If you pick up a GYN textbook the section on candida vaginitis, i.e. yeast infections, will undoubtedly begin with a description of the supposedly classic symptom of a chunky white discharge (which does sound a bit like a punk rock band name). Ask almost any gynecologist who hasn’t been trained by me and you will get that same answer.

Here’s the news flash, science says it isn’t. Chunky white discharge being synonymous with yeast is something someone once wrote in a textbook and the myth was perpetuated over and over again until it became accepted as fact by providers and patients alike.

One housekeeping point. When I write posts like this I invariably get nasty comments from women or sometimes even doctors telling me I’m wrong/stupid/don’t know their body/asking if I am a real doctor. Those comments will not be accepted because it will be clear that you have not read the post, that you are rude, or both. The point of this post is to explain how everyone who thinks a chunky white = yeast has been duped.

Several studies have actually looked at the symptom of vaginal discharge to see if it is predictive of yeast (or other causes of vaginal irritation). In one study only 14% of women presenting with abnormal vaginal discharge and 16% with a change in discharge had a yeast infection. Another study found the symptom of troublesome vaginal discharge no more common among women with yeast versus other conditions and only 15% of women eventually diagnosed with Candida albicans (the #1 cause of yeast infections) reported bothersome discharge. One study even specifically asked women about the symptom of a “thick, curdy vaginal discharge.” It was reported by 16% of women who were culture positive for yeast and 13.5% who were culture negative (the difference was not statistically significant).

Many researchers have looked at diagnosing vaginitis over the telephone and time and time again they fail. It’s easier to rule things out over the phone but much harder to diagnose. ACOG actually advises against over the phone diagnosis of vaginitis (Practice Bulletin Number 72, May 2006) stating, “Whenever possible, patients requesting treatment by telephone should be asked to come in for an evaluation.” This is because symptoms, like the presence of absence of discharge, are not reliable predictors of much.

What about the discharge a doctor sees when they put in a speculum? There are no studies that demonstrate any correlation between the appearance of vaginal discharge on exam and whether a patient has yeast. In one study only 29%, so less than one-third, of women with a curdy white discharge on physical exam had a positive cultures for candida. Put another way if your doctor uses the presence of a curdy white discharge in the vagina to diagnose a yeast infection they are misdiagnosing 71% of women. That is far worse than flipping a coin.  I don’t know about you but I expect a better diagnostic accuracy.

Pseudophae 2
This is what yeast looks like on vaginal exam, i.e. you need a microscope!

Vaginitis is misdiagnosed more often that not at home. In fact 70% of women who self-diagnose with yeast are incorrect. This is likely in part because women have been given incorrect information about discharge from their mothers and friends, from society, and from their health care providers. If every time you had a curdy, white discharge your doctor diagnosed you with yeast you would obviously think the two were related!

However, more and more it seems that women are astounded when I tell them clear/white/off white discharge is normal and that sometimes it will be  heavier than others. If you remove your pubic hair you may more discharge on your underwear because there is no hair to trap it and there can be more friction on the vulvar skin without hair. Remember, discharge in underwear is both vaginal and vulvar in origin. If you don’t have itch, irritation or pain with sex or an odor and the discharge isn’t yellow or green or bloody I usually say give it a few days (unless of course there is a concern about sexually transmitted infections).

A lot of doctors admittedly do a bad job with vaginitis. Some diagnose patients based on what the discharge looks like (you can’t) and others fail to do all the tests. Others were improperly trained in looking at discharge under the microscope. This is a country-wide phenomenon and opinion pieces have been written lamenting the modern gynecologist’s inability to correctly diagnose vaginitis.

Vaginitis can also be complicated. Women can have yeast and it not be the cause of their symptoms, just like people can have an abnormal MRI and have no back pain. If the treatment takes away the yeast but not the symptoms then the yeast was not the cause. This is why follow-up is important and cultures offer more precision. If you think you are suffering from recurrent yeast you need a cuture as 2/3 of women diagnosed with “chronic vaginal yeast” have negative cultures and thus have something else.

If there is a dramatic change in the amount of discharge it is probably worth checking out, but keep in mind many things affect discharge such as changes in the good bacteria, how often you are having sex, and hormones just to name a few. The more sex you have, the more cells you shed (friction) and cells are a big part of discharge. Also, if you aren’t using condoms ejaculate hangs around (I can often find sperm under the microscope 2-3 days later) adding to the discharge.

Concerning vaginal symptoms are:

  • Genital itch
  • Genital irritation
  • Pain with sex
  • Odor
  • Yellow discharge
  • Green discharge
  • Bleeding discharge
  • Profuse discharge

I have seen all of these symptoms among women with yeast and among women with other conditions, the overlap is huge that is why an exam and work up are required.

