Let's talk about vaginal discharge



[00:00:00] All right people. I'm meant to do this all day long because I promised the most exciting, exciting subject, which is vaginal discharge. Um, I know it's not fun. It's not pretty, but it's common. So let's talk about vaginal discharge. I just, the day got away from me, so it's now, it's later than I thought. So I've talked about this before, and I say this a lot to my patients. 

If it's not itching, burning, or smelling the she, then it's probably normal d. Nobody likes to hear that because people come in all the time and say, there's something wrong. I don't like the discharge that I have, and I have to say to them, it's actually very, very, very common to have discharge and somebody wants to come and say hi. 

Come say hi. Really quickly. Very common to have discharge. Okay, good. Goodbye. Every, so people come in saying, I don't like it. I have abnormal discharge. Okay. Is it itching? No. Is it burning? No. Is it smelling fish? No. Okay. Then maybe it's normal. We can certainly do tests to figure it out. So she's distracting me. 

[00:01:00] So I do cultures, the general cultures I do and everyone's a little bit different. But I do what's considered a general vaginal culture cuz you might have any kind of bacteria, e coli, um, like a bunch of different, just general bacterias. And then I do a special swab that looks for. Yeast, something called trichomonas, which is sexually transmitted, and BV bacterial vaginosis. 

So I do cultures for those, which is like the standard, and if those are negative, then I have a discussion about what is considered normal discharge. Normal discharge will be. A little bit whitish, occasionally a little bit colored, like a little bit yellow. Shouldn't be smelly. We're gonna talk about smells in a second and we're gonna talk about other cultures and tests to do. 

Um, and really it might vary throughout the month, especially if you're not on the pill, especially mid-cycle. Mid-cycle is a little bit of misconception because if you remember, one of my other topics about when you ovulate mid-cycle is not. Day 14. For many people, that's only if you have a 28 day cycle. 

But if you are mid-cycle, what [00:02:00] we consider mid-cycle is two weeks before your period and you notice a kind of tacky, sticky, clear, uncooked, egg white discharge, that is what ovulation outside of that sticky white discharge, you're out, you're. So your vaginal discharge throughout the month might change a little bit to a little bit more, a little bit less, a little bit more liquidy, a little bit less liquidy, a little bit more white, a little bit tinged yellow. 

Otherwise it's normal. A couple of points about discharge. What do I personally, and this is my theory, it came up three times the patients yesterday. Things that I think increase discharge that then bother you, that then cause you to keep doing these things and it becomes a vicious. The number one thing I think is panty liners. 

I think panty liners should be reserved only for like that last couple days of your period where it's really schmutzy. Otherwise, I have patience, and I'm sure many of you women are doing this. They're wearing panty liners every day, so forget the landfill and what, how bad that is, but. If you're wearing a pan liner every day, even if you say to me, but I got the organic [00:03:00] cotton, whatever those are, you are literally trapping the bacteria and the moisture. 

Cuz think about on the other side of that organic cotton pantyliner, which most of you're not even using, and I'm not even sure they make them. There is some kind of adhesive and that means it's smack up against your vulva and it is trapping all the bacteria and all the secretions that are trying to come outta your vagina and they can't come out as much. 

And then it just becomes a vicious cycle. My analogy. When you're young and you have dry skin, I mean oily skin, and you wanna dry it out, you slather it with all kinds of things to dry it out, and then it overs, secretes the oil. So I really think people get into this vicious cycle. So what I tell them is, give me one month, four weeks, no more panty liners. 

And I'm so old fashioned that I actually tell them to take a white. Washcloth, just a plain white washcloth. Cut it into strips the size of a pantyliner, put it into your underwear, bring a Ziploc to work and keep changing your, your little, um, washcloth. If the purpose is that I don't like the feeling of being damped with my discharge, right? 

So again, we've talked about a lot in a short period of time, so I just wanna reiterate, [00:04:00] we're talking about normal discharge, which is not itching, not burning, not smelling fishy. That variety that you guys go to, your gynecologist saying there's something wrong. I just have discharge. She'll usually do cultures. 

Assuming the cultures are normal, then it's probably normal discharge. Millions of women have it. And as I joke with you guys, you guys talk about everything with your best friends, right? You talk about sex, you talk about your periods, you talk about your boyfriends, but I'm betting you do not talk about your discharge with your friends because everyone considers that a hush hush secret. 

So you all come into us saying, I have more discharge than everyone else. But the truth is, you don't know what everyone else has. And I do cuz I see everyone all day. So again, normal discharge, not itching, not burning, not smelling, fish. Please stop using pantyliners and I'm gonna say something else so unpopular. 

But I think when you over groom, when your vulva is bald, then you actually don't have any of those hair follicles that are supposed to secrete a little bit of oil, and that actually helps the balance. Imagine if you're completely bald. , the tissue actually sometimes gets a little bit less elastic and more dry, and I've seen [00:05:00] that cause pain during intercourse, and that can co be coupled with, especially women who are on the pill, where the vagina also will be a little bit more painful during intercourse. 

