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ULY CLINIC

20 Septemba 2025, 01:44:40

Vaginal discharge

Vaginal discharge refers to fluid secreted from the vagina, produced primarily by cervical mucosa and vulvar glands, and influenced by estrogen levels. Physiologic discharge is clear or white, mucoid, non-bloody, and odorless, varying with the menstrual cycle. Abnormal discharge—marked by changes in color, odor, consistency, or volume—may indicate infection, reproductive tract disease, sexually transmitted infections (STIs), malignancy, foreign bodies, or medication effects.

History and Physical Examination

History

Onset, duration, color, consistency, odor, and amount of discharge.
Relation to menstrual cycle, sexual activity, hygiene practices, and pregnancy status.
Past history of vaginal infections and treatment completion.
Current medications (antibiotics, estrogens, hormonal contraceptives).
Symptoms such as dysuria, pruritus, burning, postcoital or post-douching spotting.

Physical Examination

Inspect external genitalia for discharge, redness, edema, or excoriation.
Palpate inguinal lymph nodes for tenderness or enlargement.
Abdominal examination for tenderness or masses.
Pelvic examination and collection of vaginal discharge specimens for laboratory testing.

Medical causes and Pathophysiology

Table 1: Causes and pathophysiology

Cause	Key Features	Pathophysiology	Clinical Findings
Atrophic vaginitis	Thin, watery, white discharge; pruritus; burning	Estrogen deficiency → thinning of vaginal epithelium → mucosal fragility → discharge and bleeding	Pale vaginal mucosa, decreased rugae, clitoral and labial atrophy, spotting post-coitus
Bacterial vaginosis	Thin, gray or green-white, foul-smelling discharge	Disruption of normal lactobacilli flora → overgrowth of anaerobic bacteria → release of amines causing odor	Discharge adheres to vaginal walls; mild pruritus or redness
Candidiasis	White, curdlike discharge with sweet/yeasty odor	Overgrowth of Candida albicans → mucosal irritation and inflammatory response → thick discharge, itching	Vulvar redness, edema, dermatitis on inner thighs, external dysuria
Chancroid	Mucopurulent, foul-smelling discharge; painful vulvar ulcers	Haemophilus ducreyi infection → local ulceration, inflammation, lymphadenitis → exudate formation	Tender unilateral inguinal lymph nodes, fever, malaise
Chlamydial infection	Yellow, mucopurulent, odorless/acrid discharge	Chlamydia trachomatis infects endocervical epithelium → inflammatory exudate → discharge	Dysuria, dyspareunia, postcoital bleeding, often asymptomatic
Endometritis	Scant, serosanguineous, foul-smelling discharge	Bacterial invasion of endometrium → inflammation, exudate formation → discharge	Fever, lower abdominal/back pain, enlarged uterus, malaise
Genital warts	Mosaic, papular lesions with profuse mucopurulent discharge	HPV infection → epithelial proliferation → secondary exudate if infected	Burning/paresthesia in vaginal introitus
Gonorrhea	Yellow/green, foul-smelling discharge	Neisseria gonorrhoeae infects endocervical glands → purulent exudate → inflammatory discharge	Dysuria, urinary frequency, vaginal redness/swelling, pelvic pain
Gynecologic cancers (cervical/endometrial)	Watery, bloody, or purulent discharge; foul odor	Malignant transformation of epithelium → tissue necrosis → inflammatory exudate and bleeding	Abnormal bleeding, weight loss, pelvic/back/leg pain, urinary frequency
Herpes simplex	Copious mucoid discharge with painful vesicles	HSV infection → epithelial cell lysis → vesicle formation → inflammatory exudate	Ulcerations on labia, vagina, cervix; fever, tender lymphadenopathy
Trichomoniasis	Frothy green-yellow discharge; pruritus	Trichomonas vaginalis infection → mucosal irritation and exudate → discharge	Red, inflamed vagina with petechiae, dysuria, dyspareunia

Other causes

Contraceptive creams/jellies: Increased mucoid secretion.
Estrogen-containing drugs: Enhance normal vaginal secretions.
Antibiotics (e.g., tetracyclines): Predispose to candidal overgrowth.
Radiation therapy: Vaginal mucosal irritation → watery, odorless discharge.
Foreign bodies: Tampons, diaphragms → local inflammation and exudate.

