What are Vaginal Discharge and Abnormal Vaginal Discharge?

Vaginal Discharge

Vaginal discharge is a common symptom in women. It is normal especially in child bearing age. Vaginal discharge can be commonly understood as discharge of secretions from the cervical glands of the vagina; normally these emission are clear or white or in a simple words during vaginal discharge glands in the cervix produces clear mucus. These secretions may turn white or yellow when exposed to air.

Vagina

Vagina is the lower part of the female reproductive system; a moist canal in female extending from the labia minora to the uterus. Vagina is a passage leading from the opening of the vulva to the cervix of the uterus in female; a passageway between outer body and the inner reproductive organs.

Healthy Vagina

The PH balance of the vagina is acidic, which decreases the occurrence of infections in vagina. These normally-occurring bacteria present in the vagina creates acidic environment in vagina. A healthy vagina produces secretions or emissions to regulate and clean itself likewise saliva clean and regulates the functioning and the environment of the mouth. These vaginal secretions are vaginal discharge and a sign of healthy vagina and vaginal discharge.

What is Vaginal Discharge or Normal Vaginal Discharge?

Vaginal discharge is a common symptom in every women.  Fluid produced by the glands inside the vagina and cervix carries away dead cells and bacteria. The Normal Vaginal Discharge can look like cloudy, white, clear or yellowish when it dries on your inner garment.

Vaginal discharge is normal and it varies during menstrual cycle. Before the ovulation (the release of eggs), there is a lot of mucous produced, up to 30 times more than after ovulation. It is also more watery and elastic during this phase of cycle.

Menstrual cycle, nutritional status, emotional stressors, and pregnancy are some of  the reason which can bring changes in normal discharge, even the use of medications like sexual arousal and birth control pills can bring changes in normal vaginal discharge.

Different types of Normal Vaginal Discharge

Vaginal Discharge can vary:

• Consistency (thick, pasty, thin).
• Color (clear, cloudy, white, yellow, and green).
• Smell (normal, odorless, bad odor).

1. White Discharge

Thick white discharge is common at the beginning and end of menstrual cycle. Normal white discharge is not accompanied by itching.

2. Clear and Stretchy

This is fertile liquid means you are ovulating.

3. Clear and Watery

It occurs at different times of your cycle and can be particularly heavy after exercising.

Causes of Vaginal Discharge

Non infective discharge

• Physiological
• Foreign bodies
• Cancer of cervix
• Cancer of uterus
• Ovarian cancer

Physiological Discharge

• New born infants may have small amount of vaginal discharge, sometimes mixed with blood. This is due to high level of circulating maternal hormones. This should disappear by two weeks of age.

• During reproductive years the fluctuation of oestrogen and progesterone throughout the menstrual cycle affect the quality and quantity of cervical mucus which is perceived by women as a change in their vaginal discharge. When the oestrogen is low, the mucus is thick and sticky. As oestrogen level rise, the mucus gets clear and more sticky.

• After ovulation the thickness and stickiness increases more.

The menstrual cycle influences the vaginal environment; around mid-cycle you can find increased wetness and clear discharge. The Ph balance of vagina varies during the cycle and is least acidic before and during the time of menstruation and this results the occurrence of infections. Infections are most common during these days.

What is Abnormal Vaginal Discharge?

Following are the symptoms of abnormal vaginal discharge:

• Abnormal vaginal discharge is the one that is associated with pain in the pelvis, abdomen or fever.
• Exposed to sexually transmitted disease.
• Increased thirst, appetite, weight loss, increased urine frequency, fatigue.
• Pus like discharge.
• A child who is not reached to puberty has vaginal discharge.
• If discharge is related to a medication.
• Blisters on your vagina or vulva (exterior genitals).
• Burning with urination or urinary tract infection.

Types of Abnormal Vaginal Discharge

It can be of three types:

1. Bacterial vaginosis.
2. Candidiasis. (Yeast infection)
3. Trichomoniasis.

1. Bacterial vaginosis

Bacterial vaginosis is caused by Gardnerella vaginalis bacteria. This infection is not caught from a partner.

2. Candidiasis (Yeast infection)

Small amounts of yeast fungus are found in a healthy vagina. If it grows too much it can cause a yeast infection. This infection is usually not caught by a sex partner. You can get a yeast infection if you are using antibiotics, if you are pregnant or you have diabetes or stay sweaty for long period.