Here is the truth, sometimes women have a chunky white discharge and sometimes they don’t. When it is present it is not usually a sign of much, especially not a yeast infection.

 

 

References:

 

  1. Allen-Davis et. Al. Assessment of vulvovaginal complaints: accuracy of telephone triage and in-office diagnosis. Obstet Gynecol 2002;99:18-22.
  2. ACOG Practice Bulletin, Vaginitis Number 72, May 2006.
  3. Sobel J. Vulvovaginal candidiasis. Lancet 2007;369:1961-1971.
  4. Landers et al Predictive Value of the clinical diagnosis of lower genital tract infection in women. Am J Obstet Gynecol 2004:190;1004-1010.
  5. Goldacre MJ et al Vaginal Microbial flora in normal young women Br Med J. 1979 Jun 2;1(6176):1450-3.
  6. Beigi et al. Vaginal Yeast Colonization in Nonpregnant women: a longitudinal study. Obstet Gynecol 2004;104:926-930.
  7. Hoffstetter S et al. Telephone Triage: diagnosis of candidiasis based upon self-reported vulvovaginal symptoms J Low Genit Tract Dis 2012;16:251-255.
  8. Erdem H. et al. Identification of yeasts in public hospital primary care patients with or without clinical vaginitis. Aust N Z J Obstet Gynecol 2003;43:312-316.
  9. Ferris DG et al. Over-the-counter antifungal drug misuse associated with patient-diagnosed candidiasis. Obstet Gynecol 2002;99:419-425.

Join the Conversation

47 Comments

    1. I always have chunky white discharge from ovulation until menstruation. Fighting off practitioners as I grew up (isolated, not much choice) who always saw that as something wrong was… irritating is not the right word.

      Determined to prove them wrong I ended up having to map two years of discharge to benchmark normal so I could spot abnormalities. End result: when the chunks begin to break down and split, the texture changes, and it starts to burn, itch , change colour and re chunk … that is abnormal.

      Long way of saying, how I wish I had this post when I was 17.

  1. Thanks Dr Gunter, this post was really interesting and helpful. I always appreciate when taken-for-granted assumptions around signs and symptoms are checked out for whether they actually evidence-based.

    One suggestion: it would be great if you could be both specific and inclusive when discussing sexual practices, recognizing that not all sex is heterosexual and/or penis-in-vagina sex. Mb you have done this in many/other posts and I just haven’t gotten to them all.

    Thanks!

  2. It’d be cool if there was an option for people to provide their own swabs for screening. I choose to self treat (and so far I’ve been right– treating for yeast when I think it’s yeast always results in getting rid of the symptoms) because visiting a gyn is triggering. There’s no need to force a person to get naked for a doctor just for them to take a swab when vagina owners are generally fairly competent and capable of performing such a task. I’ll go to the doctor when it’s something I can’t handle, but until doctors start being more concerned about patient comfort and safety (and apparently until they’re more aware of what a yeast infection really is?) I can’t change what I’m doing.

    Good to know info though.

    1. Yeah, it’s easier to pay a few bucks for some generic monistat than to deal w appointments and copays and whatnot. I mean, if it turns out to be bacterial you get some unpleasant burniness, but hey.

    2. Here at planned parenthood (at least mine), we let women self – swab, therefore avoiding an exam.

  3. Thank you for this! I have frequent yeast infections [both vaginal and anywhere skin touches that gets damp/sweaty – I’m fat, it’s a risk =P], and they always ask me about the infamous ‘chunky white discharge’ – I’ve NEVER had that as a symptom. Itching and red? Check. Strong bread or sourdough bread smell? Yep. Sometimes a yellowy discharge? You bet. The doc I used to see finally realized that I was right 100% of the time about it being a yeast infection and eventually stopped swabbing for unless the symptoms changed or got worse.

  4. It’s funny that I’ve known about “White discharge’ for a long time to be separate from Yeast as I suffer from chronic heavy discharge (no itch, no other cause other than that’s naturally me). I can always tell when I have a yeast infection by it changing colour and intense burning.

    I remember as a kid having discharge=infection being drilled into my brain and me being so worried when my first discharge occurred…. So good to hear the truth from someone in the know and scary that this myth is in two western countries (AUS and USA)

  5. Although I experience white chunky almost gel-like discharge during sex with an exclusive partner, it isn’t smelly or painful. And different to the clear/milky discharge which I know is normal and differs in the amount throughout my cycle. So I feel like it doesn’t warrant a visit to the doctor, (also because docs most likely wont be interested unless I have more serious symptoms) but even so I still really would like to know what’s causing this. It can be quite embarassing sometimes! I came here looking for more information on this topic and the way you’ve covered it was very insightful! One step closer to figuring it out. Thank you Dr Gunter.

