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Pregnancy brings on many physical changes, including changes in blood volume, immune response and body fluids. That includes increased vaginal discharge, and it’s important to know what’s normal (hint - a lot of it), how to care for your vaginal hygiene in pregnancy, and when to seek medical care. Read on to learn….

• ‍Vaginal discharge - what’s normal?
• What causes it?
• What to do about it
• When to seek medical care
  

What is normal vaginal discharge in early pregnancy?

In a typical pregnancy, the amount of vaginal discharge increases, and this is usually a healthy and normal symptom in early pregnancy. In any person assigned female at birth who goes through puberty, menstruation and other typical reproductive processes, leukorrhea is discharge that flows from the vagina, usually off-white in color and varying in consistency with someone’s hormonal cycles, diet and general health. 

Someone’s discharge may change over their lifetime as well as during pregnancy, but there are also types of discharge that can be a sign of infection. Here are the key differences between normal discharge and signs to seek medical care:

• ‍Thin, milky white and mild-smelling or odorless discharge is considered healthy, and the exact consistency, stretchiness, color and amount will vary over a person’s hormonal and/or menstrual cycle.
• Thick or lumpy discharge, especially if green or yellow in color or accompanied by a fishy or foul odor and vaginal itching, burning, or pain with urination, may be a sign of infection.
  

What causes changes to discharge in pregnancy?

The physiology of pregnancy brings a lot of changes, many of which begin in the first trimester but continue and shift throughout pregnancy. The changes that can cause an increase as well as variation in vaginal discharge during this time include:

• Significantly increased blood volume, bringing more blood flow to all areas and systems of the body
• A more sensitive immune response, causing and increase in white blood cell activity and protective mucus inside of the body and at areas like the genitals, mouth, and nasal passages
• Hormonal shifts designed to protect and nurture the pregnancy, funneling energy, nutrients and metabolic processes towards the fetus and pelvic area
  

All of this can make pregnancy a very fluid experience, quite literally, with an extra need for hydration and frequent urination as well. In early pregnancy, vaginal discharge cleans away old cells and bacteria, preventing infections. Your body also builds a protective layer of mucus at your cervix to protect the inside of your uterus - and your baby - from outside pathogens. 

Usually pregnancy discharge will be the typical off-white substance described above, but there are some other changes to discharge that are normal at different times in pregnancy. Brown or pink discharge may be a sign of:

• Normal “implantation bleeding” in the first 2 weeks of pregnancy;
• Sexual intercourse having irritated the cervix or vagina, which is extra sensitive during pregnancy due to increased blood flow;
• A vaginal exam at a medical appointment causing irritation;
• A vigorous workout or other physical exertion - spotting is a sign to ease up on the intensity, but bleeding is a sure sign to seek medical care;
• “Bloody show” at the end of pregnancy, when the cervix begins to dilate and the mucus protecting your womb starts to come out in streaks, pieces or clumps - some people never see a bloody show and it can happen weeks before labor actually begins.
  

What can I do about normal pregnancy discharge?

Some people experience stigma around pregnancy discharge, or the idea that it is somehow unhealthy or dirty. Normal discharge is actually incredibly healthy and helps the vaginal area to self-clean, maintaining a proper pH balance (acidity level), and promoting a healthy microbiome that protects the body from illness and infection.

If you have any signs of infection or discharge you suspect is not normal, it’s recommended to seek medical care as a short-term treatment may eliminate the problem, and sometimes simple changes in personal hygiene and diet can prevent future infection. Especially during pregnancy, it is important to treat infections, as some can risk your baby’s health as well your own. If an infection is sexually-transmitted, it may indicate treatment for any sexual partners, so seeking care is a good step in taking care of yourself as well as others.

Otherwise, healthy pregnancy discharge is not a problem that needs to be “fixed”, but there are some things you can do for your comfort and protection.

• Use breathable cotton or cotton-lined undergarments - synthetic materials can trap heat, bacteria and sweat which can result in odor, irritation and infection.
• Bathe regularly, using warm water and gentle or mild soap. Water or soap does not need to be used inside the vagina and can actually disrupt pH and healthy bacteria - use warm water and a hand or washcloth to gently wipe and rinse the vulva and the folds of the labia. Use water and soap to wash the anus and the area between the vulva and rear called the perineum.
• Use cotton pads or liners to absorb excess discharge, changing at least daily.
• Do not use vaginal douches or special wipes. Many of these products are not FDA-approved and introduce harmful fragrances and chemicals to the sensitive tissues of your genitals and even your bloodstream, altering microflora and risking health outcomes including pre-term birth and infection.
  

When should I seek medical care?

• If discharge is yellowish, greenish, grey 
• If discharge has a consistency that is thick, frothy or cheesy with clumps
• If you have sudden or sustained bleeding beyond light spotting or some pink streaks
• If there is a foul or fishy odor at the vagina or discharge
• If you have very watery and excessive fluid with your discharge, it could be amniotic fluid - since this can be a sign of preterm labor it is recommended to call your provider
• If you experience itching and/or burning inside of your vagina or at your vulva
• If it hurts to urinate
• If sex is painful (during or afterwards)
• If you experience any sustained pain, bleeding, signs of infection (including fever), or a strong intuition or instinct that something is wrong