. Rather than using a towel to dry, you may find that gentle use of warm or cold air from a hair dryer may result in less irritation than the use of a towel.
Avoid douching. Many women feel cleaner when they douche, but it may actually worsen symptoms because it removes healthy bacteria that line the vagina. These bacteria help protect against infection.
Avoid current popular trends like vaginal steaming which may increase risk of vaginal infections.
Other tips are:
- Avoid using hygiene sprays, fragrances, or powders in the genital area.
- Use pads and not tampons while you have an infection.
- If you have diabetes, keep your blood sugar levels in good control.
Allow more air to reach your genital area. You can do this by:
- Wearing loose-fitting clothes and not wearing panty hose.
- Wearing cotton underwear (rather than synthetic), or underwear that has a cotton lining in the crotch. Cotton increases air flow and decreases moisture buildup.
- Not wearing underwear.
Girls and women should also:
- Know how to properly clean their genital area while bathing or showering.
- Wipe properly after using the toilet — always from front to back.
- Wash thoroughly before and after using the bathroom.
Always practice safe sex. Use condoms to avoid catching or spreading infections.
When to Contact a Medical Professional
Contact your provider right away if:
- You have vaginal discharge
- You have fever or pain in your pelvis or belly area
- You may have been exposed to STIs
Changes that could indicate a problem such as infection include:
- You have a sudden change in the amount, color, odor, or consistency of discharge.
- You have itching, redness, and swelling in the genital area.
- You think that your symptoms may be related to a medicine you are taking.
- You are concerned that you may have a STI or you are unsure if you have been exposed.
- You have symptoms that get worse or last longer than 1 week despite home care measures.
- You have blisters or other sores on your vagina or vulva.
- You have burning with urination or other urinary symptoms. This may mean that you have a urinary tract infection.
Approximately 48 million couples live with infertility around the world.
Symptoms and Causes
What are signs of infertility?
The main sign of infertility is being unable to get pregnant after six months or one year of regular, unprotected sex. You may not have any other symptoms. But some women or men may show physical symptoms such as:
- Pelvic or abdominal pain.
- Irregular vaginal bleeding, irregular periods or no periods.
- Penile disorders or issues with ejaculation.
What causes infertility?
There are many causes of infertility, and sometimes, there isn’t a simple answer as to why you’re not getting pregnant. Only a healthcare provider can determine the cause and find the best treatment for you.
While causes of infertility vary, studies show that:
- 33% of infertility involves women.
- 33% of infertility involves men.
- 33% of infertility involves both partners or is unexplained.
Twenty-five percent of infertile couples have more than one factor that contributes to their infertility.
Infertility causes
Some causes of infertility affect just one partner, while others affect both partners. Risk factors for infertility include:
- Age, particularly being in your late 30s or 40s. For men, age begins affecting fertility closer to 50.
- Eating disorders, including anorexia nervosa and bulimia.
- Excessive alcohol consumption.
- Exposure to environmental toxins, such as chemicals, lead and pesticides.
- Over-exercising.
- Radiation therapy or chemotherapy.
- Sexually transmitted infections (STIs).
- Smoking and using tobacco products. (This behavior plays a role in about 13% to 15% of infertility cases.)
- Substance abuse.
- Having obesity or being underweight.
- Abnormalities of the hormone-producing centers of your brain (hypothalamus or pituitary).
- Chronic conditions and diseases.
Infertility causes for women
Ovulation disorders are the most common cause of infertility in women. Ovulation is the process in which your ovary releases an egg to meet sperm for fertilization.
These factors can contribute to female infertility:
- Endometriosis.
- Structural abnormalities of your vagina, uterus or fallopian tubes.
- Autoimmune conditions like celiac disease or lupus.
- Kidney disease.
- Pelvic inflammatory disease (PID).
- Hypothalamic and pituitary gland disorders.
- Polycystic ovary syndrome (PCOS).
- Primary ovarian insufficiency or poor egg quality.
- Sickle cell anemia.
- Uterine fibroids or uterine polyps.
- Thyroid disease.
- Prior surgical sterilization (tubal ligation or salpingectomy).
- Genetic or chromosomal disorders.
- Sexual dysfunction.
- Surgical or congenital absence of your ovaries.
- Infrequent or absent menstrual periods.
Infertility causes for men
The most common cause of male infertility involves problems with the shape, movement (motility) or amount (low sperm count) of sperm.
Other causes of male infertility include:
- Enlarged veins (varicocele) in your scrotum, the sac that holds your testicles.
