Vaginal Discharge

Updated: August 21, 2024

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Background

Vaginal discharge is a normal and general occurrence in a vagina of female. It helps to clean and protect the vaginal area to remove dead cells and bacteria. 

This process maintains a healthy balance of bacteria and an acidic pH level in the vagina to prevent infections. 

Vaginal discharge varies in color, consistency, and quantity throughout the menstrual cycle. These variations are linked to hormonal changes. 

Types of vaginal discharge as follows: 

Clear and Watery 

Clear and Stretchy 

Normal  

Abnormal 

Discharge is seen clear and stretchy during ovulation phase, while it is thicker and slightly yellow in the luteal phase. 

It is observed more due to high estrogen levels during ovulation, puberty, and pregnancy period. 

Epidemiology

Gynaecological advice required in vaginal discharge cases and studies shows 10% to 25% women report abnormal discharge.  

Sexual behaviour determines risk of STI, that impacts abnormal discharge from unprotected intercourse or multiple partners. 

Disruption in vaginal bacteria causes bacterial vaginosis occurs in fishy odour and thin grey discharge. 

Bacterial vaginosis affects 29% to 35% of women worldwide, while yeast infections affect 75% of women for minimum one time. 

Anatomy

Pathophysiology

Cervix mucus consistency changes during menstrual cycle to protects from infections. 

Vaginal walls secrete fluid to maintain moisture and acidic environment. Ovulation increases sticky mucus for easier sperm movement during conception. 

Increase estrogen level in pregnancy causes more clear or milky vaginal discharge called as leukorrhea. 

Yeast infections caused due to overgrown candida albicans fungus to give thick discharge. 

Etiology

  • Causes of vaginal discharge are: 
  • Yeast Infection 
  • Sexually Transmitted Infections 
  • Bacterial Vaginosis 
  • Hormonal Imbalances 
  • Cervical or Uterine Issues 

Genetics

Prognostic Factors

Hormonal issues from conditions including PCOS or menopause can affect outcomes treated with therapies and management. 

Effect of irritant type on prognosis is significant and removes irritant lead to rapid symptom improvement. 

The age of the individual can influence the prognosis. Individuals with strong immune systems generally have a better prognosis for infections.  

Untreated STIs or repeat infections can cause pelvic inflammation to affect fertility and health. 

Good hygiene and avoidance of irritants improve vaginal discharge prognosis. 

Clinical History

Detailed information including presenting symptoms, menstrual history, sexual history and medical history of patient should be gathered. 

Physical Examination

  • External Genital Examination 
  • Speculum Examination 
  • Bimanual Examination 

Age group

Associated comorbidity

Associated activity

Acuity of presentation

Acute symptoms are: 

Strong odor, itching, discomfort, pelvic pain, dysuria 

Chronic symptoms are: 

fishy-smelling discharge, dryness, irritation, bleeding 

Differential Diagnoses

  • Bacterial Vaginosis 
  • Candidiasis 
  • Trichomoniasis 
  • Chlamydia 

Laboratory Studies

Imaging Studies

Procedures

Histologic Findings

Staging

Treatment Paradigm

Dose of metronidazole and clindamycin should be taken orally two times daily for one week to treat bacterial vaginosis. 

Metronidazole gel is applied intravaginally once daily for 5 days and use clindamycin cream at bedtime for a week. 

Use of clotrimazole or miconazole topically in the form of vaginal cream or suppository for 3 to 7 days. 

Use azithromycin and doxycycline through oral route two times daily for one week to treat chlamydia. 

Normal discharge throughout the menstrual cycle does not require treatment. 

Use estrogen therapy for vaginal dryness and atrophic vaginitis in menopause cases. 

by Stage

by Modality

Chemotherapy

Radiation Therapy

Surgical Interventions

Hormone Therapy

Immunotherapy

Hyperthermia

Photodynamic Therapy

Stem Cell Transplant

Targeted Therapy

Palliative Care

use-of-non-pharmacological-approach-for-vaginal-discharge

To clean the genital area patient should use mild soaps or cleansers.  

Always dry the genital area after bath to prevent excess moisture which can promote yeast growth. 

Cotton underwear should be preferred and avoid tight-fitting synthetic cloths panties. 

Use of condoms during intercourse to reduce the risk of sexually transmitted infections that causes abnormal discharge. 

Proper awareness about vaginal discharge should be provided and its related causes with management strategies. 

Use of Antibiotics

Metronidazole: 

It inhibits nucleic acid synthesis to disrupt DNA of organisms associated with bacterial vaginosis. 

Azithromycin: 

It binds to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA. 

Use of antifungals

Clotrimazole: 

It binds with phospholipids in the fungal cell membrane that causes leakage of essential intracellular elements. 

Use of Antiprotozoals

Tinidazole: 

It causes cytotoxicity that damage DNA to prevent further DNA synthesis. 

Use of Hormonal Therapy

Estradiol: 

It is mainly responsible for the development and maintenance of the female reproductive system and sexual characteristics. 

use-of-intervention-with-a-procedure-in-treating-vaginal-discharge

Interventions with procedures for vaginal discharge are considered when initial treatments with medications or lifestyle modifications are not sufficient. 

It includes colposcopy, endometrial biopsy and hysteroscopy procedure. 

use-of-phases-in-vaginal-discharge

In the initial assessment phase, evaluation of the patient associated symptoms including menstrual cycle, sexual history, and laboratory test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of antibiotics, antifungal, and antiprotozoal agents. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and therapies. 

The regular follow-up visits with the gynecologist are scheduled to check the improvement of patients along with treatment response. 

