Vaginal odor - causes, explanations and solutions

Vaginal odor - causes, explanations and solutions

Updated blog post: This article was originally published as a PDF under the title “A thousand causes of vaginal odor”. We have now moved the content into our blog module to make it easier to read and search.

Vaginal odor or intimate area smell is one of the most common reasons women look for information and discover LadyBalance. Many describe a fishy odor; others notice an ammonia smell from the vagina or refer to a smelly intimate area. The most common cause is bacterial vaginosis, where LadyBalance intimtabletter (intimate tablets) may help. However, there are many other possible explanations.

This overview is based on an article by Chithra Subramanian et al. (2011), supplemented by clinical experience.

Infections as a cause of vaginal odor

• Bacterial vaginosis: When Gardnerella vaginalis dominates the vaginal microbiome, trimethylamine is produced, causing the characteristic fishy odor. This is a frequent cause of vaginal malodor.
• Trichomoniasis: A sexually transmitted infection caused by a protozoan parasite. Discharge may be frothy and malodorous, though not necessarily fishy. More prevalent globally than in Denmark.
• Infected vaginal lesions: Rare, but can cause foul-smelling discharge (e.g., donovanosis, chancroid).
• Acute pelvic inflammatory disease (PID): Can be accompanied by malodorous discharge. Often related to chlamydia, though mixed infections (e.g., streptococci, E. coli) are common.

Foreign bodies and ammonia smell from the vagina

Foreign bodies such as tampons, pessaries or sponges may lead to foul-smelling discharge. If retained for long, they can result in fistula formation.

• Urinary fistulas: May cause colorless discharge with a distinct ammonia smell (salmiak-like odor) from the vagina.
• Rectovaginal fistulas: Often produce a strong unpleasant odor that can be mistaken for vaginal infection.

Non-infectious causes of intimate area odor

• Excessive sweating: Can contribute to intimate area odor, especially with tight or synthetic clothing. More common in women with overweight.
• Chronic constipation: Intestinal gases (e.g., hydrogen sulfide, dimethyl sulfide) may be perceived as vaginal odor.
• Urinary and fecal incontinence: Common in women, especially after childbirth injuries or at higher age. May lead to persistent intimate malodor without infection.
• Cancers of the vulva: Infected lesions may cause pronounced putrid odor.
• Trimethylaminuria (fish odor syndrome): A rare genetic disorder with trimethylamine excreted in urine, sweat and discharge, causing fishy odor from the whole body; can be confused with bacterial vaginosis.

Psychological factors and the perception of odor

• Olfactory reference syndrome: A rare psychiatric condition where the person is convinced they emit a bad smell, although others do not perceive it. May lead to compulsive behaviors and social withdrawal.

It is important to note that poor hygiene is only rarely the cause of vaginal odor. Fear of being labeled “unhygienic” may prevent women from discussing the problem.

Summary of causes of vaginal odor

• Infections such as bacterial vaginosis, trichomoniasis or pelvic inflammatory disease
• Foreign bodies or fistulas, which can cause ammonia or salmiak-like odor from the vagina
• Non-infectious conditions such as sweating, chronic constipation or incontinence
• Rare causes such as vulvar cancer or trimethylaminuria (fish odor syndrome)
• Psychological factors such as olfactory reference syndrome

Many women find that the underlying cause is bacterial vaginosis, where imbalance in the vaginal microbiome leads to fishy or unpleasant intimate odor. In such cases, LadyBalance intimtabletter (intimate tablets) may help restore the natural balance.

Reference

Subramanian C, Nyirjesy P, Sobel JD (2011): Genital Malodor in Women: A Modern Reappraisal. Journal of Lower Genital Tract Disease, e-publication.