Vaginal Discharge

 

Manjot Kaur

Assistant Professor, Obstetrics and Gynaecological Nursing,

Shaheed Kartar Singh Sarabha College of Nursing, Sarabha, Ludhiana, Punjab.

 

ABSTRACT:

Swetha Venugopal, Kannan Gopalan, et al (2014) conducted a cross-sectional descriptive study on epidemiology and clinico-investigative study of organisms causing vaginal discharge. Abnormal vaginal discharge is a common clinical problem in reproductive age group. It is the second most common problem after abnormal uterine bleeding. It is a neglected health problem, most commonly caused due to vulvovaginal candidiasis, trichomoniasis, and bacterial vaginosis. The total of selected 100 women in the reproductive age group who presented with abnormal vaginal discharge andhad symptoms of vaginitis were examinedfrom the Vinayaka Mission KirupanandaVariyar Medical College Hospital, Salem. The findings of studyincluded that 77 (77%) cases were organism positive. Among the positive cases, bacterial vaginitis (27%) was the most common microbiological cause of abnormal vaginal discharge, followed by trichomoniasis (25%), vaginal candidiasis (22%), combined infection (Candida and BV) (3%), and nonspecific cases (23%). Hence, the study concluded that out of 100 cases, few cases showed discordance between clinical and laboratory diagnosis. This discordance can be due to pitfalls in identifying the causative agent clinically or obscuring of the findings due to improper treatment received for other ailments. Thus, clinico-investigative correlation is more important than other clinical findings alone.

 

 

 

INTRODUCTION:

Vaginal discharge comes from glands inside your vagina and cervix. These glands produce small amounts of fluid also known as vaginal secretions. The fluid flows out of the vagina each day, cleansing old cells that have lined the vagina.¹ This is a completely natural process-itswomen body’s way of keeping her vagina healthy, cleaning and moistening and helping to prevent and fight infections through natural, acidic pH of vagina and is caused by natural, good, bacteria present in your vagina..²

 

Discharge varies from woman to woman. Some women have discharge every day, while others experience it less frequently. It may indicate an imbalance of healthy bacteria in vagina, which can be a sign that all is not well.¹

 

NORMAL VAGINAL DISCHARGE:

The vagina is a complicated and dynamic ecosystem. It sees a lot of bacteria, pH, and moisture. It’s sensitive to changes that come from outside of body and from within. Fluid made by glands inside the vagina and cervix carries away dead cells and bacteria that help keep the vagina clean. This is called vaginal discharge, free from foul smell and typically has no odor at all with appearance of clear or milky when it dries on panties^.3

 

The following factors can increase the amount of normal vaginal discharge:

·       Ovulation (the release of an egg from your ovary in the middle of menstrual cycle)

·       Pregnancy

·       Sexual excitement

 

PERIOD AFFECTS VAGINAL DISCHARGE:

·       Women’s menstrual cycle has a significant effect on the type of vaginal discharge you experience throughout the month. About halfway between periods, she will see a normal increase in clear vaginal discharge due to the change in hormone levels in the body.

·       The second aspect is that she is more likely to experience vaginal infections just before or during her period. This is because the pH balance of your vagina varies during her monthly cycle, causing the acidic level to be at its lowest point a few days before and during her period.³

 

CAUSES OF ABNORMAL VAGINAL DISCHARGE

Abnormal vaginal discharge can happen when there’s a decrease in the amount of “good” microbes and an increase in “bad” microbes resulting in upset the natural pH balance of your vagina and lead to vaginal infections include:

·       Feminine hygiene products

·       Antibiotics

·       Diabetes

·       Yeast infections

·       Birth control pills

·       Cervical cancer

·       Chlamydia or gonorrhea (STDs)

·       Douching and cleansing practices

·       Sexual activity

·       Use of antibiotics or steroids

·       Hormonal changes

·       Pelvic infection after surgery

·       Pelvic inflammatory disease (PID)

·       Trichomoniasis

·       Vaginal atrophy

·       Vaginitis

·       Menopause

 

Less common causes include:

·       Cancer of the vulva, cervix, vagina, uterus, or fallopian tubes

·       Skin conditions, such as desquamative vaginitis and lichen planus⁴

 

SIGNS OF ABNORMAL DISCHARGE:

It's important to recognize the signs of abnormal vaginal discharge because it could be a sign of infection or other health condition. If she experience a vaginal discharge that suddenly and randomly increases, this may be a sign of a problem.³