Medication

 

fluconazole/ornidazole/azithromycin 

Take oral dose as per physician advised



oxyquinoline/sodium lauryl sulfate 

Adult females
Indicated for Vaginal acidification
Insert half of the applicator with gel intravaginally thrice weekly during the 1st week after pessary insertion, followed by intravaginal application of gel using the applicator twice a week



 
 

Media Gallary

Vaginal Discharge

Updated : August 21, 2024

Mail Whatsapp PDF Image



Vaginal discharge is a normal and general occurrence in a vagina of female. It helps to clean and protect the vaginal area to remove dead cells and bacteria. 

This process maintains a healthy balance of bacteria and an acidic pH level in the vagina to prevent infections. 

Vaginal discharge varies in color, consistency, and quantity throughout the menstrual cycle. These variations are linked to hormonal changes. 

Types of vaginal discharge as follows: 

Clear and Watery 

Clear and Stretchy 

Normal  

Abnormal 

Discharge is seen clear and stretchy during ovulation phase, while it is thicker and slightly yellow in the luteal phase. 

It is observed more due to high estrogen levels during ovulation, puberty, and pregnancy period. 

Gynaecological advice required in vaginal discharge cases and studies shows 10% to 25% women report abnormal discharge.  

Sexual behaviour determines risk of STI, that impacts abnormal discharge from unprotected intercourse or multiple partners. 

Disruption in vaginal bacteria causes bacterial vaginosis occurs in fishy odour and thin grey discharge. 

Bacterial vaginosis affects 29% to 35% of women worldwide, while yeast infections affect 75% of women for minimum one time. 

Cervix mucus consistency changes during menstrual cycle to protects from infections. 

Vaginal walls secrete fluid to maintain moisture and acidic environment. Ovulation increases sticky mucus for easier sperm movement during conception. 

Increase estrogen level in pregnancy causes more clear or milky vaginal discharge called as leukorrhea. 

Yeast infections caused due to overgrown candida albicans fungus to give thick discharge. 

  • Causes of vaginal discharge are: 
  • Yeast Infection 
  • Sexually Transmitted Infections 
  • Bacterial Vaginosis 
  • Hormonal Imbalances 
  • Cervical or Uterine Issues 

Hormonal issues from conditions including PCOS or menopause can affect outcomes treated with therapies and management. 

Effect of irritant type on prognosis is significant and removes irritant lead to rapid symptom improvement. 

The age of the individual can influence the prognosis. Individuals with strong immune systems generally have a better prognosis for infections.  

Untreated STIs or repeat infections can cause pelvic inflammation to affect fertility and health. 

Good hygiene and avoidance of irritants improve vaginal discharge prognosis. 

Detailed information including presenting symptoms, menstrual history, sexual history and medical history of patient should be gathered. 

  • External Genital Examination 
  • Speculum Examination 
  • Bimanual Examination 

Acute symptoms are: 

Strong odor, itching, discomfort, pelvic pain, dysuria 

Chronic symptoms are: 

fishy-smelling discharge, dryness, irritation, bleeding 

  • Bacterial Vaginosis 
  • Candidiasis 
  • Trichomoniasis 
  • Chlamydia 

Dose of metronidazole and clindamycin should be taken orally two times daily for one week to treat bacterial vaginosis. 

Metronidazole gel is applied intravaginally once daily for 5 days and use clindamycin cream at bedtime for a week. 

Use of clotrimazole or miconazole topically in the form of vaginal cream or suppository for 3 to 7 days. 

Use azithromycin and doxycycline through oral route two times daily for one week to treat chlamydia. 

Normal discharge throughout the menstrual cycle does not require treatment. 

Use estrogen therapy for vaginal dryness and atrophic vaginitis in menopause cases. 

OB/GYN and Women\'s Health

To clean the genital area patient should use mild soaps or cleansers.  

Always dry the genital area after bath to prevent excess moisture which can promote yeast growth. 

Cotton underwear should be preferred and avoid tight-fitting synthetic cloths panties. 

Use of condoms during intercourse to reduce the risk of sexually transmitted infections that causes abnormal discharge. 

Proper awareness about vaginal discharge should be provided and its related causes with management strategies. 

OB/GYN and Women\'s Health

Metronidazole: 

It inhibits nucleic acid synthesis to disrupt DNA of organisms associated with bacterial vaginosis. 

Azithromycin: 

It binds to 50S ribosomal subunit of susceptible microorganisms and blocks dissociation of peptidyl tRNA. 

OB/GYN and Women\'s Health

Clotrimazole: 

It binds with phospholipids in the fungal cell membrane that causes leakage of essential intracellular elements. 

OB/GYN and Women\'s Health

Tinidazole: 

It causes cytotoxicity that damage DNA to prevent further DNA synthesis. 

OB/GYN and Women\'s Health

Estradiol: 

It is mainly responsible for the development and maintenance of the female reproductive system and sexual characteristics. 

OB/GYN and Women\'s Health

Interventions with procedures for vaginal discharge are considered when initial treatments with medications or lifestyle modifications are not sufficient. 

It includes colposcopy, endometrial biopsy and hysteroscopy procedure. 

OB/GYN and Women\'s Health

In the initial assessment phase, evaluation of the patient associated symptoms including menstrual cycle, sexual history, and laboratory test to confirm diagnosis. 

Pharmacologic therapy is effective in the treatment phase as it includes use of antibiotics, antifungal, and antiprotozoal agents. 

In supportive care and management phase, patients should receive required attention such as lifestyle modification and therapies. 

The regular follow-up visits with the gynecologist are scheduled to check the improvement of patients along with treatment response. 

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