Vaginal Discharge

Vaginal discharge is a natural and healthy process in women. It helps keep the vagina clean, moist and protected from infections.

Vaginal discharge is one of the most common gynaecological complaints seen in OPD. Vaginal discharge may be a normal physiological occurrence or a pathological manifestation.

The amount, colour and consistency can vary depending on :

1. Menstrual cycle phase
2. Hormonal changes (Pregnancy, Menopause)

• Sexual activity

1. Contraceptive use

NORMAL VAGINAL DISCHARGE

• Normal vaginal discharge is found in 10% of those who present with vaginal discharge.
• Normal physiological discharge changes with the menstrual cycle.
• Around ovulation :character of the discharge tends to be clearer with a stretchable consistency .
• In the luteal phase or premenstrually :discharge may be thicker and slightly yellow.
• Normal healthy discharge should not be associated with symptoms such as itching, redness and swelling, and does not have a strong odour.
• Vaginal discharge can increase during higher oestrogen states, such as :

1. Ovulation
2. Puberty

• Pregnancy

1. Oestrogen-based therapies such as combined hormonal contraception and hormone-replacement therapies.

ABNORMAL VAGINAL DISCHARGE :

• Abnormal vaginal discharge is characterised by a change in colour, consistency, volume or odour, and may be associated with symptoms such as itch, soreness, dysuria, pelvic pain, intermenstrual bleeding or postcoital bleeding.
• An important follow-up question to ask is whether the vaginal discharge is significantly altered from the woman’s usual pattern.
• If the vaginal discharge has a significant change in colour and odour, contains blood or causes itch or discomfort, it is less likely to be physiological in nature.
• Abnormal vaginal discharge is most commonly caused by infection. 70% of all causes are associated with bacterial vaginosis (BV), vulvovaginal candidiasis (VVC) or trichomoniasis (TV).
• Of the three causes mentioned, BV is the most common and accounts for up to 50% of all infections.

• Cervicitis is another important cause of vaginal discharge, with Chlamydia trachomatisand Neisseria gonorrhoeae being the most common pathogens isolated. Cervicitis should be suspected in sexually active women found to have purulent endocervical discharge and easily induced cervical bleeding.
• Non-infectious causes include

1. atrophic vaginitis
2. contact dermatitis due to allergic or irritant causes

• foreign body vaginitis (e.g. retained tampon or condom)

1. cervical polyps
2. fistulas
3. genital tumours (e.g. tumours of the vulva, vagina, cervix, fallopian tube and endometrium)

RISK FACTORS FOR SEXUALLY TRANSMITTED INFECTIONS (STIs) :

1. Age less than 25 years
2. New sexual partner in last 3 months

• Two sexual partners in last 6 months

1. No usage of condoms
2. Symptoms or sexually transmitted infections in partner
3. History of sexually transmitted infection

HOW TO MAINTAIN VAGINAL HEALTH

• Keep the genital area clean and dry
• Wear breathable cotton underwear
• Avoid scented soaps, sprays or douches
• Avoid too much of vaginal douching
• Practice safe sex and regular check-ups
• Stay hydrated and maintain a balanced diet
• Lactic acid wash can be used : but not too much and use externally

WHEN TO SEE A DOCTOR :

Consult a gynaecologist if discharge is persistent, foul smelling, discoloured or associated with discomfort. Early treatment can prevent complications and improve quality of life.

TAKE HOME MESSAGES :

• Vaginal discharge can be either a normal physiologic occurrence or a pathological manifestation. It is important to differentiate between the two during the clinical consultation. A history of a change from the usual pattern of vaginal discharge is an important differentiating factor and should be explored with the woman.
• Inflammatory features such as erythema and oedema during the physical examination may be helpful in narrowing the causes of the vaginal discharge.
• STI testing is recommended in high-risk sexually active women.