PCOS discharge and smell: What does it look like?

Polycystic Ovary Syndrome (PCOS) is a condition found in around 13% of females, while most remain undiagnosed and might not even guess that they have it. Some might wonder if there are signs like PCOS vaginal discharge or specific PCOS odor to spot. The problem is that PCOS is still a mystery for science and medicine, but several studies can already give us some insights.

So what does PCOS discharge look like? And is it even possible to tell PCOS by the vaginal smell? Keep on reading to find out what experts say.

What does PCOS vaginal discharge mean? 

To understand how female discharge and vaginal smell can change because of PCOS, it’s important to figure out what exactly is imbalance in a body because of this condition.

PCOS is a complex endocrine and metabolic condition that can influence several aspects of a female body. Some of the symptoms could be easily confused with other conditions or diseases whether related or unrelated to PCOS. 

PCOS hormonal shift and vaginal health

PCOS impacts not only a reproductive system in women but also metabolic and hormonal systems. Even though the male hormone testosterone is also produced in female ovaries in small amounts, its level is higher in females with PCOS.  

For example, the normal testosterone level for females in their reproductive age is 15-70 nanograms per deciliter (ng/dL) or 0.5 to 2.4 nanomoles per liter (nmol/L), and male levels are 280–1,100 ng/dL. Testosterone levels in women with PCOS can be somewhat around 150 ng/dL (5.2 nmol/L), which is significantly higher than the norm. 

This hormonal imbalance not only affects ovarian health and overall reproductive health but can also indirectly mess with the vaginal microbiome. Although the direct correlation between PCOS and vaginal health is not fully understood, there is certain research that casts some light on it.

One study found that PCOS can be linked to bacterial vaginosis (BV) and other vaginal disorders. The study concluded that bacterial vaginosis is actually more common in females with PCOS than in non-affected by PCOS women. And one of the bacterial vaginosis symptoms are: "fishy" vaginal odor, vaginal itching, unusual gray or even green discharge, and the discharge consistency that resembles cottage cheese.

Also, a drop of female hormone estrogen, which can also be observed in females with PCOS, can cause the vaginal pH to become less acidic. This acidity shift can become a favorable environment for developing bacterial vaginosis. This is because the level of healthy vaginal bacteria called Lactobacilli declines together with estrogen when a female has PCOS.

Another topic is related to cervical mucus. While healthy women usually have a slightly increased amount of slippery, egg white discharge around her ovulation phase, women with PCOS might notice this cervical mucus to be more dense and less elastic. This increased density in a mucus consistency was discovered in one study. They noticed that mucus in PCOS-affected females was gestagenic (G-type, the least fertile and thick one), whereas in healthy females mucus was normal – types S and L (these types allow sperm to move smoother). 

PCOS and gut health link to vaginal discharge 

Gut microbiome and vaginal health are closely connected. One study found that women with high testosterone levels also had gut microbiome imbalance, pretty much similar to PCOS, and this also had an impact on the vaginal microbiome. 

Another study says that females with PCOS, regardless of testosterone levels, also had a higher chance to develop bacterial vaginosis. 

Although there are no specific PCOS discharge or PCOS vaginal odor, the secondary inflammations and infections like bacterial vaginosis, yeast infections, bacterial vaginitis, and vulvovaginal candidiasis, can cause some of the symptoms associated with PCOS. To summarize all these studies and conclusions, this is what PCOS discharge looks like:

• Unusual and/or smelly vaginal discharge – symptoms, common and typical to various vaginal infections such as bacterial vaginosis, yeast infection, and more.  
• More sticky and less elastic vaginal mucus during. 
• Lack of discharge caused by PCOS-related vaginal dryness. This can also lead to an unpleasant or harsh vaginal odor.

It’s important to keep in mind that bacterial vaginosis or other vaginal infections don’t necessarily mean PCOS and PCOS itself does not directly cause these infections. Also, many women with PCOS don’t even experience any unusual discharge or vaginal odor. Make sure to consult a doctor to be on the safe side.

Does PCOS cause smelly discharge?

