What does “cleanliness grade 3” mean?

People often hear about the “cleanliness grading” of vaginal discharge in women, which is categorized into three levels. So, what does “Grade III cleanliness” mean?

What Does Grade III Cleanliness Mean?

Grade III cleanliness indicates the presence of only a small number of Lactobacillus (vaginal bacilli) and epithelial cells, but with a large number of pus cells (i.e., neutrophils) and various other bacteria. Grades I–II are considered normal, whereas Grades III–IV indicate abnormal findings—most commonly suggestive of vaginitis—and pathogenic organisms such as bacteria, fungi (e.g., Candida), or trichomonads are frequently identified. Vaginal secretion examination helps determine whether vaginal inflammation is present and further aids in identifying its underlying cause. A diagnosis of vaginitis—including bacterial vaginosis, trichomoniasis, or candidal (fungal) vaginitis—is typically made when cleanliness reaches Grade III or IV, thereby providing direct evidence to guide treatment. Isolated elevation in cleanliness grade without other clinical features is commonly associated with nonspecific vaginitis.

The cleanliness of vaginal discharge primarily depends on the quantity and diversity of bacteria present, the presence of miscellaneous (non-Lactobacillus) bacteria, and the presence of white blood cells (leukocytes). Generally, Grades I–II indicate normal vaginal discharge. If the cleanliness grade is elevated to Grade III, it suggests the presence of miscellaneous bacteria and leukocytes—but this alone does not confirm inflammation; clinical correlation with the patient’s symptoms and physical examination findings is essential for accurate diagnosis.

Under physiological conditions, the female reproductive system possesses natural protective mechanisms. Specifically, the presence of Lactobacillus in the vagina helps maintain an acidic pH environment. Therefore, for routine intimate hygiene, feminine washes with a weakly acidic pH of ~4 are recommended. We hope this article has been helpful. Wishing you a happy life and good health!