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Vaginal Discharge During Pregnancy

What's normal and what's not

When you are expecting, your body goes through so many changes it's hard to know what's normal and what's cause for worry. Am I supposed to feel hot all the time? Why I am so forgetful? And what is this weird vaginal discharge?

If you are noticing increased vaginal discharge as your waistline expands, you have plenty of company. During pregnancy, changing hormones and increased blood circulation in the vaginal area cause a discharge called leukorrhea. This runny, whitish substance shouldn't have an offensive odor, even to your pregnancy-sensitized nose. There is nothing you can do to reduce this fluid, and you wouldn't want to anyway: This is your body's way of flushing out bacteria to keep you and your baby healthy.

Of course, that doesn't mean you have to feel uncomfortable. Changing your underwear often or wearing panty liners can help keep you feeling dry. Don't douche or wear tampons, however, as this could introduce new bacteria into the area.

Another completely normal type of vaginal fluid appears during the last few weeks of pregnancy. Up to a month before delivery, you may notice an increase in discharge as well as a thicker consistency.

You may also note a jelly-like substance: this generally means you are passing the mucous plug -- something that can happen a week or two before labor begins or just before your first real contractions. Check with your doctor to be sure, but in general neither of these conditions is cause for alarm. If the mucous is pink or streaked with blood, however, this usually means that labor will take place within 24 hours.

While most of the time vaginal discharge is completely normal and even beneficial, in some instances it may indicate a problem. You should see your doctor about any vaginal discharge that is heavier or different than expected during pregnancy, since the stakes are higher than usual. Some vaginal infections (though not all) may be associated with preterm labor or problematic births, and it's important to diagnose and treat them before complications develop.

When to call the doctor

Here are signs that you should call your doctor right away:

  • spotting or bleeding
  • discharge that looks like cottage cheese
  • discharge that smells like yeast or bread
  • green or yellow discharge
  • irritation or itching of the vaginal lips
  • pain during urination or sex

When to get medical help right away

If you leak amniotic fluid less than 35 weeks into your pregnancy. As your body prepares for birth, amniotic fluid may also leak steadily (or emerge in a gush) from the vagina. If this happens and you are less than 37 weeks along, notify your doctor or midwife. You will need to be examined right away.

When vaginal discharge signals an STD

Some types of vaginal discharge may mean that you have a yeast infection, bacterial infection, or a sexually transmitted disease (STD). Read on to find out how to prevent them, and what to do if they occur.

Yeast Infections

Yeast infections are caused by a microscopic fungus that lives in the vagina. The fungus may proliferate and upset the balance of organisms in the area. Because of the hormones that are flooding your body and changing the vagina's chemical environment, you are more susceptible to yeast infections than ever. Yeast feeds on sugars, which are present in greater concentrations in your vaginal fluid when you are pregnant.

Although you do need to get treatment promptly if the fungus gets out of hand, yeast infections will not affect the fetus during pregnancy. If you give birth when you are infected, however, your baby may develop thrush, an infection of the mouth. Thrush is easy to treat and rarely causes problems.

Make a doctor's appointment if you think you have a yeast infection, because you'll probably need treatment with an antifungal cream or suppository. Your doctor can confirm the diagnosis by analyzing your vaginal fluid; make sure you follow instructions and take the entire course of the medication, even if you get relief sooner. This will ensure that the yeast infection is completely wiped out and lessen the chance that it will recur. (Self-treatment of yeast infections with over-the-counter antifungals is generally safe, but it's still wise to talk to your doctor if you are considering using an over-the-counter treatment during pregnancy.)

Bacterial vaginosis

Like a yeast infection, bacterial vaginosis (BV) -- which can be transmitted through sex -- results from an imbalance in the microscopic organisms in your vagina. Many of the same symptoms may be present, such as itching and irritation, but BV often produces a distinctive fishy-smelling discharge and a burning feeling while urinating.

Sometimes, however, bacterial vaginosis causes few or no symptoms. According to the U.S. Centers for Disease Control and Prevention (CDC), pregnant women with BV are more likely to have babies who are born too small or too soon. For this reason, if you suspect BV, contact a health professional immediately. Your doctor or midwife can help you determine whether you should be tested. If you've had a premature or low birth weight baby in the past, you should also be tested for BV.

