From experience gathered while clerking patients, both as a medical student, and now as a doctor; most ladies are clueless about Vaginal discharges, often mistaking the “normal” vaginal discharge as “abnormal”. Hence the question, “are you having a vaginal discharge?” is often met with the answer “yes.” However, when you probe further you realise, in most cases, that they actually meant the normal vaginal discharge.
Some [the population who doesn’t go to hospitals] often even end up treating these normal discharges with antibiotics, thereby clearing the vagina of its normal protective microbial flora, altering the delicate acid-base balance, and ending up with opportunistic infections like Candidiasis and Vaginosis.
Normal Vaginal Discharge
The Vagina has often been described as a “self-cleansing organ”. This all-important fit it is able to perform by means of the normal vaginal discharges, which are actually secretions from the vaginal and cervical[of the cervix] glands, the quantity and quality of which depends on hormonal variations, which in turn depends on the phase of the menstrual cycle. Thus during periods of Oestrogen surge[usually the 1st half of the menstrual cycle], the typical normal discharge is thin; while during periods of low levels of Oestrogen[usually the 2nd half of the cycle, which starts after ovulation and corresponds with period of Progesterone surge], the discharge becomes thick.
These discharges have a slightly acidic pH, so while their flow mechanically “cleanses” the vagina, their acidic nature also confers a bacteriostatic cum bactericidal function on the vagina, limiting the colonisation of the vagina by harmful microbes, and the establishment, and thriving, of such organisms. This function is aided by the Lactobacilliary species [ a harmless group of microbes that inhabit the vagina] which constitute the bulk of the normal vaginal flora.
Features of the normal vaginal discharge
The normal vaginal discharge is usually whitish in colour, or clear, and is NOT associated with any of the following:
- A foul or malodorous smell
- Vulval itching
- Copious quantity
- Dyspareunia [excessive pain during sex]
- New-onset Dysmenorrhoea [painful periods]
Abnormal vaginal discharges
These results due to alterations in the composition of the normal vaginal discharge in the setting of a local, or systemic, disease affecting the genital tract. They usually present physically as abnormalities of colour, quantity, consistency [quality i.e. degree of thinness or thickness], and smell. Probable causes include:
Genital infections like
- Vaginal thrush
- Bacterial Vaginosis
- Gonococcal and Chlamydial infections, including Cervicitis and Pelvic Inflammatory disease.
Non infective Causes like
- Cervical cancer and other malignancies of the female genital tract.
- Cervical ectopy
- Foreign bodies like a retained tampon
Features of abnormal vaginal discharges
- Changes in colour, examples greenish, yellowish, brownish discharges.
- Changes in quantity.
- Presence of a foul smell
- New-onset dysmenorrhoea
- Dysuria [painful urination]
- Lower abdominal pain
- Post-coital bleeding [bleeding after sex]
- Loss of Appetite
Not all vaginal discharges point towards an existing disease process; and even when a disease process is a culprit, not all are of infective origin.
Vaginal discharges –which are whitish, clear, non-foul smelling, and not associated with the symptoms listed above– are unlikely abnormal, and therefore does not require treatment.
On the other hand, vaginal discharges with abnormal features, or other constitutional symptoms, are likely “abnormal” and calls for proper clinical evaluation for identification of the cause, and appropriate treatment.
Finally, do not sit at home and play “Doc;” when you are confused, even with the absence of the above listed symptoms [which is by the way far from exhaustive] please consult a doctor, not a lab! The first step in clinical evaluation remains clinical assessment, it is the outcome that will determine what test you would benefit from.
Most labs in Nigeria may not be able to culture chlamydia, for instance, and most of such tests I see grow organisms, like Staph aureus, which is actually a mere lab contaminant and does not cause any STI. Also, Vaginal swab tests cannot diagnose a malignancy, neither can they diagnose a retained tampon, endometriosis, an ovarian cyst, and a host of other genital problems that may come with a discharge, and or pelvic symptoms. So, the first step remains seeing a doctor!