Okay. Second is we're gonna talk about smells and odors. I talked about this once before, but I, I categorize three smells in the vagina. The one. . Oh my God. It smells like something died. And that is a tampon. Almost always patients will come in and say, Nope, there's no tampon. I'm telling you there's no tampon. 

Something died in there. And I look with my speculum. Lo and behold, there's an old tampon and those things smell. , like something died. So if you have brown discharge or something dyed smell, that is a tampon, I'm telling you, go to your gynecologist. It's very rare to get toxic shock these days, but go to the gynecologist. 

Second smell is the fishy odor. It sounds so embarrassing. It sounds so unique. , it's actually a dime a dozen in a gynecology office. Like you could call my secretaries will know, oh, bi yoder, great. That's bacterial vaginosis. And then depending on how frequent, how often we will either diagnose over the phone and call in a vaginal gel, which is my choice. 

I would rather not use oral antibiotics if [00:06:00] I don't need to because they throw off your microbiome. Um, but if it recurs more than once or twice, then I usually tell patients, let's just not do this over the phone. Come on in. Because we should culture for other things. Cuz sometimes you have a couple of infections together. 

So, The watery, fishy odor. And then the third odor, which is the most annoying because it's the most common and someone you guys don't like, which is the not so fresh, which is what I say. Listen, end of the day, if someone put their nose into someone's armpit, it would stink. Even with deodorant, like it's not so fresh at the end of the day. 

Cuz there's bacteria, it's the same thing. Our vagina is a damp. Dark place, right? That makes it sound bad and onerous. It's a beautiful damn dark place with a lot of flora and all that flora, at the end of the day when you've been wearing jeans or leggings, or tights or spanks or whatever, is not gonna breathe and you're gonna have a not so fresh smell. 

Very normal, very common. Do not try to over scour your vagina, wash it once in the morning or once in the evening. I always suggest the morning just cuz I sweat overnight. Um, [00:07:00] and that's it. There's a little bit of a controversy as to what you should wash your vagina with. Do you need soap, do you not? 

There's two camps. There's the self-cleaning oven. That's a lot of the analogy that a lot of gynecologists use. Your vagina is a self-cleaning oven. You don't need anything but water. Um, I'm in the other camp, which is I am absolutely fine with using something, but that's something I would request is, and I'm not being paid by Dove, but I should dove just the cheap dove bars of soap. 

Don't go buying all those liquids like Summers Eve liquid and all those things. You don't need it. It's a waste. It's bad for the landfill. You're paying. And it might be overs stripping your vagina. So dove is very moisturizing. So I tell patients, just dove on your hand with your finger. If you wanna stick your finger in there with a little bit of soap just to freshen up, that's fine. 

Do not over scour it. Just like your skin, it will get angry, it will overs, secrete, it will get rid of all the good bacteria. You don't wanna do that. Okay, so we talked about odors. We talked about what is normal discharge. We talk, we didn't talk yet about Second level is, let's say patients come in, and this is a bigger topic, so I'm just gonna skim it.[00:08:00]  

What if you come in with really bad, recurrent, recurrent, recurrent yeast or bb? Then different people do things differently. But I do a special culture that looks for a lot of other bacteria that sometimes we would miss on the typical. Cultures because sometimes you're harboring some underlying bacteria that if we don't treat, you might continue to have irregularities and what you consider like, oh, it never goes away and it's chronic when in reality it's being treated and going away. 

But then the underlying issue, which is the balance of your vagina, or what we call the flora, the normal bacterial flora, the microbiome that you know we have on our skin in our GI tract and all over and in our vagina is normal yeast and bacteria that keep each other in. When that's thrown off, that's why you get an overgrowth of yeast or an overgrowth of bacteria. 

And if it's chronic, meaning you keep getting it back and forth, it just means the offending issue has not been addressed. Um, and again, bigger talk, but things like sometimes semen. So when you have sex, The semen itself can drop the balance. Sometimes it's your cycle, different times of your cycle.[00:09:00]  

Sometimes it's the products you're using or if you're overly groomed. Sometimes it's just something hormonal in your system that we can't measure where your vagina is just being thrown off balance. And there's been some data that's not so strong, but I will always try to plug vitamin D. That vitamin D deficiency increases the chance of BV in particular, which is the fishy smelling one. 

And then just a quick, if you have a chunky white discharge, it's usually yeast if you have a watery, clear discharge, especially with. . It's usually bv, bacterial vaginosis. Okay. That's it. I kept it under 10 minutes. Wow, that's hilarious because that's really long. I know. Okay. There's a lot more to talk about with vaginal discharge, but that's it. 

Talk about it with your friend so that you know that y'all have discharge. Okay. Bye. And be honest about it.