Women with ovarian imbalance are more at risk of experiencing certain vaginal discomforts, but does PCOS cause vaginal odor? PCOS itself does not cause smelly discharge or a fishy smell, but it can favor other infections that can actually change the vaginal smell. 

In one study, a group of females diagnosed with PCOS complained about a number of symptoms. The most commonly reported were unpleasant/fishy smell of the discharge, as well as vaginal burning and/or dryness, redness, and itching of the vulva, “abnormal” grey appearance of vaginal discharge common to a bacterial vaginosis infection. However, these are not exactly PCOS symptoms, but vaginal infection symptoms, so there is no such thing as PCOS odor.

So, can PCOS cause a fishy smell? The answer is: indirectly yes. The fishy odor can be caused by various infections, like yeast infection or bacterial vaginosis. And females with PCOS are more prone to vaginal microbiome imbalance and thus to developing these infections.

PCOS and vulvar itching

Itching and burning in the vagina is quite common for females with PCOS. There can be several reasons for it. 

Because PCOS is characterized by a decreased level of female hormone estrogen, vaginal dryness is often a common symptom, accompanied by itching and discomfort. 

Another reason for vulvar itching can be a vaginal infection described earlier in this article. Although all these symptoms do not directly mean PCOS, it is recommended to speak to a medical professional if you experience an unusual and annoying discomfort in your body. 

PCOS urine smell

There is no specific odor in urine that can be a definite sign of PCOS. However, since this condition is closely related to metabolic problems, it is possible to analyze metabolic breakdown products in urine. 

Several studies tried to find biomarkers of PCOS in urine to see if it’s possible to diagnose the syndrome with urine samples. For example, in one study conducted in 2014-2016, they found at least 35 elements in the urine of PCOS-diagnosed females that are different from a healthy control group of women. They discovered that PCOS patients had higher levels of lactose, stearic, and palmitic acids in urine, while at the same time having lower levels of succinic acid. 

Another study has discovered several more potential PCOS signifiers, including testosterone-glucuronide (a urinary metabolite of testosterone) and 11-alpha-hydroxyprogesterone (a metabolite of progesterone, a weak antiandrogen). This means that certain elements and their abnormal levels found in urine can directly or indirectly hint to PCOS.

Strong and sweet urine odor and UTI

Another quite common issue in females with PCOS is that they are at higher risk of having urinary tract infections (UTI), although PCOS doesn’t directly cause UTI. Inflammations of the urinary tract can also produce an unusual smell in urine – strong, pungent, or fetid. UTI is also often accompanied by painful pee.

Sweet urine smell

Another thing is a blood sugar imbalance and insulin resistance in females with PCOS. Urine may smell sweet if it contains too much glucose in it, and a high glucose level indicates insulin resistance. In that case, the body tries to get rid of excess sugar through the urine, and so the pee might have a sweet odor. 

Please keep in mind that this is also an indirect symptom, but insulin problem is one of the common “companions” of PCOS.

None of the studies said anything about PCOS-related urine smell; however other conditions like UTI or insulin resistance, associated with PCOS, can indeed show up as an unusual urine odor, ranging from honey and burnt sugar to pungent smell. Changes in urine odor can potentially be a sign of some metabolic imbalance or infection. Make sure to consult a doctor if you notice any strange change in your urine and its smell.

Final verdict

PCOS does not directly cause unusual vaginal discharge or a fishy smell, but these symptoms can be indirect signs of other infections, whether related to PCOS or not.

Numerous studies found links between PCOS, hormonal imbalance, gut health, and vaginal microbiome changes. These changes can affect vaginal discharge and smell.

Urinary tract infections can also be connected to PCOS, although indirectly and not necessarily. Even certain biomarkers in urine can potentially signify PCOS. However, these studies had their limitations, and experts admit that further research is still needed.

Women with PCOS often have insulin resistance problems, and so it is important to notice extreme sugar cravings and a too sweet smell in urine as potential signs of imbalance.

Several diagnostic tests might be needed to discover if such symptoms as unusual vaginal discharge, fishy odor or strange urine smell are related to PCOS or to something else. It’s important to consult a doctor to find a solution specific to your case since even PCOS symptoms can vary from woman to woman.