Table2: Summary of the characteristics of vaginal discharge and their possible causes

Discharge Characteristic	Appearance / Odor / Amount	Possible Causes	Additional Findings / Notes
Physiologic discharge	Clear or white, mucoid, odorless, scant to moderate	Normal menstrual cycle changes, estrogen stimulation	No irritation, cyclic variation
Atrophic vaginitis	Thin, watery, white, scant; may have spotting	Low estrogen / postmenopausal	Pruritus, burning, clitoral and labial atrophy, pale vagina
Bacterial vaginosis	Thin, gray or green-white, foul-smelling	Gardnerella or vaginal flora imbalance	Minimal redness or irritation; discharge adherent to vaginal walls
Candidiasis (yeast infection)	Thick, white, curdlike, sweet / yeasty odor	Candida albicans	Vulvar redness, edema, intense itching, possible dysuria
Chancroid	Mucopurulent, foul-smelling	Haemophilus ducreyi (STD)	Vulvar ulcers, tender unilateral inguinal lymphadenopathy, fever
Chlamydia	Yellow, mucopurulent, odorless or acrid	Chlamydia trachomatis (STD)	Dysuria, dyspareunia, postcoital or post-douching bleeding; often asymptomatic
Endometritis	Scant, serosanguineous, foul odor	Infection of endometrium	Fever, lower abdominal/back pain, uterine enlargement, malaise
Genital warts	Mucopurulent, may be foul if infected	HPV	Mosaic or papular vulvar lesions, burning/paresthesia at vaginal introitus
Gonorrhea	Yellow or green, foul-smelling	Neisseria gonorrhoeae (STD)	Dysuria, urinary frequency, vaginal redness/swelling, possible fever/pain
Gynecologic cancers	Watery, bloody, or purulent, may be foul	Endometrial or cervical cancer	Abnormal bleeding, weight loss, pelvic/back/leg pain, fatigue
Herpes simplex	Copious mucoid discharge	HSV infection	Painful vesicles/ulcers, erythema, edema, tender inguinal nodes, fever, malaise
Trichomoniasis	Frothy, green-yellow, foul-smelling; or thin white, scant	Trichomonas vaginalis (STD)	Vaginal redness with petechiae, pruritus, dysuria, dyspareunia, postcoital spotting
Medications / contraceptives	Mucoid or increased discharge	Hormonal contraceptives, estrogen-containing drugs	Usually no odor; antibiotics may predispose to candidiasis
Radiation therapy	Watery, odorless	Radiation-induced vaginal changes	Usually post-treatment; may cause irritation
Foreign body / hygiene products	Varies; may be purulent/foul	Tampon, diaphragm, douching, perfumed products	Local irritation, inflammation, sometimes infection

Special considerations

Maintain perineal hygiene, keep area dry, and avoid tight-fitting clothing.
Cotton underwear is preferred.
If appropriate, vaginal douching with 5 tablespoons vinegar in 2 liters warm water may relieve discomfort.
Complete prescribed therapy for infections, and avoid intercourse until cleared.
Use condoms during treatment of sexually transmitted infections.

Patient counseling

Emphasize perineal hygiene and wearing breathable underwear.
Encourage completion of prescribed medications.
Educate about safe sexual practices and partner treatment for STIs.
Inform patients about signs of complications or persistent infection.

Pediatric pointers

Neonates: White mucous discharge may reflect maternal estrogen exposure; yellow discharge is pathological.
Older children: Purulent, foul-smelling, or bloody discharge may suggest foreign objects or sexual abuse.

Geriatric pointers

Postmenopausal mucosa becomes thin due to estrogen deficiency, increasing susceptibility to infection.
Elevated vaginal pH reduces natural defense mechanisms, raising the incidence of vaginitis.

References

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