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Vaginal Discharge

Introduction

Mucus secreted from the vagina is referred to as vaginal discharge. It consists of dead cells and bacteria and serves to keep the vagina healthy and clean. While it is normal and healthy for all women to secrete vaginal discharge, in some instances its texture, color and/or odor can indicate possible infections.

Cause

Beneficial bacteria living in the vagina produce acids. The acidic environment of the vagina helps prevents infection. Glands in the vagina and cervix secrete fluids, which along with dead cells and bacteria are secreted as vaginal discharge. This is part of the self-cleansing mechanism of the vagina and is necessary to keep the vagina moist and infection free.

The amount, color, texture and odor of the discharge varies throughout the menstrual cycle and can also change due to a variety of non-infectious reasons such as pregnancy, emotional stress, level of nutrition, sexual arousal, infections and medications such as birth control pills and hormone treatment.

Risk Factors:

Individuals who are pregnant, use antibiotics and other medication, practice douching, use feminine hygiene sprays and scented perfumes in their genital area, wear restrictive and synthetic underwear, indulge in unprotected sex, are at risk for contracting infections (Bacterial, fungal or viral) which can lead to abnormal vaginal discharge.

Clinical Presentation

Normal vaginal discharge is clear or milky white in color, has a mild odor or sometimes lacks scent completely, and is pasty, sticky or stretchy in texture. A sudden change in color, consistency or smell, sometimes accompanied by itching, sores, pain or bleeding can be a warning sign for some infections.

A thick, white and cheesy type of discharge usually accompanied by itchiness and soreness around the vagina or vulva may indicate a yeast infection (Thrush or Candidiasis).

A fishy smelling discharge, white or grey in color accompanied by burning, itchiness and soreness in the vaginal region may indicate bacterial vaginosis.

A green, yellow and frothy, foul-smelling discharge points to Trichomoniasis, a sexually transmitted infection (STI) caused by the tiny protozoanTrichomonas vaginalis.

A cloudy or yellow discharge, accompanied by bleeding and pain can be an indication of Gonorrhea. A particularly malodorous discharge, also accompanied by bleeding and pain is typical of Chlamydia. Both STIs if not treated may spread upwards to the fallopian tubes causing inflammation (Pelvic inflammatory disease).

Abnormal discharge with sores and blisters around the genital region can be a sign of genital herpes.

In post-menopausal women abnormal discharge is unusual and could indicate cervical polyps (non-cancerous growths in the cervix) or cervical or endometrial cancer.

Diagnosis

A patient with abnormal vaginal discharge isfirst asked about their health history. A doctor will ask a variety of questions about recent sexual partners, medication use, douching, diet etc.                        Microscopic examination of samples of the vaginal discharge will help diagnose fungal (Candidiasis) and bacterial infections (Bacterial vaginosis and Trichomoniasis).                                                                       A pelvic exam is then usually done by inserting a speculum into the vagina to inspect the cervix. Tenderness of the cervix may indicate pelvic inflammatory disease and/or an STI like chlamydia or gonorrhea. Further laboratory tests (urine test, cervical and/or urethral swab) will need to be carried out to confirm STIs.    The pelvic examination will also identify the presence of polyps on the cervix. Mostly benign, a cervical biopsy can confirm this.                                                                                                                                        Genital herpes is detected with a blood test and /or by cell culturing.                                                                                                                                                                                                                                                                                                                                                                                    A Pap test may also be done to rule out cervical cancer.

Treatment

Treatment of abnormal vaginal discharge depends on the cause of the problem.

In the case of bacterial infections such as vaginosis, metronidazole (Flagyl), an antibiotic in oral, pill form or as a topical cream, is used for treatment. Trichomoniasis can be treated by oral metronidazole and Tinidazole. Alcohol usage is not recommended while using antibiotics. It is also advisable to avoid sex until the infection has cleared.

Yeast infections are treated using anti-fungal creams, pills or suppositories. Since yeast is normally found in a healthy vagina, treatment is aimed at restricting its excessive growth rather than completely eliminating it.

Chlamydia and gonorrhea can be treated with a combination of antibiotics such as azithromycin and doxycycline. Pelvic inflammatory disease may require intravenous antibiotics or surgery. Infected sexual partners will also have to be treated to prevent recurrent infections.

Prevention

Ask your sexual partner to wear a condom during sex

Keep the vaginal area clean and dryby washing regularly and patting dry with a clean towel.

Avoid wearing tight and synthetic underwear. Cotton underwear is recommended as it absorbs moisture and also allows air to pass through.

Avoid using scented soaps or deodorants and perfumes in the vaginal area. These can irritate the vagina and cause infections.

A healthy lifestyle involving a balanced diet, adequate sleep and plenty of hydration will make one less prone to vaginal infections.

Always wipe from front to back after urination or bowel movement to prevent bacteria from entering the vagina.

Avoid douching. It changes the normal balance of organisms in the vagina. There is also no scientific evidence to prove that douching is beneficial to women, on the contrary the risks of infection far outweigh the benefits.