Entering the small exam room, brightly decorated with abstract art and greenery, I found my thin patient with her neatly trimmed bob and freshly painted nails sitting on the table.
“He messed up my cookie!” she announced as soon as I closed the heavy door behind me. “I always smell the tissue after I wipe. Now, one time with no condom and he got my cookie smelling like a penny!”
As a gynecologist, I don’t think a day goes by without me hearing about the smell of someone’s vagina – whether it be musty, ammonia-like, sweet or sour – I’m pretty sure I’ve heard it all. So, here are seven of the most common vagina smells and what they mean.
1. Fishy
What it could mean?
Bacterial vaginosis (BV) is the most common cause of vaginal symptoms in women. The prevalence of bacterial vaginosis increases based on the number of lifetime sexual partners but may be seen in women who have not had sex as well.
What to do?
See your gynecologist. Your gynecologist can prescribe antibiotics to help restore the normal bacteria in the vagina.
How to prevent it?
Avoid douches and scented vaginal products, including scented tampons, which are known to disrupt the normal vaginal pH increasing the risk for BV. If you seem to keep getting BV, talk to your gynecologist about long term management options.
2. Decaying Fish
What it could mean?
Trichomoniasis is the most common curable sexually transmitted infection (STI). However, only about 30% of people with trichomoniasis will develop symptoms. For those who do develop symptoms, common complaints include itching, burning, redness and soreness of the genitals, discomfort with urination, abnormal vaginal discharge and/or a foul-smelling odor.
What to do?
Trichomoniasis infection increases the risk of contracting other STIs. However, it is curable with antibiotics. Therefore, seeing your gynecologist ASAP is imperative to receiving proper treatment.
How to prevent it?
For women who are sexually active, you can decrease your risk for trichomoniasis by using latex condoms every time you have sex and/or by being in a long-term, mutually monogamous relationship with a partner who has been tested and has negative STI results.
3. Onions
What it could mean?
Natural body odor can have a musty smell similar to onions. Apocrine glands, which are located in the groin (and armpits) release an odorless, oily fluid during times of stress. When this fluid comes in contact with bacteria on your skin, it often results in a musty odor that many people associate with body odor.
What to do?
Bathing with a mild soap can eliminate the smell of body odor.
How to prevent it?
Wearing cotton underwear can help with absorbing excess moisture which can cut down on body odor. Also, strong smelling foods, such as onions and garlic, can cause associated smells in our vaginal discharge and urine. Eliminating these foods from your diet can help to prevent body odor. However, if you do partake in food of the pungent variety, you should notice your bodily fluids return to their normal smell within 24 – 48 hours.
4. Bread
What it could mean?
Yeast infections are very common in the vagina. Candida is a type of fungus normally found in the vagina; however, at times this fungus can overgrow causing an infection.
What to do?
Antifungal medications found over the counter, such as miconazole, can be used to treat vaginal yeast infections. If using an over-the-counter therapy, the three-day and seven-day preparations are more effective than single-dose therapies. Many infections, however, can mimic vaginal yeast infections. Therefore, if you are not certain whether or not you have a yeast infection or if your symptoms do not improve with over-the-counter therapy, it is important to follow-up with your gynecologist.
How to prevent it?
Wearing cotton underwear can reduce your risk for yeast infections. On the other hand, taking antibiotics increases the risk for yeast infections. Therefore, take antibiotics only when and how they are prescribed for you.
5. Ammonia or Bleach
What it could mean?
Bacterial vaginosis (BV) was discussed earlier, but some women note a chemical-like smell when they have a BV infection rather than a fishy odor. Another common cause of a chemical-like odor is leaking urine or incontinence. Incontinence can occur at any age but is more common in women over 50 years old.
What to do?
Incontinence can have many causes, ranging from a bladder infection to diabetes. If you are concerned about leaking urine, a gynecologist can help evaluate the cause of your incontinence and ultimately develop a treatment plan that is right for you.
How to prevent it?
Depending on the type of incontinence that you have there are behavioral therapies, dietary modifications, pelvic floor exercises, medications and medical procedures that can be used to help prevent recurrence.
6. Rotting meat
What it could mean?
A forgotten tampon is a common cause of a foul-smell resembling rotten meat emanating from the vagina.
What to do?
Retained tampons increase the risk for toxic shock syndrome and therefore should be removed immediately. Oftentimes, you can remove a retained tampon on your own by following the steps below:
i. Wash and dry your hands
ii. Relax and sit on the toilet with your feet slightly elevated
iii. Bear down as though you are having a bowel movement
iv. Place a finger into the vagina and feel for the tampon or strings
v. Once the strings or tampon are located, grip them with two fingers and then pull to remove
Do not use tweezers or other objects to remove anything from the vagina as this could result in injury and infection. If you are unable to remove the tampon yourself, follow-up with your gynecologist ASAP.
How to prevent it?
Never leave a tampon in the vagina more than 4 – 6 hours. Alternatively, you could also consider using other feminine hygiene products, including sanitary pads and menstrual cups.
7. Copper or Metal (a.k.a. Why her 'Cookie' Smelled Like a Penny)
What it could mean?
Blood contains iron, which can be responsible for a metallic smell. Therefore, women who are currently menstruating or recently finished menstruating may notice a copper-like odor. Even women who are not menstruating may experience slight bleeding from sex that may lead to a slight metallic smell.
What to do?
A copper-like smell is no cause for alarm unless you also note itching, burning, abnormal discharge or any irregular bleeding. If you note any of these associated symptoms, call your gynecologist for further evaluation.
How to prevent it?
If you are noting light bleeding with intercourse, try using a lubricant to help prevent small tears. If this does not help, follow-up with your gynecologist who can evaluate and treat you further.
So, as my boisterous patient would say, “if something has your ‘cookie’ smelling different, refer to this list and then consider seeing your gynecologist!”
I now have a much better understanding, thank you for sharing.