Vaginal discharge and its friends—itching, odor, and irritation—need no introduction. When they arrive, you know they’re there. They are some of the most unwelcome guests, and you’ll pretty much do anything to boot them from your bottom. As complaints go, they’re the cause of many calls and visits to the GYN and overall can leave you miserable.

Vaginal discharge usually indicates vaginitis (the medical way of saying “inflammation” or “infection”). Vaginitis is the umbrella term used to describe all the lovely symptoms listed above. And when they’re present, it’s a sure sign that something is off in the vagina. Let us share what these things usually are.

For starters, the vagina is an acidic place (a.k.a. the pH of the vagina is usually about 4.0 to 4.5). Acidity is important because it assists in keeping the bugs away—bacteria and fungus are more fans of a basic environment. When the pH is off and things are skewing in the basic direction, bugs start to flourish.

Anything from menstrual cycle phase to a foreign body to sex to antibiotics can throw things off (a.k.a. the pH) and set the stage for vaginitis. In come the bacteria or the fungus, and out goes your comfort (bacterial vaginosis, candida vulvovaginitis, and trichomoniasis are the most common culprits). When it comes to symptoms, the most common symptoms women with vaginitis complain of are vaginal discharge, itching, burning, redness, pain with intercourse, pain with urination, and even spotting.

It’s important to call your doctor when you get that “things don’t feel right down there” sensation. You should trek to their office for a chat (a good history can tell you more than any test), a pelvic exam, a vaginal plus or minus cervical culture, a pH test, and a close look at the discharge under the microscope. While there are some classic features of different bugs (trichomonas usually present with a greenish-yellow discharge, candidiasis with a thick, white, cottage-cheese-like discharge, and bacterial vaginosis with a thin, fishy-smelling gray discharge), it’s best to make the diagnosis before initiating any treatment.

If the tests come up without a clear diagnosis (which happens in about 25–35% of cases), your doctor will start delving deeper into some of the more unlikely causes (low estrogen, medications, hygienic practices, allergies). Whatever the cause, we may have ways to treat you and end your torture. Whether it is an oral medication or a vaginal cream, we can find the right medication to return the vagina and its pH back to normal.

Vaginitis can be super annoying. It can sideline you from doing a lot of fun things (no explanation needed) as well as some not-so-fun things (a.k.a. working). But you don’t have to suffer in silence. And you shouldn’t rely on self-diagnosis. While your intuition is probably pretty spot on, without a microscope and a pH test, you can’t be certain. Although it is usually bacteria or a fungus causing the problem, it’s important to confirm which one. This will ensure that you get the right treatment and get right back into the swing of things.