By Harriet Birungi

"Sometimes, my private parts itch and a smelly, milk-like fluid comes out. I tested for syphilis, but the results were negative. Please help me,” wrote Ritah, to ‘Ask the Doctor’ column in the New Vision.

She is not alone. Dorothy, a student, has similar concerns: “I had a discharge for some time. It was after it lasted close to six months that I told the senior lady at school and was sent back home that I discovered it was candida. I have since self-medicated. I seem to have the milk-like discharge often. How can I get rid of it?”

In the world of vaginal discharges, things can get confusing, but experts say it is important to know what is normal and what is not.

According to Dr. Evelyn Nabunya, an obstetrician and gynaecologist at Mulago Hospital, genitals have a self-cleaning mechanism.

It comes in form of a discharge, which ensures that the vagina is in the right condition. However, due to imbalances in our internal and external environments, she explains that it may get infections whose symptoms may take the form of abnormal discharges.

What is normal?

Nabunya says it is normal to have a discharge, although the amount of discharge is different for each woman. “The glands inside the vagina and cervix make small amounts of fluid that flows out of the vagina every day, carrying old cells that had lined it.

This is the body’s way of keeping healthy and clean. The discharge is usually clear or milky and does not smell bad,” she explains.

The colour and thickness of the discharge changes with the woman’s monthly cycle. It increases during ovulation, when breastfeeding and when one is sexually excited.

Dr. Nabunya points out that there could be less or no discharge after the menstrual periods. There may be minimal or no discharges experienced for a few days.

The discharge closer to ovulation can be brownish or yellow, but it is usually white when it dries on the panty.

During ovulation it is very slippery, transparent or white and can stretch over one centimetre when stretched between fingers. This is the most fertile period and sperms can survive in this mucus for three days.

After ovulation, the discharge becomes sticky again and one may feel dryness or less discharge.

A brown or scanty bleeding almost similar to spotting, in the middle of the menstrual cycle, could be implantation bleeding, which is an early indication of a pregnancy. It may also occur with certain types of contraceptives.

A dark discolouration or brown discharge, which can happen at the end of the menstrual cycle, is old blood from the period that is being discharged.

During pregnancy, the vaginal discharge is more than usual and one may require a panty liner. After giving birth, there is bleeding for four to six weeks, called lochia, which reduces as the days go.

What is not normal?

Not all discharges are normal and there are certain things that a woman can look out for.

Dr. Nabunya says there are many signs, but the most common have to do with an increase in the amount of discharge. One can tell when the discharge suddenly is so much that one’s underwear actually gets wet.

If there is green or yellow discharge during ovulation, accompanied by vaginal irritation, pain or any kind of discomfort or soreness around the vagina and rashes, there is a possibility of infection and one must consult a gynaecologist.

A change in colour to green, yellow or gray should be of concern.

The smell is another indicator and a bad odour is a definite alarm. If there is irritation, an itch or burning in and around the vagina, then there is a problem.

A foamy discharge or one that looks like cottage cheese or like spoilt milk should also be checked.

Women should also take action if there is a blood-stained discharge when they are not in their periods. It could be a sign of a problem like cervical or uterine cancer.

Causes of change

Changes in vaginal discharge occur if the normal balance of healthy bacteria in the vagina is upset. This can be caused by douching, feminine hygiene sprays and certain soaps or bubble baths (where one sits and soaks the body).

Some changes can also come about if one is taking antibiotics or suffering from diabetes.

Ignoring these changes is at the risk of carrying dangerous infections in your system that could lead to adverse effects, like infertility.

Common Vaginal infections

Yeast infections: these present in a thick, white state, like cottage cheese. It is not caused by sex.

Trichomoniasis: It can show through signs of a discharge which is green, yellow or gray. It is transmitted through sexual contact.

Bacterial vaginitis: Here the discharge looks white with a fishy smell and is probably not sexually acquired, but changes in the environment inside the vagina can cause it. Left untreated, it can lead to infertility.

Gonnorrhoea: Presents through a cloudy or yellow discharge, often with no other symptoms. If not treated, it spreads to cause pelvic infection and pain. It is spread through sexual intercouse.

Chlamydia: This infection often presents no symptoms. But when not treated, it can cause pelvic inflammation. One can suffer pain in the lower abdomen that gets worse during the menstrual period. It is also spread through sex.

“A woman may have more than one infection at the same time, which means one should go for tests,” says Dr. Nabunya.

Tips on preventing infections

Like the doctor said, the vagina is self-cleansing, but many women cannot believe that. Washing inside the vagina (douching) with soaps, water or other ‘feminine’ products predisposes one to infections. Douching removes good bacteria that should fight infections.

Avoid feminine hygiene sprays, coloured or perfumed toilet paper, deodorised pads or tampons and bubble baths.

After using the toilet, always wipe from front to back. This helps prevent bacteria spreading from the rectal area into the vagina.

Wear cotton panties during the day to allow the genital area to ‘breathe’. Do not wear underpants at night if possible. Avoid wearing tight panties, pantyhose or biking shorts for long periods.

Change your laundry detergent or fabric softener if this irritates the genital area.

The latex in condoms and diaphragm and sperm killing gels that are used for birth control can be irritating for some women.

Avoid hot tubs — sitting and soaking. They change the environment of the vagina.

Bathe/shower daily and part your genital area dry.