Vaginal odour might not be something you feel comfortable talking about, but getting to know your body can help you identify what’s ‘normal’ for you and when you may need to seek help.
‘Everyone with a vagina has a natural bacterial flora that’s there to keep a good balance,’ explains Dr Rosén. It’s because of this natural bacteria that the cervical mucus in the vagina always has a smell. You may also experience changes throughout your menstrual cycle as the pH balance in your vagina changes.
So, what does a vagina normally smell like? Dr Rosén says that it usually ranges from a slightly tangy or sour smell to a more metallic smell around or after your period. ‘Generally, if you’re feeling well and your vaginal odour or discharge isn’t unusual for you, there’s no reason to worry.’
Here are 8 common causes of vaginal odour and when to talk to a doctor:
1. Bacterial vaginosis (BV)
- Smell: fishy
Bacterial vaginosis is one of the most common causes of a smelly vagina, affecting 15% to 50% of women of reproductive age. ‘It’s a condition where there’s an imbalance in the vaginal flora,’ Dr Rosén explains. ‘The first symptom is often a fishy smell, which can progress to a frothy, almost grey or green-ish discharge. You may also feel itchy and swollen.’
There are a number of different treatment options if the symptoms of BV don’t clear up on their own. ‘A doctor can prescribe you a course of antiseptics or antibiotics,’ says Dr Rosén. Unfortunately, recurrence is not unusual after antibiotic treatment. Some studies have proven that the use of probiotics could be helpful, and Dr Rosén suggests that changing contraception can help, especially if you’re using the coil.
She adds that your sexual partner may be the cause of your infection, so talking to them about their personal hygiene and using external or internal condoms for a while might be a good idea. If you find that this helps, your partner will likely need a course of antibiotics, too.
‘If you’re having these symptoms, you should see a doctor to rule out any underlying conditions that may need treatment,’ Dr Rosén says. ‘That’s especially important if you’re pregnant, as there’s an increased risk for premature labour.’
- Smell: pungent and fishy, similar to BV
Trichomoniasis is the most common non-viral sexually transmitted infection (STI) in the world. ‘It’s a parasitic disease that typically doesn’t cause a lot of symptoms,’ says Dr Rosén. ‘Some people experience subtle symptoms like a yellowy-green vaginal discharge with an unpleasant smell, and the vulva can be a little red and itchy. A course of antibiotics usually clears it up.’
3. Toxic shock syndrome (TSS)
- Smell: very unpleasant, but vaginal odour is a minor symptom in the context of TSS
Toxic shock syndrome has become a very rare illness – it was often caused by high-absorbency tampons. ‘If this bacteria enters your system, you get very sick very quickly. You’ll get a high fever, blood pressure changes and possibly a rash and diarrhoea or vomiting, and you might feel faint,’ says Dr Rosén.
‘If you experience these symptoms, you should go straight to A&E. TSS cases are now very rare, though.’
4. A tampon you’ve forgotten to remove
- Smell: very obvious and unpleasant
‘There have been instances of people seeking help for a bad vagina smell and finding it’s caused by a tampon that’s been left in for days, sometimes longer,’ says Dr Rosén.
‘If this happens, the smell will get worse quickly and be extremely obvious and offensive – so if you’re experiencing vaginal odour that escalates, it’s always best to just check.’
5. Vaginal thrush
- Smell: occasionally yeasty
Vaginal yeast infections like thrush are very common and typically cause itching, burning and changes to vaginal discharge, which can become lumpy and white, similar to curdled milk.
This discharge usually isn’t very smelly, though. ‘If your thrush symptoms are so pronounced that there’s a bad smell, you should see a doctor to rule out any underlying conditions,’ says Dr Rosén.
6. Hormonal changes
- Smell: individual
Similar to the changing smells throughout your menstrual cycle, other hormonal changes can also affect the smell of your cervical mucus. ‘During the menopause and in the post-menopausal years, the smell can change,’ says Dr Rosén.
Pregnancy changes the cervical mucus, too. ‘You may have more discharge, or sometimes it’s thicker or thinner, but it shouldn’t be smelly,’ Dr Rosén explains. ‘If you’re pregnant and have a foul-smelling discharge, you should speak to a doctor or midwife.’
7. UTIs and other urinary issues
- Smell: ammonia-like
If you experience an ammonia-like vaginal odour, it’s likely that urine is involved. This can happen if you have a urinary tract infection (UTI). ‘This is more likely if a UTI is left untreated and you might be leaking,’ explains Dr Rosén. ‘An infection that’s left untreated will also cause a fever, and the smell will be quite distinct and sickly.’
Occasionally, an ammonia-like smell can be a sign of an existing incontinence issue that the woman is unaware of, says Dr Rosén. ‘These issues are very common. A doctor or gynaecologist can advise on treatment options.’
8. Gynaecological cancers
- Smell: metallic and sickly
Very rarely, foul-smelling discharge can be a symptom of cervical or uterine cancer. Discharge and vaginal odour are unlikely to be the only or first symptoms, though.
‘You might have experienced bleeding during intercourse, or perhaps occasional spotting that becomes more regular. The smell will be a little metallic,’ says Dr Rosén. ‘The smell is very different from the fishy or rotten smells of BV or a forgotten tampon.’
If you experience unusual bleeding, you should always talk to a doctor.
Do STIs cause vaginal odour?
‘STIs like chlamydia and gonorrhoea rarely change the smell of the cervical mucus but can cause other symptoms like pain when peeing,’ says Dr Rosén. ‘If you notice a smell, it might be that you’ve also got bacterial vaginosis. If in doubt, talk to a doctor for advice.’
How should I wash myself and keep my vagina healthy?
‘Like any part of the body that gets sweaty, the area around the vulva can get smelly,’ says Dr Rosén. But soaps can disturb the natural balance of the vaginal bacterial flora and possibly increase the risk of bacterial vaginosis. Douching – a method of washing out or rinsing the vagina – can do the same. Wash yourself with nothing but water, and avoid perfumed pads and vaginal deodorants.
‘If you’re very dry as a result of breastfeeding, vaginal atrophy [the thinning, drying and inflammation of the vaginal walls, often caused by lower oestrogen levels] or a recent infection, you can use vaginal moisturisers – but nothing with perfume, ever.’
When is a smelly vagina a cause for concern?
‘If you find that the smell is abnormal or escalates and you’ve also got other symptoms, speak to a doctor,’ says Dr Rosén.
This article has been medically approved by Dr Elisabeth Rosén, a medical doctor at Livi who specialises in gynaecology and obstetrics.