  6. I’ve had a yeast infection (on and off) for 2 almost 3 months now. I haven’t had one in years and nothing ever this bad. I am on the depo shot and my shot was due. I was having spotting and very hormonal imbalanced..I ended up getting a yeast infection. I went to my planned parenthood and they did the speculum and the lady who did it, said it looked like yeast. White, spotty, flaky, discharge. She took a swab to confirm it was. She gave me 5 pills of Diflucan, it didn’t help any. I was back within 5 days for additional treatment. She looked at me again and did a swab test. she said the microscope didn’t show any yeast but she clearly saw it in me so she gave me Tercanozole for 3 nights. That helped for about a week. A week later, I was yeasty again. I’d go pee and look down and see the white spotty discharge surrounding my clitoris. But not everytime. That’s what gets me. What causes yeast to be there one minute and the next it’s not. I have tried inserting yogurt with the L. Acidophillius ingredient. I have tried inserting coconut oil. Both, did nothing. Now it has been almost 3 months later and yeast is still present. I went and bought Monistat a 7 day treatment. Did my 1st one last night, Didn’t notice any yeast all day until just now-things felt very wet down there so I looked and sure enough, there it is again. I don’t know what’s causing it to act up like it is.

    1. Did you read the article? Discharge does it equal yeast. Yeast can only be seen under microscrope. If its not under microscope its something else. Discharge alone is not a confirmation of yeast. Are you itchy? Red? Burning? It might be yeast, if it shows unde4 microscope. If not its something else. Find another doctor.

      1. This resonates with me so much. I have been to two doctors in the past 4 1/2 months trying to get relief with negative yeast tests but yeast symptoms. Is there a specific kind of GYN dr that I should look for? Is there specific training or professional affiliation that share the same school of thought? Ones that are advocates and really look at all possibilites?
        Thank you in adavance!

  7. I thought vaginitis and yeast infections were two different things according to other health professionals, that is.

  8. Hi Doc.I am quite impressed with this article. I find it very informative and it gives one a clear understanding about issues we or I have come as a woman. Clearly your article reveals the great possibility of being misdiagnosed when thorough examination is not done. This means one has to visit the doctor again to be treated for the same infection. Another issue thatis of concern to me is when health practioners don’t bother to explain to their patients about whatever infection or sickness that affects them(patients). Understanding a sickness allows patients to take necessary protective measures to prevent reinfection.

    Thank you for your contribution.

  9. For sure thanks I have been worried. I don’t have any pain but I have that white discharge. How much days will the discharge take to go.

  10. Ok so you say that it comes and goes, what about constant thick pasty vaginal discharge day in and day out with no odor or irritation, redness or burning? I saw my gyno and she told this is normal and that she didn’t see any discharge during the exam and i couldn’t help but think is she serious because i just saw glue globs of it this morning before i came. I just want the discharge to stop, any advice on how to stop it?

  11. Question…
    I have a chunky off white discharge on my labia and nothing when I wipe. No smell, no itching and have not had sex in 7 months. It has been there for about 5 months. When I use a wipe to clean it or after a shower it’s back the next day or that evening. I was tested for a yeast infection and I don’t have one. I’m 39 years old and have never had this unless it was actually a yeast infection (after taking antibiotics or wearing tight jeans) and after taking medication it went away.

  12. Hello I have been back and forth to Baltimore City specialist and before test they diagnosis are always yeast infection through out taking my meds problem remains and still occurs. Is the any direct or more one on one fir further explanations??

  13. i have been having this discharge for about a month now,i went to a gyn i was told is yeast,i treated it it came back again,but i dnt have itching,burning or redness,am worried what could this be,will it go away on it on,i just finished another yeast medication(gynodarterine capsule)but the chunky pale yellow stuff still comes out,please i need advice on what to do.

  14. Thank you so much for this information. I have been to the doctor multiple times and they have ruled out STDs, yeast and other types of vaginal infections. I am still having this white discharge and was puzzled as to why it was still happening.

  15. Great piece, thanks for putting my mind at rest, you are completely right about Candida being everywhere… very interesting and will pursue this further, great references btw too. I am completely baffled by what is happening to me? It only started in the last few days… I put it down to menopause 😦

  16. Thank you so much for this helpful information. I love it when people debunk certain things most people consider common knowledge. Keep up the good work.

