Genital odour is due to the combination of vaginal secretions, eccrine and apocrine sweat and external sources (urine, faeces, topical applications).
What symptoms should lead to concern?
A bad smell could be due to genital infection or disease. Clues include:
- excessive vaginal discharge
- itching (pruritus vulvae)
- pain and soreness.
What conditions cause vaginal malodour?
Sometimes the apparently bad vaginal smell is actually normal, as vaginal secretions in every adult woman have a rather musty odour. The smell can vary throughout the menstrual cycle. There is also a wide variation in what is considered acceptable.
Bad smell is however often associated with infectious or non-infectious causes of vaginitis or less often, vulval disease.
Malodorous vaginal infections include:
- Bacterial vaginosis (the most common reason for genital malodour, a fishy smell)
- Trichomoniasis (this is foul-smelling in only about 20% of infected women)
- Vulval ulceration of any cause, particularly if due to donovanosis or chancroid
- Vaginal discharge associated with pelvic inflammatory disease
- Forgotten foreign bodies such as tampons, diaphragms or sponges
- Fistulas or passageways linking the vagina with the rectum or bladder following childbirth, injury or surgery
- Hidradenitis suppurativa.
Although candidal vulvovaginitis (thrush) is very common, it causes a yeasty smell, which is not considered particularly unpleasant by most women.
Noninfectious causes of vaginal malodour include:
- Excessive perspiration ( hyperhidrosis leading to bromhidrosis) especially associated with obesity
- Chronic constipation and bloating or dietary factors leading to release of smelly rectal gases
- Urinary incontinence, releasing ammonia
- Faecal incontinence
- Poor hygiene, often in women who are elderly or mentally unwell
- Vulval cancer, when it is due to necrosis (death of tissue)
- Discharge or necrosis of other genital cancers
- Trimethylaminuria (fish-odour syndrome)
- Olfactory hallucinations, e.g. associated with temporal lobe epilepsy
- Psychiatric conditions.
What tests should be done?
Women complaining of genital malodour should undergo careful external and internal examination after a careful history has been taken. Tests may include pH, vaginal and/or vulval swabs for microbiology and sometimes skin biopsy.
Treatment:
Treatment depends on the underlying cause. Antibiotics should be prescribed for confirmed infection.
General measures should include:
- Avoid wearing tight or occlusive underwear
- Change underwear frequently
- Bathe gently using non-soap cleanser once or twice daily
- Attempt to lose weight, if relevant
- If incontinent of urine, copper acetate impregnated incontinence pads may help to reduce the smell.
The hazards of self-treatment:
Excessive washing, antiseptics, deodorants and douching (rinsing out the vagina) may irritate the vagina and vulva, potentially resulting in increased irritation and discharge from vulvitis, chemically-induced vaginitis or secondary infection. Don't do it!
