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vagina, vaginal discharge

How much vaginal discharge is normal? I made a roux to demonstrate.

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.

 

Discussion

15 thoughts on “How much vaginal discharge is normal? I made a roux to demonstrate.

  1. Thank you for posting this. It is a shame that there is not more open, and frank discussion of these basic biological processes. It often seems like the only people discussing vaginal health are those who are trying to sell a product that probably isn’t good for vaginal health.

    Posted by ZenHeathen | May 6, 2017, 12:30 pm
    • It is shameful. I’ve not come across it here (in the UK) but I’ve talked to so many American women who use tampons every day for normal vaginal moisture, which horrifies me. I talked with one young woman who was shoving talcum powder inside herself because she thought she should be dry. Again, absolutely horrible to hear about.

      I think that the US in particular needs to drop the collective stigma and disgust over sexual education, over talking to children about puberty, and the ways in which their bodies will change over the years. Young women especially need to know that menarche is not the beginning and end of bodily changes until menopause, and that their bodies will continue to change and develop throughout their lives. Not everyone is lucky enough to find Dr Jen, or to stumble across online communities that give safe, sane advice about bodies, sex, and contraception.

      Posted by Boostick | May 7, 2017, 12:06 am
      • Good luck with that. Some areas seem especially prone to Abstinence Only edumacation. Like -that’s- ever worked

        Posted by Demodocus | May 7, 2017, 4:42 am
  2. Given that (it seems) most people can’t accurately estimate how much discharge they have, and that such things are hard to measure…how did anyone come up the numbers for the “normal” range?

    Posted by Miriam | May 6, 2017, 3:08 pm
  3. Thank you. It is important to have these visual demonstrations.

    Posted by Necia | May 6, 2017, 4:06 pm
  4. These things don’t get talked about enough! Fortunately, I had access to plenty of sources of info that said discharge is normal when I was younger. I grew up in Germany where many magazines geared towards teenagers always had a couple of pages of sex ed stuff (including pictures of what your average young naked person looks like). Even then, it took me about 14 years of menstruating to figure out I was losing more blood than is considered normal, as I had no baseline. Most of the materials I had read simply said “it may look like a lot, but it’s just three tablespoons”.

    Posted by C | May 9, 2017, 12:43 pm
  5. Just curious – are these amounts also normal for someone post hysterectomy? Uterus and cervix gone, kept ovaries. I’m dealing with that now and was treated with an antibiotic in case it was bacterial, but nothing’s changed.

    Posted by A | May 10, 2017, 8:31 am
  6. This is helpful, but I also wonder if you can shed some light on what consistency of discharge is normal. I ask because I keep getting sticky, mucus-y discharge, especially later in the day. There’s no pain, no itching, and no abnormal odor. I’ve been in to my ob/gyn and tested positive twice for bacterial vaginosis, and treated topically twice with metronidazole gel, but I’m back in the same boat again. According to my gyn, the second test showed less bacterial load than the first, and we did a longer treatment with the gel the second time around, but my guess is, when I go in again, I’ll once again test positive. I know she’ll want to do oral antibiotics at that point, but the last time I took those, 18 months ago for a positive bv test, I got a yeast infection immediately, treated with diflucan, and then tested positive for bv again a month later. So, not overwhelmed with confidence in that course of treatment. (I’ve also tried taking oral probiotics, but it didn’t seem to make a difference.)

    Is it possible to test positive for bv as a result of normal vaginal bacteria?
    Is it possible that wet and sticky discharge is just normal at this point? (It’s certainly different than where I was before, but it’s been this way basically since the end of the postpartum discharge after I had my first child in late August – so, since about October.)

    Anything you could suggest that I might bring into the conversation with my gyn would be great. Thanks!

    Posted by CE | May 10, 2017, 6:24 pm
  7. I have a pretty good eye for what 1ml looks like in a test tube or pipette but I had no idea it looks like that much on a panty liner. Holy cow.

    Posted by Xenobio | May 21, 2017, 3:43 am

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