Vaginal Discharge

Introduction

Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricates and protects the vagina. Its composition, amount, and quality can vary among individuals and throughout different stages of the menstrual cycle and reproductive development. While most vaginal discharge is normal, some changes can indicate infection or other pathological processes. This essay will look at the characteristics, causes, and treatments of both normal and abnormal vaginal discharge.

Normal Vaginal Discharge

Normal vaginal discharge primarily consists of cervical mucus, vaginal fluid, shedding vaginal and cervical cells, and bacteria. It is usually clear or white with a mild to non-existent odour and can vary from thin and watery to thick and clumpy. The amount of discharge can increase during sexual arousal due to increased transudate from vaginal walls, which has a neutral pH.

Stages of Development

Neonatal

Neonatal vaginal discharge occurs due to in-utero exposure to oestrogen and can be white or bloody.

Paediatric

Pre-pubertal girls have minimal vaginal discharge with a neutral to alkaline pH and different bacterial flora dominated by staphylococcus species.

Puberty

During puberty, increased oestrogen levels lead to more vaginal discharge, which becomes more acidic due to lactobacilli growth converting glycogen to lactic acid.

Menstrual Cycle

Post-menstruation, discharge is minimal and thick. Approaching ovulation, discharge increases and becomes clear and elastic. After ovulation, discharge decreases and becomes thick and opaque.

Pregnancy

Pregnancy increases vaginal discharge volume, typically white or slightly grey with a musty smell but without blood or itching. The pH is more acidic, providing protection from infections but increasing susceptibility to yeast infections.

Menopause

Post-menopause, reduced oestrogen leads to thinner vaginal tissues, decreased lactobacilli, and increased pH. Discharge decreases, potentially causing dryness and pain during intercourse, treatable with moisturisers or hormone creams.

Abnormal Vaginal Discharge

Abnormal discharge can indicate infections or imbalances in vaginal flora or pH. Symptoms include itching, irritation, green or foamy discharge, different odours, and pain. Diagnosis often requires a potassium hydroxide test or vaginal pH analysis.

Common Causes

Bacterial Vaginosis (BV)

BV results from a decrease in lactobacilli and an increase in anaerobic bacteria like Gardnerella vaginalis. Symptoms include a strong fishy odour and thin grey or green discharge. Diagnosis involves a pH test, clue cells, and a "whiff test." Treatment includes antibiotics like metronidazole.

Vaginal Yeast Infection

Overgrowth of Candida albicans causes thick, white, clumpy discharge with itching, burning, and irritation. Diagnosis involves microscopic examination or culture, and treatment includes antifungal medications.

Trichomonas Vaginitis

A sexually transmitted infection, Trichomonas causes yellowish-green, frothy discharge with a foul smell, burning, and pain during urination or sex. Diagnosis involves microscopic examination or a PCR assay, treated with oral antibiotics like metronidazole.

Chlamydia and Gonorrhoea

These STIs can cause pus-filled discharge, often asymptomatic. Accompanied by pelvic pain, it suggests pelvic inflammatory disease. Diagnosis and treatment involve appropriate antibiotic regimens.

Other Causes

Foreign objects like tampons or toilet paper can cause chronic, foul-smelling discharge.

Pre-Pubertal Discharge

In pre-pubertal girls, vaginal discharge often results from irritation or infection due to the thin vaginal walls and different microbiota. Common causes include bacterial colonisation from oral or faecal sources and foreign objects, which may cause bloody or brown discharge.

Diagnosis and Treatment

Upon diagnosing vaginitis, a speculum exam evaluates the vagina and cervix. Samples of discharge are tested for pH and examined under a microscope. Treatment varies by cause, including antibiotics for BV and Trichomonas, and antifungals for yeast infections. Self-treatment is not recommended as it can worsen symptoms.

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Self-assessment MCQs (single best answer)

What primarily composes normal vaginal discharge?

Which stage of development is associated with a white or bloody vaginal discharge due to in-utero exposure to oestrogen?

What characteristic change occurs to vaginal discharge during ovulation?

Which infection is characterised by a strong fishy odour and thin grey or green discharge?

What is the primary cause of the increased vaginal discharge volume during pregnancy?

Which symptom is NOT typically associated with a vaginal yeast infection?

What type of discharge is typically associated with Trichomonas Vaginitis?

Which diagnostic test is used to identify Bacterial Vaginosis by detecting a fishy odour?

What is a common cause of vaginal discharge in pre-pubertal girls?

What is the recommended treatment for a confirmed case of Trichomonas Vaginitis?