People who menstruate have physiological vaginal discharge, composed of vaginal cells, bacteria and cervical mucus. Cervical mucus is a type of mucus produced by cervical crypts, the appearance, consistency and quantity of which vary depending on the different stages of the menstrual cycle. Cervical mucus is produced during the follicular phase, just before ovulation, and is crucial for the survival and transport of sperm at the level of the cervix. Diet, stress, sexual activity, use of medications or synthetic hormones can alter the appearance of cervical mucus.

This physiological vaginal discharge is usually white or clear in colour, can have a creamy consistency or be clear and stretchy like egg white, and has no particular odour. The equivalent of half to one teaspoon may be produced daily during fertile periods. It can be accompanied by a feeling of moisture at the vulva level. These discharges are normal and a sign of good health.

However, some vaginal discharges are pathological and can be a sign of vaginal infection by bacteria or fungi (mycosis). Infection should be specifically investigated when the discharge is yellow, grey or green in colour, foamy in consistency or has an unpleasant odour, or when accompanied by fever, bleeding, itching, burning during urination or pain in the lower abdomen or during sexual intercourse.

The most common vulvovaginal infections are:

• vulvovaginal mycosis
• bacterial vaginosis
• trichomoniasis

Vulvovaginal mycosis is an infection caused by a fungus called Candida albicans. It causes vulvar itching, redness, irritation and sometimes swelling of the vulva and vagina, as well as white, lumpy discharge that may resemble cheese or cottage cheese. These discharges usually have no particular odour or have a mild yeast smell. Vulvovaginal mycosis may sometimes be accompanied by burning during urination or pain during sexual intercourse.

Candida is a fungus that is commonly found in the vagina and intestines. Certain conditions, such as taking antibiotics, stress or some other factors, can cause an imbalance of the vaginal microbiota and lead to the overgrowth of Candida, which will cause the aforementioned symptoms.

If your doctor makes this diagnosis, they may prescribe an antifungal treatment, either locally or orally.

The vaginal microbiota is a fragile ecosystem, consisting mainly of various types of Lactobacillus, but also other bacteria and fungi in small amounts. Many factors can disrupt this microbiota and lead to an overgrowth of certain microorganisms compared to others. This is called dysbiosis.
In the case of vaginosis, we observe a reduction in the normally dominant Lactobacillus, and an increase in other bacteria, such as Gardnerella vaginalis.

Bacterial vaginosis is not always symptomatic. Common symptoms are an abundant white-grey discharge and/or an unpleasant fishy vaginal odour, which may be more noticeable after sexual intercourse or during menstruation.

There is usually no itching or pain.

Vaginosis is treated with antibiotics (locally or orally) to kill the overgrown bacteria, and probiotics (locally and/or orally) to help restore a healthy microbiota.

Although the main risk factor is an active sexual life and that risk increases if you have more partners, vaginosis is not considered a sexually transmitted infection and it is not recommended to treat partners (except for partners with a vagina who also have symptoms).

Symptoms of vulvo-vaginitis, with vulvar and vaginal burning, can also occur in the case of irritations caused by products or foreign bodies (soaps, creams, toilet paper, tampons, ...). In this case, there is usually no abnormal vaginal discharge. This is called vulvar dermatitis.

Other dermatoses can also cause vulvar irritation, such as lichen planus, psoriasis or eczema.

Vulvo-vaginal atrophy that occurs with menopause may cause symptoms similar to vulvo-vaginitis and usually responds well to local treatment with oestrogen-based cream.

Sometimes the symptoms are clear enough to identify their cause, but often a visual examination and a local sample will be required to determine the origin of the symptoms and which microorganism is causing the infection, as well as to propose appropriate treatment. These examinations are usually performed by a gynaecologist.