Abnormal Vaginal discharge is quite frequent complaint of a
woman met in day to day. The discharge may range from what is called excess of
normal to one, which is a part of wide spectrum of ailments.
Vaginal
discharge may be blood stained or contaminated with urine or stool, but here we
are only concerned with a white , cream, yellow or greenish discharge which is
often loosely and wrongly called LEUCORRHOEA-a term which should be reserved
for only one type.
LEUCORRHOEA
It is strictly defined as an excessive normal vaginal
discharge.
CAUSES
1.Physiological
2.Pathological.
PHYSIOLOGICAL
Normal secretions from the vulva, vagina and
cervix show an increase under following conditions -
1.Seen in newborn
baby for a week due to maternal oestrogen.
2.Seen in girls
during puberty due to hormonal changes.
3.At the time of
ovulation and in early pregnancy.
4. During sexual
excitement.
PATHOLOGICAL
In
pathological Leucorrhoea the causes are:
1.General health causes
A. Ill health
and under nutrition
B.
Psychological
2. Dysfunctional state in genital tract
The
important cause of leucorrhoea are-
·
Vaginitis
·
Cervical erosion
·
Genital prolapse
·
Cervical carcinoma
VAGINITIS
Between
puberty & the menopause , presence of lactobacilli maintains a vaginal pH
between 3.8 – 4.2 . This protects against infection. Before puberty & after
menopause, the higher pH increases the risk of infection.
The vagina
may be infected pathologically by various microbes such as – Trichomonas
vaginalis, candida albicans, & other nonspecific organisms.
TRICHOMONIASIS
Vaginal trichomoniasis is the common and important cause of
vaginitis in the child bearing period
CAUSITIVE ORGANISM:
It is caused by
trichomonas vaginalis, a pear shaped parasite .
MODE OF TRANSMISSION
The organism is predominatly transmitted by sexual contact .The
transmission may also be possible by the toilet articles from one women to
other or through examining gloves . The incubation period is 3-28 days.
PATHOLOGY
In about 25% of
women in the reproductive period , the parasites harbor in the vagina in
asymptomatic state. When the local defense is impaired during and after
menstruation, after sexual stimulation and following illness, the ph of the
vagina is raised to 5.5-6.5. At this level of ph , the tricomonads thrive . The
organism usually lie in between the rugae and produce surface inflammatory
reaction when the defence is lost. In about 75% cases, the organism can be
isolated from the urethra , skene’s tubules or even from the bartholian glands.
CLINICAL FEATURES:
Symptoms:
1. Copious vaginal discharge.
2. Itching of vulva
3. Dyspareunia
4. Frequency of urination & dysuria
SIGNS :
1. Vaginal wall when exposed by a speculum is
found swollen, red, tender, with red papilae which bleeds on touch.
2. Discharge is copious,
frothy, greenish yellow & offensive.
3. Cervix appears like
strawberry.
CANDIDA VAGINITIS
(MONILIASIS)
Caused by over growth of
monilia albicans- a fungus of yeast group.
Its growth is faoured
with vaginal pH below 4.5 & rich supply of carbohydrate.
Incidence is increased
during pregnancy which can be as higher as 40%
CLINICAL FEATURES:
Symptoms :
1. Profuse vaginal
discharge. Thick curdy white.
2.
Intense vulval itching.
Signs :
1. Redness of the entire vaginal
& vulval mucus wall.
2.
Adherent curdy flakes on vaginal wall which shows petechial haemorrhage
on removal.
NON
SPECIFIC VAGINITIS:
During the
reproductive period, when the vaginal defence is lost , the local pathogens
like staphylococcus, streptococcus(haemolytic and anaerobic), E.coli etc.. Gain
footing and produce acute symptoms. Foreign bodies like pessary, tampon, IUCD
or child birth trauma or vaginal operations predispose to such infection.
CLINICAL FEATURES:
There is varying amount of vaginal discharge
sometimes offensive with irritation of the
vulva.
ON EXAMINATION:
- The colour, consistency and the amount
of discharge varies.
- Vulva may be congested and swollen with
evidence of pruritus
- Vaginal mucosa is red , tender and
swollen
Hence,
the vaginal ecosystem is a complex system of micro-organism interacting
with host factors to maintain its equilibrium .
SOURCES:
Text books :
1.
Jaffecoate’s principle of gynaecology –
international edition
2.
Howkin’s & bourne , shaw’s textbook of
gynaecology – 12th Edition
3.
D.C. DUTTA, Textbook of gynaecology – 4th
Edition
4.
Current obstetric & gynecologic diagnosis
& treatment by Ralph C. Benson