Background: Abnormal vaginal discharge is among the most frequent gynaecological complaints encountered in clinical practice, especially among women of reproductive age. The etiology of abnormal vaginal discharge is broadly categorized into infectious and non-infectious causes. The major infectious causes include bacterial vaginosis (BV), vulvovaginal candidiasis (VVC), and trichomoniasis. Present study was aimed to study abnormal vaginal discharge in women of reproductive age group at a tertiary hospital. Material and Methods: Present study was hospital-based prospective observational study, conducted in sexually active women in age group 21 to 49 year with abnormal vaginal discharge. Results: The age distribution showed that most women with abnormal vaginal discharge belonged to the 26-35 years age group, constituting 69% of the study population. Type of residence had a moderate influence, with 54.5% urban and 45.5% rural participants Socio-demographic variables such as education and economic status played a significant role. Symptomatology was diverse, with vaginal itching (58.5%) being the most common symptom. The characteristics of vaginal discharge provided valuable diagnostic clues. White discharge was reported in 48% of cases, followed by curdy white (36%) and yellowish white (16%). Thick discharge consistency (47%) was most prevalent, consistent with fungal infections, particularly vulvovaginal candidiasis. Microbiological diagnosis revealed vulvovaginal candidiasis in 27%, bacterial vaginosis in 14%, and mixed infections in 2.5%, while 56% had no identifiable pathogen. Treatment was administered per syndromic guidelines. A majority (56%) were reassured with no specific therapy, indicating likely physiological or non-infective causes. Green Kit (29.5%) and metronidazole (14.5%) were used in symptomatic cases. At follow-up, 78% showed complete symptom resolution and 15% no relief,7% loss to follow up. Conclusion: Treatment based on definitive laboratory investigations allows for precise diagnosis and tailored therapy, thereby offering greater accuracy and efficacy compared to the syndromic approach which is primarily symptom-driven.