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Vaginal discharge is very common. The distress and perception of normal vaginal discharge is extremely subjective. Some women get annoyed with slight discharge while some do not complain even with heavy discharge. Therefore clinical examination by a gynecologist is necessary to assess the condition properly.

Women of reproductive age generally produce cervical mucus. During puberty and menopause, hormonal changes result in physiological vaginal discharge. The mucus-secreting glands in the vagina and cervix are controlled by female reproductive hormones.

Because different phases of the menstrual cycle are controlled by different hormones, the characteristics of vaginal discharge change throughout the menstrual cycle.

Just after menstruation, some women get a brownish discharge. This may be residual menstrual blood from the inner lining of the uterus (endometrium). Because various infections can give rise to similar discharge, it is difficult to differentiate between the two by clinical examination only.

In a normal menstrual cycle, the vagina is relatively dry following menstruation, which cervical mucus at a minimum. When eggs (follicles) develop in the ovaries, estrogen levels rise and glands in the vagina and cervix start to secrete increasing amounts of mucus. The day before ovulation, estrogen levels and mucus secretion reach their maximum and mucus becomes stretchy, clear and sticky. Many women compare this mucus to raw egg whites.

Mucus becomes viscous and gelatinous after ovulation. The corpus luteum, the structure left behind by the released ovum, produces progesterone after ovulation. Under the influence of progesterone, mucus becomes clear and whitish. This discharge disappears with the next menstrual bleeding.

If the woman gets pregnant, the fertilized ovum reaches the uterus 6 to 7 days after fertilization. Implantation starts and a slight bleed or a brownish discharge may occur. Dip a pregnancy test strip into an early morning urine sample and see if you are pregnant.

With sexual exposure, infections can enter the vagina from penile skin, condoms and spermicides.

The vast majority of infective discharges are due to Candida, Gardnerella and Trichomonas.

Candidiasis features a thick, whitish vaginal discharge associated with itching. Anti-fungal local applications, tablets and pessaries are effective against candidiasis.

Trichomonas causes a foul-smelling purulent greenish discharge associated with a sore and itchy vulva. A week-long regimen of metronidazole clears the infection up.

A Gardnerella infection features a fishy-smelling vaginal discharge worsening after sex and at mid-cycle. Metronidazole is very effective. Your doctor may treat you in accordance with the clinical diagnosis. Confirmation requires a high vaginal-swab culture.

Some women are hypersensitive to various chemicals contained in sanitary towels.

Allergic reactions to these chemicals cause pain, redness and vaginal discharge. Switching to a different brand, anti-histamines and steroids relieve the condition.

Hormonal contraceptive methods such as the pill and Depo-provera expose the inner lining of the cervix to the hostile acidic environment of the vagina (cervical ectropian). This as well as cervical erosions, polyps and infections causes blood-stained vaginal discharge. Cervical and endometrial cancers are important causes of profuse clear vaginal discharge.

In many countries, women above 35 years of age are screened for breast diseases and cervical cancer at well-women clinics. These screenings have made early detection and treatment of sinister gynecological conditions a reality.

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