THE vagina has normal daily secretions termed physiological vaginal discharge. This fluid is made by the glands of the vagina and cervix and serves to remove bacteria and dead cells, hence the colloquial saying: “The vagina is cleaner than the mouth”. This discharge keeps the vagina clean and prevents infection.

Normal discharge is thin, odourless and smooth in consistency with a colour that is usually clear to “white-ish”, based on the menstrual cycle. During ovulation or sexual arousal, the amount will increase. The smell also changes during pregnancy or with infrequent baths.

MICRO-ORGANISMS IN THE VAGINA

Micro-organisms live in the vagina in a certain amount termed microflora. The acidity is kept at a pH of about 4.5. This is partly due to some harmless bacteria, including lactobacillus, which produce lactic acid and hydrogen peroxide. This, along with fluids from the vagina, is responsible for its scent and helps to keep harmful bacteria from overgrowing, such as Gardnerella vaginalis, Escherichia coli and Bacteroides. Candida albicans also thrive with lactobacillus, but not in amounts to produce an infection.

VAGINAL DISCHARGE CHANGES

Changes in this vaginal discharge is one of the main reasons a female would visit the general practitioner and gynaecologist. The commonest cause of vaginitis are infections. Topping the list are non-sexually transmitted causes such as Bacterial vaginosis and Candidiasis (overgrowth of organisms that live around the perianal area) and sexually transmitted causes such as gonorrhoea, chlamydia, trichomoniasis and mixed infections. Non-infectious causes of abnormal vaginal discharge include hormonal changes, cervical polyps (growths), foreign bodies, for example, retained tampons, skin diseases, and cervical cancers.

ASSESSMENT

Evaluation of these patients include a complete history, physical examination and maybe further blood tests, microscopic evaluation, swabs, or cultures.

The doctor will find out the date the discharge started, the duration, the colour, odour, and if it is associated with an increase in urination, itching, burning, pelvic pain during sex or otherwise, abnormal bleeding, skin conditions, fever, joint pain, eye, throat or rectal symptoms. Use of cleaning products like douche and medication will be important. The patient’s medical history is also pertinent, for example, if the patient is immunocompromised with HIV or diabetes mellitus, their menstrual and obstetric history; sexual preferences and history including the number of partners, presence of commercial exposure, and travel history.

ABNORMAL DISCHARGE

Abnormal discharge is usually thicker, heavier, yellow, green, white and clumpy, mixed with blood, grey or with an odour.

This discharge may be swabbed for culture of the causative micro-organisms or examined under the microscope. Other blood tests for sexually transmitted infections, such as syphillis, herpes and HIV, can be done. A pap smear may also be recommended.

TREATMENT

Treatment of vaginal discharge depends on the cause. Bacterial vaginosis is usually treated by antibiotic pills and or vaginal creams or inserted pills. Yeast infections are treated by oral and or topically inserted antifungal drugs. Trichomoniasis, gonorrhoea and chlamydia are treated with antibiotics. A yearly pap smear would also be recommended.

PREVENTING ABNORMAL DISCHARGE

Preventing abnormal discharge is a challenge. Daily cleaning with soap and water is adequate. After stooling, the patient should wipe from front to back. Douche and scented products are not recommended. Cotton-seated underwear, along with not wearing tights and tight clothing, will prevent excessive moisture and has been shown to be preventative.

Some people are also prone to yeast infections once they get antibiotic therapy and so they should also request antifungal treatment.

Dr Romayne Edwards is a consultant emergency physician at the University Hospital of the West Indies and an associate lecturer at the University of the West Indies.