 

TYPES OF VAGINAL DISCHARGE:

Type of discharge (color):	It could be (infection):	Smell	Sign and symptoms:	Treatment
Thicker, white, milky, stretchy discharge	Normal discharge – ovulation	Nil	Nil	Nothing – all is well
Pinkish	Shedding of uterine lining after childbirth	Nil	Nil	Nothing – all is well
Yellow to greenish yellow	Postmenopausal	Nil	Desquamative inflammatory vaginitis	·  Vaginal atrophy where vaginal skin/wall thins out becoming red andinflammed ·  Sex is sometimes painful.
Bloody/Brown	Irregular menstrual cycles/less often cervical/endometrial cancer	Odor smell	·    Abnormal vaginal bleeding ·    Pelvic pain	·  Talk to health care professional
Yellow	Gonorrhea	Odor smell	·    Pelvic pain ·    Urinary incontinence ·    Bleeding between periods	·  Talk to health care professional
Yellow/greenish	Trichomoniasis (STD)	Unpleasant strong smell	·    Pain ·    Itching while itching	·  Single dose of metronidazole or tinidazole pill by mouth ·  Some women may need prolonged treatment for 5-7 days
Thick, white cheesy	Yeast infection (candida albicans)	Odor smell	·    Burning ·    Swelling ·    Pain around vulva ·    Itching and pain during intercourse	Over counter drugs: ·  Tioconazole ·  Prescription pills (fluconazoles) ·  Prescription vaginal creams (clotrimazol)
White, grey/yellow	Bacterial vaginosis	Unpleasant fishy smell	·    Redness ·    Itching ·    Swelling of vulva/vagina	Two vaginal ointments: ·  Metronidazole gel ·  Clinodamycin cream4

 

 

HOW TO CHECK VAGINAL DISCHARGE:

She knows that its checkup is as important as a breast exam. A self-exam can help her to detect abnormal vaginal discharge earlier and start treatment sooner.

Find a comfortable position. Sit on the toilet, squat, or stand up and put one leg up on the toilet seat or bathtub edge. There are three ways to check her vaginal discharge:

·         Before she pee, wipe the opening of the vagina with white toilet paper. Check the color, odor, and consistency of the mucus.

·         Take a look at the color and texture of the vaginal discharge on her underpants.

·         Clean her fingers and insert them into her vagina. Check the color and texture of the discharge on her fingers.

·         To best feel the texture and consistency of the discharge, she should rub it and pull it between her thumb and index finger. Press her fingers together and slowly move them apart.

·         Record everything about discharge on a chart, on a daily basis about color, consistency, smell.

 

(Also, keep in mind that some medication may interfere with cervical fluids).⁵

 

WHEN SHOULD SEE A DOCTOR:

It’s recommended to seek medical care if shethinkher vaginal discharge has changed. If she noticed a change in color, odor or consistency, or have other symptoms such as burning and itching, make an appointment with her doctor right away. As doctor may take a sample of the discharge or do a Pap test for examination.

 

TIPS TO PREVENT VAGINAL INFECTIONS THAT CAN LEAD TO ABNORMAL DISCHARGE:

·       Keep her vagina clean and healthy by washing often with warm water and mild soap.

·       Keep foaming and scented soaps away from her vulva.

·       Avoid feminine sprays and bubble baths.

·       Avoid deodorant pads or tampons

·       Always use protection with new sexual partners.

·       Wear cotton underpants.

·       Avoid tight clothing.

·       After going to the bathroom, wipe from front to back to avoid bacteria from entering into the vagina.

·       Change laundry detergent or fabric softener if she think it may be causing irritation.⁵

 

In short, remember^:6

 

REFERENCES:

1.     https://www.monistat.com/vaginal-health-blog-articles/vaginal-discharge-101-what-every-woman-should-know

2.     https://kidshealth.org/en/teens/vdischarge2.html

3.     https://www.verywellhealth.com/lets-talk-about-vaginal-discharge-3522663

4.     https://medlineplus.gov/ency/article/003158.htm

5.     https://health.clevelandclinic.org/vaginal-discharge-mean/

6.     https://flo.health/menstrual-cycle/health/vaginal-discharge/normal-abnomal-discharge

7.     https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5389219/

 

 

Received on 12.05.2020          Modified on 27.05.2020

Accepted on 07.06.2020             ©AandV Publications All right reserved