- Genetic disorders, such as cystic fibrosis.
- Chromosomal disorders, such as Klinefelter syndrome.
- High heat exposure to your testicles from tight clothing, frequent use of hot tubs and saunas, and holding laptops or heating pads on or near your testes.
- Injury to your scrotum or testicles.
- Low testosterone (hypogonadism).
- Misuse of anabolic steroids.
- Sexual dysfunction, such as erectile dysfunction, anejaculation, premature ejaculation or retrograde ejaculation.
- Undescended testicles.
- Previous chemotherapy or radiation therapy.
- Surgical or congenital absence of testes.
Prior surgical sterilization (vasectomy).
Diagnosis and Tests
How is female infertility diagnosed?
First, your healthcare provider will get your full medical and sexual history.
Fertility for females involves ovulating healthy eggs. This means your brain has to send hormonal signals to your ovary to release an egg to travel from your ovary, through your fallopian tube and to your uterine lining. Fertility testing involves detecting an issue with any of these processes.
These tests can also help diagnose or rule out problems:
- Pelvic exam: Your provider will perform a pelvic exam to check for structural problems or signs of disease.
- Blood test: A blood test can check hormone levels to see if hormonal imbalance is a factor or if you’re ovulating.
- Transvaginal ultrasound: Your provider inserts an ultrasound wand into your vagina to look for issues with your reproductive system.
- Hysteroscopy: Your provider inserts a thin, lighted tube (hysteroscope) into your vagina to examine your uterus.
- Saline sonohysterogram (SIS): Your provider fills your uterus with saline (sterilized salt water) and conducts a transvaginal ultrasound.
- Sono hysterosalpingogram (HSG): Your provider fills your fallopian tubes with saline and air bubbles during an SIS procedure to check for tubal blockages.
- X-ray hysterosalpingogram (HSG): X-rays capture an injectable dye as it travels through your fallopian tubes. This test looks for blockages.
- Laparoscopy: Your provider inserts a laparoscope (thin tube with a camera) into a small abdominal incision. It helps identify problems like endometriosis, uterine fibroids and scar tissue.
How is male infertility diagnosed?
Diagnosing infertility in men typically involves making sure they ejaculate healthy sperm. Most fertility tests look for problems with sperm.
These tests can help diagnose or rule out problems:
- Semen analysis: This test checks for low sperm count and poor sperm mobility. Some people need a needle biopsy to remove sperm from their testicles for testing.
- Blood test: A blood test can check thyroid and other hormone levels. Genetic blood tests look for chromosomal abnormalities.
- Scrotal ultrasound: An ultrasound of your scrotum identifies varicoceles or other testicular problems.
Management and Treatment
How is infertility treated?
Treatment for infertility depends mostly on the cause and your goals. Your age, how long you’ve been trying to conceive and your personal preferences are factors in deciding on a treatment. Sometimes, one person needs treatment, but other times, treatment involves both partners.
In most cases, women and couples with infertility have a high chance of pregnancy. Things like medication, surgery or assisted reproductive technology (ART) can help. Often, lifestyle changes or improving the frequency and timing of intercourse can improve your chances of pregnancy. Treatment can also include a combination of methods.
Infertility treatment for women
Treatments for infertility in women include:
- Lifestyle modification: Gaining or losing weight, stopping smoking or using drugs, and improving other health conditions can improve your chance of pregnancy.
- Medications: Fertility drugs stimulate your ovaries to ovulate more eggs, which increases your chance of getting pregnant.
- Surgery: Surgery can open blocked fallopian tubes and remove polyps, fibroids or scar tissue.
Providers may make suggestions on how you can improve your odds of conceiving. These may include things like:
- Tracking ovulation through basal body temperature, using a fertility tracking app and noting the texture of your cervical mucus.
- Using a home ovulation kit, a kit you can purchase at the drug store or online to help predict ovulation.
Infertility treatment for women
Treatments for infertility in men include:
- Medications: Medications can raise testosterone or other hormone levels. There are also drugs for erectile dysfunction to help you maintain an erection during sex.
- Surgery: Some men need surgery to open blockages in the tubes that carry sperm or to repair structural problems. Varicocele surgery can make sperm healthier and improve the odds of conception.
What are common fertility treatments?
Some couples need more help conceiving using assisted reproductive technology (ART). ART is any fertility treatment that involves a healthcare provider handling the sperm or egg. To increase pregnancy odds, you can take medications to stimulate ovulation before trying one of these options:
- In vitro fertilization (IVF): IVF involves retrieving eggs from your ovary, then placing them with sperm in a lab dish. The sperm fertilizes the eggs. A provider transfers one to three of the fertilized eggs (embryos) into your uterus.
