Smelly Discharge in Pregnancy

Tell your midwife

The NHS puts changes in discharge on its list of pregnancy symptoms you need to get help for: "It's normal to have more vaginal discharge in pregnancy. But if you're unsure about any increase or change in your vaginal discharge (such as a change in smell or colour), you should speak to your midwife or doctor."

It also notes on the same page that "fluid leaking from your vagina may also be a sign of labour", which is why an increase in wetness before 37 weeks is worth a call rather than an assumption.

The NHS stomach pain page adds discharge that is unusual for you to its list of symptoms that, alongside stomach pain, mean calling your maternity unit immediately. And the HSE's preterm labour advice includes fluid from the vagina that is greenish or smelly among the things to report urgently.

What healthy discharge is supposed to be like

The NHS baseline is precise and worth having: healthy vaginal discharge "is usually thin, clear or milky white, and should not smell unpleasant", and "towards the end of pregnancy, the amount of discharge increases further".

So more is expected. Different is what gets reported. A mild smell is normal; an unpleasant one is not.

Bacterial vaginosis, which is what this usually is

The NHS describes bacterial vaginosis as "a common cause of unusual vaginal discharge" caused by an imbalance of bacteria in the vagina. It is explicit that it is not classed as a sexually transmitted infection, "but sexual activity can trigger it or pass it on".

Its symptoms:

• an unusual vaginal discharge that has a strong fishy smell, particularly after sex
• a change to the colour and consistency of your discharge, such as becoming greyish-white, thin and watery

Two details from the NHS make this easier to identify. First: "Bacterial vaginosis does not usually cause any soreness or itching." That is the cleanest distinction from thrush, which is typically itchy with thick white discharge that does not smell. Second: "Half of women with bacterial vaginosis do not have any symptoms."

Why it matters in pregnancy

The NHS states the reason without overstating it: "The condition is not usually serious, but if you have it you may need to be treated with antibiotics. It's also important to seek treatment if you're pregnant as there's a small chance it can cause complications with pregnancy."

That is the honest version. Not a crisis, not something to ignore, and a specific reason why the same symptom is treated differently when you are pregnant.

What happens when you raise it

The NHS says a GP or sexual health clinic will want to confirm it is bacterial vaginosis and rule out an STI. You will be asked about your symptoms, a doctor or nurse may look at your vagina, and a cotton bud may be wiped over the discharge to test for BV and other infections.

Treatment is antibiotic tablets, gels or creams prescribed by a GP or sexual health clinic. In pregnancy this is a conversation with your GP or midwife rather than a walk-in purchase.

The NHS also notes that BV commonly comes back, usually within a few months, and that if it recurs more than four times a year you may be given a vaginal antibiotic gel to use over a few months. A clinic can also help identify triggers, such as sex or your period.

What the NHS says helps prevent it

Its list is almost entirely about leaving the vagina alone:

• Use water and plain soap to wash your genital area.
• Have showers instead of baths.
• Do not use perfumed soaps, bubble bath, shampoo or shower gel in the bath.
• Do not use vaginal deodorants, washes or douches.
• Do not put antiseptic liquids in the bath.
• Do not use strong detergents to wash your underwear.
• Do not smoke.

Douching and intimate washes are the specific trap here, because they are marketed as the solution to exactly this symptom and they make recurrence more likely by disturbing the balance further.

The other things a smell can mean

• Thrush. Thick, white, cottage-cheese-like discharge that does not usually smell, with itching and soreness. Common in pregnancy and treated differently from BV, with pregnancy-specific rules about which treatments are used.
• Trichomoniasis and other STIs. Can produce a change in smell and colour, which is why testing looks beyond BV.
• Amniotic fluid. A gush or persistent trickle of clear or pale fluid may be your waters rather than discharge. Before 37 weeks this needs an immediate call. The NHS lists greenish or smelly fluid as a specific reason to contact your maternity unit immediately after waters have broken, because it can indicate infection.
• Urine. Leaking small amounts of urine is common in pregnancy and can be mistaken for discharge, particularly on coughing or laughing.

What not to do first

Two responses are worth naming because they are so common and both make things worse. Buying a thrush treatment on the assumption that any discharge is thrush treats the wrong condition and delays the right one — and the NHS distinction is clear, since bacterial vaginosis "does not usually cause any soreness or itching". And washing more thoroughly, with more products, disturbs the balance further, which is precisely the mechanism behind the problem.

The reason to say something

This is the symptom people most often decide to live with, out of embarrassment. It is worth setting against what the guidance actually says: half the people who have BV do not know, it is treated with a short course of antibiotics, and the NHS specifically names pregnancy as a reason to seek treatment. Midwives ask about discharge routinely, which means the conversation is one they have several times a day.