Vaginal Discharge

Vaginal discharge is the term used for fluid or mucus that comes from the vagina. Vaginal discharge is one of the common complaints with which women see their doctor. Some amount of vaginal discharge is normal in every lady unless it is associated with itching, burning, or other bothersome symptoms. 

Before we understand about vaginal discharge, it is important to have a basic understanding of the female reproductive anatomy. You will notice vaginal discharge only when the discharge comes out of the vagina. Vaginal and cervical cells have glands and they secrete small amounts of fluid on a daily basis. This fluid which comes out of the cervix and vagina carries out old cells. This discharge is labeled as “physiological white discharge”. This discharge is usually clear or milky and does not have a bad smell. It has been noticed that the amount of this discharge varies under the influence of the female hormone called estrogen. Oestrogen hormone is high in the body before ovulation thus you may notice an amount of white discharge to be more around ovulation and also just before menstruation. Since estrogen levels drop after

menopause these women will have very minimal vaginal discharge. 

In all women vagina will have some organisms present and they are known as “normal vaginal flora”. The amount and type of bacteria present in the vagina will have significant implications for a woman's overall health. The main bacteria of a healthy individual are a group of bacteria called Lactobacillus these bacteria produce lactic acid and are thought to protect against infection by pathogenic species. Any change in normal vaginal flora can lead to vaginal infection. 

What causes the changes in normal vaginal flora? 

Vaginal infection can occur if the normal vaginal flora is altered. There are various reasons that can cause this imbalance such as - 

Douching

If you are taking antibiotics

If you are using feminine hygiene sprays

Use of certain soaps or bubble baths

If you are diabetic

If you are using scented condom

How can douching be harmful? 

The chemicals present in the liquid which is used for vaginal douches may irritate your vagina and change the normal balance of good bacteria. Douching will wash away the normal vaginal flora and causes an imbalance of the good bacteria thus with douching you wash away the good bacteria and invite the bad bacteria which causes infection. Douching can also spread infection from the vagina/cervix up into the uterus and can cause pelvic inflammatory disease (also called PID). 

When do I seek help for vaginal discharge?

When the vaginal discharge is not physiological but “pathological” you need to seek help. The pathological discharge will have the following signs and symptoms:

White discharge is curdy white, foamy, or greenish-yellow in colour

Itching of the external genitalia (vulva, vaginal opening, or labia)

White discharge is associated with bad odour (fishy odour)

Burning sensation, redness, soreness, or swelling of the vulvar skin

Burning sensation while urination

Blood-tinged vaginal discharge

Abdominal or pelvic pain

Pain with sexual intercourse 

Ferver and chills

What are the cause for vaginal discharge?

The most common causes of vaginal discharge include:

  • Infection: yeast or bacterial vaginosis, sexually transmitted infection such as chlamydia, gonorrhea, or trichomonas trichomonas

  • Sexually transmitted disease

  • Foreign body: such as a forgotten tampon, condom, or piece of paper

  • Use of irritant substance (such as bubble bath, spermicide, sex toy), women allergic to latex condom

  • After menopause due to lack of oestrogen, the vagina becomes thin and dry this is more likely to become irritated and inflamed, resulting in a discharge 

  • Forgotten ring pessary: ring pessary is used to treat uterine prolapse to keep the uterus and cervix within the vagina

  • Cancer of the cervix, vagina, and uterus 

  • Rarely, some women develop abnormal openings (fistulas) between the intestine and vagina, resulting in a discharge from the vagina. This discharge sometimes contains stool. Fistulas may result due to: damage to the vagina and rectum during delivery, Crohn’s disease, radiation therapy directed at the pelvis, as part of the complication of pelvic surgery done for tumours in the pelvis. 

  • Ectropion: sometimes the cervix pops out causing the fragile endocervix to be exposed and cause excessive watery discharge 

What tests will be required for diagnosis?

The doctor will usually do a vaginal examination (per-speculum) to note 

  • for the type of vaginal infection 

  • for any foreign body in the vagina

  • to check to see if you have cancer of the cervix or vagina

  • to rule out any fistulas

  • if the doctor notices discharge a swab test can also to taken and sent to the laboratory to confirm the exact organism growing

Ultrasound: If your doctor suspects pelvic inflammatory disease (PID) you may be advised for an ultrasound. 

Sometimes blood and urine tests may also be advised. 

What are the treatment options?

  • If you have been diagnosed with sexually transmitted diseases (such as chlamydia, gonorrhea, or trichomonas) then your sexual partner will need evaluation and treatment. For other infections, such as yeast or bacterial vaginosis, your sexual partner does not need treatment. If treatment is advised, you should avoid having intercourse until the treatment is completed.

  • You may be prescribed antibiotics to be taken by mouth or antibiotics in the form of pessaries (which are inserted into the vagina) or gel or cream to be applied to the external genitalia.

  • If the cause is due to a foreign body that will be removed either in the clinic at the time of examination. If the foreign body is stuck and causing discomfort it may have to be done under sedation in an operating theatre.

  •  If the cause is due to cervical ectropion this can be treated by either freezing (cryotherapy) or vaporizing the tissue with a cautery under local anesthetic.

Are there any tips on preventing vaginal infections?

  1. There are some basic tips to be followed it prevent infections such as:

  2. Do not douche, do not wash away the normal vaginal flora. 

  3. Avoid using scented toilet paper, sanitary pads or or perfumed that contain a deodorant and bubble bath. 

  4. After using the toilet (either after stools or urine), always wipe from front to back “do not wipe back to front”. With this practice you will not bring bacteria from your rectal area towards vagina.

  5. Use cotton panty as they would allow to “breathe.” 

  6. Try to avoid wearing tight pants, shorts or swimming suits for long period of time.

  7. Avoid any irritants, change your laundry detergent or fabric softener if you think it may be irritating your genital area. 

  8. Avoid allergens, latex condoms and diaphragms and the sperm-killing gels that are used as birth control methods can be irritating to some women. If you think one of these may be causing the problem for you, talk to your doctor about other types of birth control. 

  9. Avoid using hot tubs with scented bubble bath, instead use plain warm water and gently pat your genital area dry with a clean towel. 

  10. Try to avoid wearing pantyliners every day, if there is a need to wear get yourself checked.

Can normal women have white discharge? 

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