The good news is that BV is relatively easy to diagnose and treat. Tests on vaginal fluid will determine whether you have BV, and treatment usually consists of the antibiotics metronidazole or clindamycin, according to the CDC.

Sexually transmitted diseases

Another reason for abnormal discharge is a sexually transmitted disease (STD), which is acquired through sexual contact. If your doctor has ruled out a yeast infection, he or she will likely screen you for STDs -- particularly if you've had sex with more than one person, or suspect that your partner has had sex with someone else. If not, request that you be screened. Some STDs can cause premature labor and postpartum uterine infections, so it's always better to get tested just in case.

Certain diseases, such as syphilis, HIV, and genital herpes, may not cause vaginal discharge but can be passed on to your baby during pregnancy or at birth. If left untreated, STDs can lead to serious problems for your baby such as stillbirth, low birth weight, brain damage, blindness, and deafness. Some STDs, like chlamydia, can lurk in cervical secretions while showing few symptoms for months or even years, so most doctors recommend chlamydia screening during every pregnancy, regardless of your current relationship patterns.

Many women infected with chlamydia have no symptoms at all, so if you have engaged in unprotected sex or have had multiple sexual partners, it's a good idea to get checked out even if you are symptom free.

Don't be reluctant to seek help; there's nothing wrong or shameful about having been sexually active. Equally important, just knowing that you have an STD -- and getting treatment -- will help you protect you and your precious baby. Treatment options depend on the type of STD you have, but all except herpes and HIV/AIDS are curable (and antiviral medications may be able to keep symptoms of the latter under control).

For example, if you have active genital herpes sores at the time of labor, you may choose to have a c-section to protect your baby from the disease. If you're HIV-positive, doctors will prescribe a medication that dramatically reduces the chance that you'll pass the virus to your baby.

How can I protect myself from STDs and other infections that cause abnormal discharge?

The best ways to keep STDs from affecting your pregnancy are:

  • To be in a monogamous relationship with a partner who is free of STDs. (The only way to know for sure is for both you and your partner to be tested.)
  • Use a spermicide-free latex condom. This isn't 100 percent effective, but it can greatly reduce your chances of contracting an STD.
  • Talk with your doctor and get screened for STDS if necessary.
  • Don't douche.

To help prevent yeast and other bacterial infections:

  • Wear loose-fitting cotton clothing, especially undergarments.
  • Dry your vaginal area thoroughly after washing.
  • Always wipe from front to back after using the toilet (this will also help prevent urinary tract infections).
  • Change wet or damp clothing promptly.
  • Don't use any toilet paper or feminine product, including tampons and sanitary pads, that contains deodorant or scents.
  • Avoid bubble baths -- tempting as they are, they can irritate the vagina and encourage infections.

References

American Pregnancy Association. Vaginal Discharge During Pregnancy. http://www.american pregnancy.org/pregnancyhealth/vaginaldischarge.html

American Pregnancy Association. Yeast Infections During Pregnancy. http://www.americanpregnancy.org/pregnancycomplications/yeastinfection.html

Yale-New Haven Hospital. Body Changes Later in Pregnancy. http://www.ynhh.com/maternity/concerns/later_in_pregnancy.html

Bacterial Vaginosis. CDC Fact Sheet. http://www.cdc.gov/std/bv/STDFact-Bacterial-Vaginosis.htm

STDs & Pregnancy. CDC Fact Sheet. http://www.cdc.gov/std/STDFact-STDs&Pregnancy.htm

Vaginitis Due to Vaginal Infections. NIAID Fact Sheet. http://www.niaid.nih.gov/factsheet/stdvag.html

Chlamydia.CDC Fact Sheet. http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm

Gonorrhea. CDC Fact Sheet. http://www.cdc.gov/std/Gonorrhea/STDFact-gonorrhea.htm

Syphilis. CDC Fact Sheet. http://www.cdc.gov/std/Syphilis/STDFact-Syphilis.htm

Trichomoniasis. CDC Fact Sheet. http://www.cdc.gov/std/trichomonas/STDFact-Trichomoniasis.htm

Herpes. CDC Fact Sheet. http://www.cdc.gov/std/Herpes/

HIV and AIDS in Pregnancy. March of Dimes. 2010.

Murkoff, Heidi, Arlene Eisenberg and Sandee Hathaway. What to Expect When You're Expecting. 4th ed.Workman Publishing. 2008

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