3. Trichomoniasis

Trichomoniasis is caused by an organ called Trichomonas vaginalis. You can be infected but have no signs for a long time.

Non-sexually transmitted infection

• Bacterial Infection:

It is mostly seen in sexually active women.

• Brown discharge

It may happen after periods. It is just cleaning out vagina. Old blood looks like brown.

• Blood spotting

It occurs at the mid of ovulating cycle. Sometimes in early pregnancy spotting or brownish discharge is seen at the time of periods.

Causes of abnormal Vaginal Discharge

Epidemiology

• The most common cause of vaginal discharge in childbearing women is bacterial vaginosis.
• 50% cases of bacterial vaginosis are same that its true occurrence is mostly unknown.

Infective cause

The most common infective cause is vulvovaginal infection which affects 75%of women during their reproductive life.

Vaginal Discharge in pregnancy

The quality and quantity of vaginal discharge change during pregnancy. More discharge is produced during pregnancy.

Vaginal discharge during pregnancy is due to miscarriage, preterm labor, and premature rupture of membranes or low birth weight.

Diagnosis of Abnormal Vaginal Discharge

1. A full clinical and sexual history should be sought with the nature of the discharge (what is its color, odor, duration, consistency) and symptoms that includes itching, dyspareunia, abdominal pain, abnormal bleeding.

2. Consider the medications (e.g. antibiotics, steroids) previous treatments used and medical conditions like diabetes.

3. Patients who have the symptoms of bacterial infection can be treated without sampling. Otherwise “Triple Swab” test should be taken.

Triple Swab test consists of following steps

• High vaginal swab to identify bacterial infection.
• Endocervical swab in transport medium to diagnose the disease.
• Endocervical swab for DNA test to diagnose the abnormal discharge.

4. Vaginal pH testing (using narrow range pH paper) is a quick, cheap, simple test for the abnormal vaginal discharge.

Treatment for Vaginal Discharge

Non infective causes of vaginal discharge:

Foreign bodies

• Most can be manually moved but these may be very small (fibrous material or small beads in child’s vagina, a small piece of torn condom) not visible and require a lavage.
• Large or irregular shaped objects cause muscular contraction of vaginal walls. Anesthesia may also be needed.
• A short course of antibiotics may be needed to treat secondary infection.
• Allergic reactions can be treated by identifying and removing the cause.

Treatment of persistent discharge

• In some cases, repeated examination and screening no positive results and the patients still complain of vaginal discharge.
• It is appropriate to explore the nature of discharge relative to its normal discharge to review personal hygiene habits. Advise to avoid perfumed products, tight synthetic clothing.
• Explore the complaints like depression, anxiety or psychosexual dysfunctions.
• Premenopausal changes may predispose women to vaginal infection which may respond well to hormonal creams.

Complications in Vaginal Discharge

• Untreated vaginal infection can spread to the upper reproductive tract. It can cause more serious illness and ultimately infertility.
• Cervical infection is generally harmless although it may cause infertility if it grows very large.
• There are complications associated with infective discharge in pregnancy too.

Cure Rate of Vaginal Discharge

• Bacterial vaginosis has 70-80% cure rate after one course of treatment.
• Candidiasis has cure rate of 80-95%
• Trichomoniasis has a 95% cure rate.

Prevention in Abnormal Vaginal Discharge

Following steps should be taken to prevent abnormal vaginal discharge:

• Keep genital area clean and dry.
• Use infection treatment creams.
• Preferably use condoms to avoid sexually transmitted disease.
• Try to avoid using feminine fragrances, powders or hygiene sprays in the genital area.
• Wearing extremely tight pants may cause irritation, so its better to avoid it.
• Try to use and wear cotton panties and simply stay away and avoid underwear made of silk,  nylon or of any other synthetic fibers, synthetic fibers are not so absorbent, in fact they restrict the air flow and increase sweating in the genital area and end result comes is only irritation.
• Don’t use tampons, try to use pads.
• If you are diabetic then try to keep blood sugar level under good control.

Having some amount of vaginal discharge is normal. It may be either due to physiological or pathological reasons. Many cases of vaginal discharge are not caused by sexually transmitted diseases bur still require treatment. Sexually transmitted diseases may also present with the vaginal discharge. So if one observes symptoms of abnormal vaginal discharge like change in color, consistency or in odor of the discharge, doctor must be consulted as soon as possible.