Vaginal bleeding and discharge

What is vaginal bleeding and discharge?

This includes bleeding between periods, pain and bleeding during sex, and discharge.

Causes and risk factors

• Sexually transmitted infections (STIs) – the risk of getting these increases if you're having casual sex. If left untreated, long-term complications include chronic pelvic pain and infertility can result. The sooner it's diagnosed, the better. This is best done by having an internal examination, during which swabs will be taken but self-swabbing using a simple vaginal swab is also an effective way of testing for chlamydia and gonorrhoea. Urine sampling, available for testing in men, is not suitable for women as infections can lurk in the cervical area.
• Thrush or candida - although this is caused by a yeast infection, usually it isn't passed on through sex. Instead, most women carry the yeast in small amounts all the time. If you become run-down or ill, candida takes over. It usually causes itching and discharge, but in severe cases may also cause pain and bleeding.
• Cervical cancer - if you're sexually active, you're at increased risk of cervical cancer and should be having regular smear tests. This is especially true if you've ever had an infection with Human papilloma virus (HPV). Smokers are also at increased risk. The earlier it's caught, the more likely it is to be treated successfully. In the UK, all women between the age of 25 and 64 are offered regular screening for cervical cancer every three to five years on the NHS, so if you are in this age group and haven’t had a smear test, ask your GP to arrange one.
• Cervical erosions - non-cancerous changes to the cervix can also lead to bleeding between periods (and during sex) and discharge.
• Occasionally an irregular vaginal bleed may occur between periods, with or without discharge, simply due to temporary hormonal variation. However, if it recurs you should be checked out.

If you have discharge other than bleeding, then it possibly may not be a problem. Almost all women, especially during childbearing years, have some vaginal discharge at some point for no obvious reason. For some it's an ongoing problem.

If this is the case then scrupulous personal hygiene, with a shower or bath at least once a day, regular change of cotton underwear and the use of panty liners help most women to cope.

When the discharge changes colour (such as to yellow), has an unpleasant smell and causes itching, then this may be the result of an infection (see above). Infections are easily treated. For example, you can buy treatments for candida directly from the pharmacist (although you will need to see a doctor if you think it is a bacterial infection, which needs a prescription for antibiotics).

There's also a condition called non-specific vaginitis, or ‘bacterial vaginosis’. This occurs when the bacteria that normally inhabit the vagina multiply and cause an unpleasant fishy-smelling discharge. The cause of this isn't clear, but it may be related to stress or being run down. Ensure you follow the usual advice to keep your immune system healthy with a balanced diet and plenty of rest. Usually it settles without treatment but if it persists your doctor may offer you antibiotics.

Occasionally, discharge is caused by a forgotten tampon, diaphragm or retained pessary. Get your doctor to check for this.

Inflammation of the vagina may be caused by an allergy, and this can result in a discharge.

Common allergens include:

• Spermicidal creams in barrier contraceptives
• Chemicals in soaps, vaginal douches or shower and bath products

You may want to try changing the bath or shower products that you use, to see if this helps you.

Changes in normal discharge, as well as some irritation , may occur during or after the menopause as hormonal levels fall.

Treatment and recovery

If you're sexually active, it's important to have regular smear tests and follow good advice about contraception and protecting yourself against STIs.

Make an appointment at your local genitourinary medicine (GUM) clinic or with your GP. GUM clinics offer expert advice on all areas of gynaecology, not just STIs, and are usually able to do all the tests you may need immediately.

The health professionals you meet won't be embarrassed to deal with your problems - it's their job. Neither will they be judgmental.