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Vaginal discharge is usually recognized as an increased amount of vaginal secretion, but patients use this term to address any vaginal discomfort, including change in color, consistency, and smell. It is quite frequent, and it is listed among 25 most common complaints in primary care.

Normal Vaginal Discharge

Production of vaginal secretion is a very dynamic process affected by many factors, and therefore, there is a wide range of normal results when it comes to the assessment of normal vaginal discharge. Some of the physiologic factors that can change the properties of vaginal discharge are: ovulation, pregnancy, emotional stress, sexual arousal, etc. These factors can change not only the amount of secretion produced, but also the other properties such as thickness, transparence, and odor.

In general, normal vaginal discharge is clear to white, with no aggressive odor, and with occasional white clumps that represent vaginal epithelial cells.

Of course, in order to be classified as normal, vaginal discharge has to be presented without other symptoms.

Slight changes in appearance and amount of vaginal discharge can be normal, but if there are sudden and aggressive changes, associated with other symptoms such as pain and discomfort, they are usually the signs of a pathological process.

Causes of Pathological Vaginal Discharge

Infections of vagina and/or cervix are the most common causes of pathologically changed vaginal secretion. Several types of bacteria are frequently involved in these infections, such as Gardnerella vaginalis, Chlamydia trachomatis, and Neisseria gonorrhoeae. Of fungal causes, the most common is Candida Albicans, and viral infections are caused by Herpes simplex virus. Most parasitic infections are caused by Trichomonas vaginalis.

Vaginal discharge has some specific properties in each of these infections.

  • Gardnerella vaginalis is a bacterium which seizes the opportunity to cause the infection when there is already a disturbed balance of normal vaginal microflora. In women with bacterial vaginosis, Gardnerellais almost always predominant, but it can also be found in vaginal discharge of women without infection. The most common symptoms are: uncomfortable feeling and irritation, and vaginal discharge with characteristic "fish-like" smell, although the infection may also be completely asymptomatic. The treatment is successfully provided using oral, as well as local antibiotics.
  • Chlamydia trachomatis infection is the most frequent sexually transmitted disease (STD) today. This infection can be presented without symptoms, but can also produce the specific unpleasant odor of vaginal discharge, urgent urination accompanied with pain and burning sensations, painful sexual intercourse - dyspareunia. It also causes the inflammation of the vulva with redness and bleeding. Chlamydia is treated with antibiotics, and it is extremely important that this bacterium is completely eliminated, because of the high percentage of infertility cases in untreated or poorly treated women. Chlamydia is also dangerous for pregnant women because it can cause premature delivery and serious infections of the fetus. Therefore, all pregnant women should be checked for the presence of this bacterium.
  • Neisseria gonorrhoeae is a bacterium which often causes a significant increase in vaginal discharge, but also painful urination, unusual vaginal bleeding, especially after sex, and pain in lower abdomen. Gonorrhea is a STD which can cause not only the infection of reproductive organs, but also throat, eyes, mouth, and anus. The infection starts in vulva and vagina, but it can spread upwards reaching uterus and fallopian tubes, thus causing a condition called Pelvic Inflammatory Disease, with often consequential infertility if untreated.
  • Trichomoniasis is a parasitic infection caused by Trichomonas vaginalis, a protozoan microorganism which is exclusively transmitted by sexual contact and sometimes mother-to-child during the delivery. The symptoms include yellow-green foamy vaginal discharge of an aggressive odor, painful urination, itch and discomfort of vulva and vagina, as well as lower abdominal pain. The treatment is conducted using various Antiprotozoal Drugs.
  • Genital herpes is most often caused by Type 2 Herpes simplex virus, but Type 1 virus can also cause this condition, although it is more commonly responsible for oral herpes. First onset of genital herpes is presented with more pronounced symptoms than the next, recurrent virus activations. The main symptoms are small, grouped, painful vesicles, located in genital area. Different sensations, including itching, burning, pain, and tingling are present in the areas of vulva and vagina. Swollen lymph nodes located in groins are very often reported. Acyclovir is an antiviral drug used locally or systemically against genital herpes. This virus remains in organism in its latent form, so it can reactivate in cases when local or systemic defense mechanisms are reduced.
  • Candidiasis is a fungal infection caused by Candida Albicans, a fungus which is a normal part of vaginal microflora. In vagina, it is always present in certain amount, but when there is a loss of microbial balance on the surface of vagina or the loss of immunity for any reason, it can reproduce in great amount and cause an infection. Vaginal discharge in candidiasis is variable, often described as liquid or thick, white and chunky secretion. The urination is painful as well as sexual intercourse, and accompanied with burning and itching sensations. The appropriate treatment with antimycotics successfully eliminates the infection, along with all the symptoms.

Persons with diabetes mellitus have increased blood sugar levels, but if those levels exceed the capacity of kidneys to reabsorb it, the sugar appears in the urine too. Sugar is a great ground for the development of bacteria, which is why persons, particularly women with diabetes have a greater risk of urinary infections.

Women with poorly regulated diabetes mellitus are especially susceptible to fungal and bacterial infections.

Very often, the changed vaginal discharge is a consequence of a disturbed balance in normal vaginal bacterial flora, which is called bacterial vaginosis. As said above, the predominant bacterium in this disorder is Gardnerella vaginalis. Usual properties of the secretion in cases of infection include increased amount of secretion, loss of transparency, increased thickness, and bad odor, associated with lower abdominal pain, burning sensations, itching, urgent urination, and general discomfort.

About 50% of women with bacterial vaginosis have no other symptoms than the changes in vaginal discharge.

Other, non-infectious causes of vaginal discharge include: contact dermatitis - allergic or non-allergic sensitivity to some foreign materials, foreign body in the vagina, malignancies, chemical irritations caused by female hygiene products or contraceptives, and mechanical injuries of vagina and cervix.

Malignancies can induce overproduction of oddly colored vaginal discharge, which often leaks continuously and is associated with abnormal vaginal bleeding. Periods last longer than usual and there are other symptoms such as loss of appetite, fatigue, and weight loss.

The Significance of Vaginal Discharge

Changes in vaginal discharge properties can be important clues for establishing the diagnosis of the above mentioned conditions, although they are not always pathological.

The secretion of vaginal and cervical glands is regulated by sex hormones and neural factors, so it is important to distinguish normal dynamics of secretion from abnormal discharge.

Besides regular gynecological examinations, a gynecologist should be consulted in cases of sudden and significant changes in vaginal discharge.

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