- Intracytoplasmic sperm injection (ICSI): This procedure may be performed during the IVF process. An embryologist injects a single sperm directly into each egg. Then, a provider transfers one to three of the embryos into your uterus.
- Intrauterine insemination (IUI): A healthcare provider uses a long, thin tube to place sperm directly into your uterus. IUI is sometimes called artificial insemination.
- Assisted hatching: A process that involves opening the outer layer of an embryo to make it easier for it to implant in your uterine lining.
- Third-party ART: Couples may use donor eggs, donor sperm or donor embryos. Some couples need a gestational carrier or surrogate.
What are common fertility treatments?
Complications of infertility treatment include:
- Higher chance of multiples (twins, triplets or more): Producing multiple eggs and transferring more than one embryo increases your risk of becoming pregnant with more than one fetus. Complications such as miscarriage, premature birth, low birth weight, neonatal death, and long-term health complications are more common in women pregnant with multiple fetuses.
- Ovarian hyperstimulation syndrome (OHSS): A condition that causes painful and swollen ovaries as a result of fertility medications. It can become serious and require immediate medical attention.
- Ectopic pregnancy: IVF has an increased risk of ectopic pregnancy.
- Failed cycles: A failed cycle is when you go through infertility treatment and it doesn’t end in pregnancy.
Can infertility be cured?
Yes, but it depends on the cause. In 85% to 90% of cases, lifestyle modification, medication, ART or surgery can treat infertility and allow a woman to conceive.
Prevention
How can I prevent infertility?
You can take these steps to protect your fertility, especially while trying to conceive:
- Eat a well-balanced diet and maintain a weight that’s healthy for you.
- Don’t smoke, misuse drugs or drink alcohol.
- Get treated for STIs.
- Limit exposure to environmental toxins.
- Stay physically active, but don’t overdo exercise.
- Don’t delay conception until an advanced age.
- Undergo fertility preservation procedures (freezing eggs or sperm).
Outlook / Prognosis
What can I expect if I have infertility?
Approximately 9 out of 10 couples get pregnant after undergoing fertility treatments. Success rates vary depending on the cause of infertility, the couple’s ages and other factors.
Infertility has emotional, physical, financial and psychological side effects. Don’t forget to practice self-care and be patient with yourself and your partner throughout the process. Infertility isn’t easy, so surround yourself with supportive people or consider joining an online support group. Sometimes, sharing your feelings with people who understand what you’re going through can be helpful.
Living With
Does insurance cover infertility treatment?
Health insurance policies vary, so you should always check with your insurance provider. Most insurers cover medically necessary procedures, such as surgeries to treat endometriosis and uterine fibroids. Some policies cover fertility procedures like IUI, but may not cover ovulation-stimulating medications or IVF.
Certain states have laws that require employers to provide infertility coverage as part of their health insurance policy for employees. As of June 2022, The National Infertility Association (Resolve) states:
- Twenty states have passed fertility insurance coverage laws; 14 of those laws include IVF coverage; and 12 states have fertility preservation laws for iatrogenic (medically induced) infertility.
If you live or work in a state that has an infertility coverage law in place and want to know your coverage details, you should contact your employer.
When should you seek help for infertility?
People who are under the age of 35 and who aren’t pregnant after one year of trying should see a healthcare provider. You should seek help sooner (after six months of trying) if you’re 35 to 39 years old. If you’re 40 or older, you should seek evaluation after fewer than six months of trying. Your chances of getting pregnant decrease with age. For example, a 25-year-old female has a 25% to 30% chance of getting pregnant each menstrual cycle. By the time you reach 40, your chances are less than 5% each cycle.
Regardless of sex, you should seek help early if you have a risk factor or medical condition that affects fertility. Seek prompt evaluation if you have a history of risk factors for premature ovarian failure, severe endometriosis, or known or suspected uterine/tubal disease.
Primary care providers and gynecologists may recommend couples see a fertility specialist, urologist or reproductive endocrinologist for help with infertility diagnosis and treatment.
What questions should I ask my healthcare provider?
You may want to ask your healthcare provider:
- Do I need to see a fertility specialist?
- Should my partner and I both get tested for fertility problems?
- Based on my partner’s age and my age, how soon should we get tested for fertility problems?
- What’s the best treatment for us?
- What’s the treatment success rate?
- What are the treatment side effects or risks?
- Should I look out for signs of complications?
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