Vaginal discharge : white discharge ...

Vaginal Discharge is a very common symptom reported by young women .This condition is scientifically called as Leucorrhea which literally means white discharge. Vaginal discharge can be white, colourless , sometimes foul smelling or odourless and may or may not be associated with symptoms such as itching or pain. The commonest cause is reproductive tract infections, commonly sexually transmitted affecting vagina and the cervix called as vaginitis and cervicitis. But it can also be without any infection or a normal physiological cleansing mechanism .

Vaginitis can be three types: Trichomonal( parasite), Candida(fungal ) and Bacterial Vaginosis( bacteria) . Mixed infection is also common. The discharge can be due to cervical infection which is often due to Gonorrhoea ( sexually transmitted bacterial infection ) and Chlamydia ( bacteria) infection. Genital herpes(Viral) can also have vaginal discharge. These reproductive tract infections can be treated by the recommended antimicrobial therapy.

Your doctor will ask you the following questions on consultation

• Nature and duration of discharge.

• Association with sexual contact or menstrual cycle

• Earlier similar episodes and treatment history.

• History of medications / local applications /change of toiletries /any medications especially antibiotics for some other infections

• Whether it is first episode or there are recurrent or persistent symptoms.

• Associated symptoms like vulval itching, burning at urination, lower abdominal pain, low backache, painful sex, menstrual abnormalities, infertility etc

• Personal hygiene practices

If the woman has pain in lower abdomen, low backache, painful sex, these signs are suggestive of pelvic inflammatory disease ( PID) for which prolonged antimicrobial treatment is recommended.

The doctor will conduct local examination

• To see any rash, ulcers, discharge, scratch marks, warty growths on vulva and perineum

• Perform speculum examination in good light and observe the vagina, cervix for redness, any lesion, ulcer, growth on cervix.

• Perform bimanual vaginal examination and note uterine size, position, contour and mobility.

• Look for painful cervical manipulation, tenderness on vaginal examination, adnexal mass. Arrive at a probable diagnosis

• May perform a test to determine the PH of your vagina or a swab test to study the cause of the infection

Additional tests performed

• Laboratory tests relevant to your condition may be suggested for anaemia , diabetes , obesity etc .

• Any other site infection such as the urinary infection

• Ultrasonography may be advised for certain structural or functional issues

Treatment

The recommended treatment for vaginitis or cervicitis along with counselling is specified based on the assessment findings and you will be asked to come for follow up after the treatment to see the relief o Chronic PID : Antibiotics o Suspicious lesion on the cervix : Cytology or biopsy o Unhealthy cervix: follow pre-cancer work-up SOPs o Look for uterine enlargement, tenderness suggestive of pyometra ( pus in the womb).

Counselling will be done as under

• The possible cause

• Personal hygiene practices

• Sexual hygiene

• Preventive methods

• Compliance issues

• Associated condition treatments

Physiological vaginal discharge

Excessive vaginal discharge that is clear, not foul smelling is physiological discharge which does not need any treatment. This happens around the time of ovulation. Also during pregnancy the discharge can be increased.

• Recurrent Vaginitis or persistent symptoms after complete treatment: HIV infection, diabetes mellitus, immunosuppressive conditions, steroid therapy need to be ruled out.

• OTC ( over the counter /self medications) antibiotics and intra-vaginal douching should be discouraged. Reinfection can be due to sexual transmission or faecal soiling of vagina, poor perineal & vaginal hygiene, marked obesity, chemical & mechanical irritants.

• Inadequate treatment , poor patient compliance , drug resistance could be treatment related factors .

Treatment of Persistent/Recurrent Vaginitis:

• Specific complete treatment for the identified pathogen.

• Diagnosis & treatment of sexual partners.

• Avoid sex until treatment is completed, condom use, control of diabetes.

• Improve perineal hygiene, change dress habits and sanitary practices.

• Probiotics can be considered in supportive therapy for recurrent vulvo-vaginal infections

Rarely excessive stress , improper nutrition can also cause recurrence of excessive vaginal discharge .

What is important is to understand that "stitch in time saves nine" .

So seek medical guidance early and do-not do self medications .

Take medicines as recommended and be frank with your doctor and tell all .

It could be a very basic reversible infection but sometime may be a serious one especially when neglected and therefore proper evaluation is important .

This can also be your opportunity to ask the doctor for guidance for birth control measures and become up-to-date with your adult vaccination .