ABNORMAL VAGINAL DISCHARGES – A COMMON HEALTH PROBLEM IN WOMEN

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:

1. The colour, consistency and the amount of discharge varies.
2. Vulva may be congested and swollen with evidence of pruritus
3. 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 – 12^th Edition

3.       D.C. DUTTA, Textbook of gynaecology – 4^th Edition

4.       Current obstetric & gynecologic diagnosis & treatment by Ralph C. Benson