  17. Late reader to this blog post. Extremely interesting piece and I am so happy that someone has finally put out reliable information that was able to ease my anxiety at least a little. Since about November, I have noticed a white discharge, kinda thick, appearing more so than ever before. My automatic thought was a yeast infection, but there wasn’t any itching. My gyno diagnosed it as BV. I took the medication for about three months, and each time it went away for about a week, but then it went right back to the what it used to be. Very odd because I never used to discharge like this, it basically came out of nowhere. I got tested for everything and everything came back negative. I guess the only explanation is that my body chemistry changed and this is the new normal.

  18. Yeah okay so if I’ve been diagnosed with chronic yeast infections, my cultures are negative, and I have profuse white clumpy thick SOUR discharge, and 6 months of diflucan doesn’t cure it… WTF IS IT? The doctors can’t help me. Idk what to do.

    1. i am so glad i found your article, started beening sexually active 6 years ago and i had no i idea the change in my discharge it did not itch or burn but u had chunky discharge i went to my doctor she took a look and said yes you have yeast infection and gave me pills for it but every time i get this chunky discharge i panic and was told to buy over the counter pill and cream and if it dont go away to go back to the doctor to give me some thing stronger but then I had to find another way because its not normal to just take pills i checked online alot about this yeast infection and it always says itcy burning but i only had that 1 time in my life but never again then why they give me the pills this is why i hope that Dr.jengunter should educate all the doctors
      thank you for information p.s do semeniers on this topic 🙂

  19. Thanks for posting this. I went to the gyn today thinking I had a yeast infection. I had chunky, white discharge but no other symptoms. My doctor looked at it under a microscope. Not only was there no yeast, but there was an abundance of healthy bacteria. I had self diagnosed in the past based on discharge. I wonder how many times I used Monistat when I didn’t need to? Ladies, ask for your discharge to be evaluated under a microscope. Maybe it is a yeast infection. But, maybe it’s not!

  20. So if I only have thick chucks of discharge after sex and it only appears to be on his penis after sex does this mean I do not have a yeast infection. Let me add I had a hysterectomy a year ago and I am just now having sex more frequently now that I am in a relationship. This has NEVER been an issue and has only happened twice in the last two months. I have no discomfort at all! I have even check myself after sex and later the next day and no chunky discharge at all!! Just the normal stuff

  21. Very informative. I enjoyed the article and feel much better knowing that my body is just doing what is normal. Thank you for putting this on the web for women to read. We should be able to find actual truth about our bodies and what to expect or look for before having to run and get a physical at the sign of a slight change.

  22. Sorry for the overshare but this is also news to me! I Loved this article!

    I get a thinner milky discharge with chunky lumps of white with no odour, no pain, no itching all around time of ovulation.

    I’ve taken numerous OTC medication for yeast infections and it disappears after a few days. It might just be that during ovulation I shed more cells or something, as it almost rolls away from the walls, like dry skin in the shower lol. It’s always baffled me.

    Thank you again for this article, it’s eye opening.

  23. Dr Jen, I have this white light clumpy but more dry discharge. I’ve had a yeast infection before but this time it doesn’t itch or burn. I have been tested for chlamydia and gonorrhea. And the test was negative for both. I have take fluconazole and it had taken it away but I always have this discharge and nothing seems to help. Do you have any clue what this may be?

  24. Thank you for your time you gave to write this and the courage it took to publish it.
    I am one of the many women who have fallen into the misdiagnosis abyss and in reading this piece my ‘condition ‘ makes sense.
    Thanks again,
    Romana

  25. Wow maybe I’ve been worried about nothing all this time!!! Hahahha thank you this has put my mind at ease

  26. Thanks for this useful article!

    Can you direct us towards want research or conditions which my account for thrush like / BV like symptons ? I am BV/candida/STI free but have itching and discharge as well as raised glands. Any further signposting would be great!

  27. I have this,but is wet toilet paper consistency and I’ve already been checked for STDs and bacterial vaginosis both came back negative. I don’t know what else to do I did a round of Monistat 3 which should help initially but after a couple weeks and having my period it’s right back to the way it was and I can’t take much more of it. It doesn’t have a smell oh, I don’t have an itching or burning, and I don’t believe that it has a color maybe a slightest yellow tint but nothing significant

  28. Thank you for this article.
    I had been diagnosed with yeast infection a month ago. After all the medicines and treatment, there is no discharge but the itching remains. What could this be? Am very worried

  29. I was so lost on the internet, every health website spitting the same bullshit “white cottage cheese-like discharge = yeast infection” i became so angry because i absolutely do not qualify for the other common symptoms. After vaginal intercourse with condom i noticed i left a lot of small white pieces of discharge on the condom(which resembled curdled cottage cheese) but i had no itching or burned feelings down there, even not few days later. Actually i still dont know what has caused this but im sure i have no yeast infection.
    I’m glad i found this article. Thank you

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