Vaginal Discharge

Vaginal discharge is one of the common reasons for gynecological consultation. Not all women with vaginal symptoms have an underlying medical problem. Patient's history and physical examination findings along with appropriate tests may suggest a diagnosis. Effective treatment of vaginal discharge requires that the cause be established. The problem of white discharge can occur before puberty, in reproductive age group as well as post menopausal.

Vaginal Hygiene

Vagina is protected from the external environment by its acidic pH around 4 during the reproductive age group(after puberty and before menopause). This pH is maintained by two major factors - Female sexual Hormones  and  local bacteria present (lactobacilli). Therefore conditions that alter the pH such as lack  of hormones, excessive or frequent antibiotic usage that kills the lactobacilli , repeated washing, Diabetes that causes growth of other microorganisms can all disturb the vaginal environment and lead to problems. Simple washing of the external genitalia or the perineum will be an ideal way to maintain hygiene. Washing the vagina or douching needs to be strictly avoided. 

When can  the vaginal  discharge be considered normal? 

Cyclical hormonal changes during menstruation, ovulation, Hormonal contraception, Pregnancy, the period after delivery can all cause vaginal discharge without local symptoms such as itching or foul smell which can be considered normal. Other common causes that can lead to this symptom are (avoidable causes) Personal habits and hygiene Retained tampon or condom Chemical irritation ( to disinfectants such as dettol/savlon) Allergic responses (to condom, sanitary pads, local creams ) Intrauterine device (Cu-T) Atrophic changes of vagina - common in old age, Smoking Frequent, antibiotic usage & Ectropion  - that is eversion of cervical  epithelium Cervical polyp

When should it raise a concern

When there is Large amount of discharge Associated itching,  boils, soreness or lower abdominal pain  Or urinary tract infection Foul smelling or frothy Change in colour - yellow, green Or  accompanied with blood Aggravated after sexual intercourse, When there is an associated systemic disorder such as Diabetes, Recurrent episodes

Don'ts when it comes to vaginal  discharge 

The most vital thing is to maintain the acidic vaginal  pH. Repeated washing Washing the vagina with soap or vaginal douching Using antiseptic lotions such as dettol, savlon  and even harsh soaps Using very hot water to relieve itching. All these disturbes the vaginal pH and aggravates the condition.

Treatment

Identifying the cause is the key to treatment. A detailed history regarding the nature of discharge, associated symptoms, usage of antibiotics, systemic problems if any, sexual history and physical examination are essential to make a diagnosis. The physical  examination of the vulva, vagina and cervix along with examination of the discharge under microscope and if needed microscopic  culture of the discharge will be needed. Self  treatment or antibiotics prescribed without proper examination and investigation will cause more harm than good.