Normal Characteristics of Healthy Vaginal Mucosa

Visual Characteristics

The mucosa should appear smooth and uniform without lesions, ulcers, papules, vesicles, pustules, fissures, or warts, according to the American Academy of Pediatrics 3
An ectropion (squamocolumnar junction visible on the exocervix) is a normal developmental finding in adolescent cervices and typically regresses into the cervical canal with advancing gynecologic age, as noted by the American Academy of Pediatrics 3
The cervix should be visualized without friability or hyperemia, which would indicate infection, as stated by the American Academy of Pediatrics 3

The discharge should be white to clear in color, thin consistency, as recommended by the Centers for Disease Control and Prevention (CDC) 2
The discharge should not smoothly coat the vaginal walls (which would indicate bacterial vaginosis), according to the CDC 2 and the CDC 4
The discharge is non-inflammatory in nature, as stated by the CDC 2

Vaginal pH should be 3.8-4.5 (specifically less than 4.5), as recommended by the American College of Obstetricians and Gynecologists (ACOG) and the CDC 1 and 2
pH greater than 4.5 indicates bacterial vaginosis or trichomoniasis, according to the CDC 2, the CDC 5, and the CDC 4
Abundant H₂O₂-producing Lactobacillus species should dominate the vaginal flora, as stated by the ACOG and the American Academy of Family Physicians (AAFP) 1 and 6
Absence of clue cells (epithelial cells studded with bacteria), as recommended by the CDC 2 and the CDC 4
Absence of motile Trichomonas vaginalis, according to the CDC 2 and the CDC 5
Absence of yeast or pseudohyphae, as stated by the CDC 2 and the CDC 5
Negative whiff test (no amine/fishy odor when 10% KOH is applied to vaginal secretions), as recommended by the CDC 2, the CDC 5, and the CDC 4

Do not mistake a prominent cervical ectropion for infection in adolescents - this is a normal developmental finding, as noted by the American Academy of Pediatrics 3
Do not assume absence of symptoms means normal flora - up to 50% of women with bacterial vaginosis are asymptomatic, according to the AAFP 6