What is the cause of persistent malodorous discharge after sexual intercourse in a 33-year-old individual?

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Last updated: April 28, 2025 • View editorial policy

Differential Diagnosis for Bad Odor after Intercourse

Single Most Likely Diagnosis

  • Bacterial Vaginosis (BV): This condition is characterized by an imbalance of the normal vaginal flora, leading to an overgrowth of bacteria. It is a common cause of vaginal odor, especially after intercourse, due to the alkalinity of semen which can disrupt the vaginal pH balance further.

Other Likely Diagnoses

  • Trichomoniasis: A sexually transmitted infection caused by the parasite Trichomonas vaginalis, which can lead to a foul-smelling vaginal discharge.
  • Vulvovaginal Candidiasis: Although typically associated with a yeast infection, it can cause a strong odor, especially if the infection is severe or if hygiene practices are poor.
  • Poor Genital Hygiene: Inadequate cleaning of the genital area can lead to the accumulation of sweat, bacteria, and other substances that cause odor.

Do Not Miss Diagnoses

  • Gonorrhea and Chlamydia: These sexually transmitted infections can cause symptoms including discharge and odor. While they might not be the first consideration for bad odor alone, missing these diagnoses can have serious health implications, including infertility and pelvic inflammatory disease.
  • Cervical Cancer: Although rare and less directly linked to odor after intercourse, advanced cervical cancer can cause foul-smelling discharge. It's crucial to not miss this diagnosis due to its severe implications.

Rare Diagnoses

  • Foreign Body in the Vagina: A rare cause of vaginal odor, this could be due to a forgotten tampon or other object.
  • Rectovaginal Fistula: An abnormal connection between the rectum and vagina, which can cause fecal matter to leak into the vagina, resulting in a bad odor.
  • Diabetes: Uncontrolled diabetes can lead to glucose in the urine and genital secretions, which can promote bacterial growth and cause odor. However, this would typically be associated with other symptoms of diabetes.

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