It seems more and more women are troubled by the symptom of vaginal discharge. I’ve been running a clinic for vaginitis for 20 years and over the past five years I have definitely noticed an increase in the number of women who are concerned about their normal vaginal discharge. Some women even believe that any vaginal discharge is abnormal.
I’m not sure of the why and I will probably post on some theories at another time, but for now let’s focus on what is normal so everyone has a baseline. Most textbooks and studies quote 1-4 ml per 24 hours as the normal range of vaginal discharge. What does that translate to in real life term? A pretty thick streak of discharge on a pantyliner is going to be about 1 ml. Most women who come in worried about their volume of discharge have about 2 ml on their pad.
When I evaluate a woman who thinks she has an abnormal volume of discharge and the tests indicate it is physiologic (meaning normal) I will look at her pantyliner and then show her with a syringe full of water the range of normal. It’s a great visual and the idea originally came from one of my fellows a few years back. Since we are seeing more and more women with no irritation or itch who are simply concerned that their volume of discharge is abnormal one of my amazing OB/GYN residents encouraged me to make this video so we could reach hopefully reach more women. We made it on the fly so no comments about the production quality or my crazy hair (I was in the operating room earlier in the day and a surgical cap does not lead to video-ready hair!).
After looking at the video and googling vaginal discharge images I decided I needed something even better. There is no good visual representation of a normal volume of discharge online! Challenge accepted! So I made a roux to approximate the consistency of normal vaginal discharge (I am baking bagels so I had the flour out and needed to do something while the dough was rising) and added some yellow food coloring so it would show up well on a photo (if your discharge is this bright yellow you need it checked out no matter how much there is).
Here is 1 ml of a roux the consistency of normal discharge on a pantyliner.
And here is 2 ml.
From my experience and reading the literature it seems that 1-3 ml is the average range and it will vary day-to-day. The 3-4 ml range might be worth checking out if you are irritated, but sometimes there can just be a lot especially around ovulation or if a woman is taking estrogen. Women wearing a NuvaRing often have a lot of normal discharge and may consistently be in the 3-4 ml range probably because the estrogen administered directly in the vagina gives an abundance of good bacteria. It is never wrong to check it out your discharge if you are worried, but unfortunately misdiagnosis with vaginal symptoms, especially discharge, is common (op-eds in OB/GYN journals are written on the unfortunate lack of training in this area), hence by desire to get what is normal out there!
Amount of discharge tends to be less important medically than symptoms. Irritation, itch, strong odor, or pain with sex are much more important symptoms medically speaking. Conditions that cause profuse discharge (meaning 4 ml and above) include trichomonas (a sexually transmitted infection), desquamative inflammatory vaginitis (a bacterial imbalance that is not well understood), a foreign object (think rogue tampon or rolled up condom that has been missing for days or weeks), and a fistula (abnormal connection between the bladder or bowel and vagina). There are obviously other causes, but when I see a vagina full of fluid those are the top conditions that run through my mind.
There are so many myths about vaginal discharge (for example, a chunky white discharge is not a sign of a yeast infection) and celebrities and magazines promoting vaginal health regimens don’t help! Yes, Kardashians I am looking at you. No healthy woman needs an 8-step vaginal regimen.
I know, I made a roux to demonstrate vaginal discharge and that may be a little odd but I really want women to know what is normal! How can you be empowered about your own health when you can’t even find a picture of what is normal online?
Vaginas are meant to be wet. Discharge is the by-product of the process that keeps everything in working order. It’s not gross, it’s normal.