Hoo ha, Vajayjay, Ladybits, Flower — whatever you want to call it, the Vagina is a delicate and complex part of our body. In order to maintain it’s natural balance, the Vagina is constantly going through a system of checks and balance, and if this is upset — abnormal vaginal discharge may occur.
All vaginas contain large numbers of bacteria (more bacteria, in fact than any other part of a woman’s body, after the bowel). The most dominant form is a bacterium called Lactobacillus which makes lactic acid to maintain the acidic position.
Vaginal discharge is the most common gynaecological reason for women to seek medical advice and most will experience an episode at some point. There are many different causes for discharge, some common and some more complex. Regardless, it is vital that an accurate diagnosis is made so that proper treatment may be undertaken.
All women produce some vaginal discharge (fluid) which consists of shedding cells, bacteria and fluid. The characteristics vary from person to person so it is often difficult to determine whether it is in fact normal or abnormal.
Normal discharge has the following characteristics:
Many factors can affect vaginal discharge such as the menstrual cycle, pregnancy and sexual intercourse. The most important thing for you to take note of is whether there has been a change in any of the above.
Whether it be a significant increase in the amount of discharge, a change in colour to yellow/green, or an offensive smell — this usually means that something has gone wrong and needs further investigation. Additionally, if you experience bleeding after sex or in-between the periods it is vital to have this investigated.
There are numerous causes of abnormal vaginal discharge; some are common, some less common, and others quite rare. While an infection accounts for about 2/3 of cases, a noninfectious cause usually accounts for the remaining 1/3. The three most common infections are; Bacterial Vaginosis, Thrush and Trichomoniasis. Some infections are sexually transmitted, including Chlamydia and Gonorrhoea. A frequent non-infectious cause identified in younger women is Cytolytic Vaginosis and in older women; Atrophic Vaginitis. Cervical polyps and immune related conditions such as Desquamative Inflammatory Vaginitis can also cause abnormal discharge.
Accurate diagnosis is the key to getting the right treatment. A number of studies have shown that guessing the cause from the symptoms alone is incorrect in about 1/3 of cases and therefore we recommend that appropriate investigations are carried out. Furthermore, it is not unusual for patients to have simultaneous infections occur, leading to confusion.
Investigations are carried out in the laboratory and consist of microscopy, culture, and DNA techniques. Samples are either collected directly from the vagina or in some case, urine or blood can be used. It all depends on exactly what tests are required at the time.
After samples are taken, slides can be prepared for microscopy, in which the appearance and patterns of cells, healthy bacteria and pathogens (organisms causing disease) are assessed. Culture and newer DNA techniques allow us to identify specific organisms and test them for the correct antibiotic. Occasionally tissue is taken for histological analysis.
Once an accurate diagnosis is made, treatment is usually straightforward. Infections are treated with antibiotics, and other conditions will be treated according to the underlying cause. For example, Cytolytic Vaginosis is treated by reducing the acidity of the vagina and Atrophic Vaginitis is treated using a hormone cream. If a sexually transmitted infection is identified, it is essential that your partner is also treated to prevent reinfection.
Bacterial Vaginosis (BV) is the most common vaginal condition diagnosed in women. Although many women will complain of an abnormal discharge, some women will not, and instead it will be found during an examination investigating for another infection. The commonest symptom women notice and complain of is a ‘fishy’ smell.
In BV, the normal healthy bacteria disappear and are replaced by a huge number of other bacteria. This raises the pH (reducing acidity) and upsets the balance of the vagina causing the symptoms. This pattern can be easily recognised under the microscope. At times the symptoms of BV can be mistaken for thrush. It is important to treat BV, as it increases the risk of getting some sexually transmitted diseases, and occasionally causes complications in pregnancy.
Treatment is usually straightforward and consists of antibiotics which kill off the abnormal bacteria and allow the vagina to return to its normal state. Unfortunately, many women will experience a recurrence and sometimes these are frequent. There is no long term cure but we can devise a personalized management plan for you to help reduce your suffering.
Thrush, sometimes called candida, is the second most common cause of an abnormal discharge. About 75% of women will experience an episode during their life. Typical symptoms that women notice and complain of are a thick, white/yellow discharge and itch.
Thrush is usually easy to diagnose as it is a yeast (fungal) infection and can be readily seen under the microscope in about 60% of cases. It is also very easily cultured in the laboratory. Roughly 20% of women carry thrush in their vaginas as a commensal (not causing harm). Therefore, sometimes when it is found it is assumed to be the cause of the symptoms in error.
Treatment consists of antifungals. Unfortunately many women will experience a recurrence and sometimes these are frequent. There is no long term cure but we can devise a personalized management plan for you to help reduce your suffering.
Trichomonas vaginale (TV) is the third most common cause of vaginal infection. It is caused by a tiny parasite and is usually acquired through sexual intercourse. About 50% of women notice no symptoms and it is found during examination, often while investigating for another infection. Typical symptoms that women complain of are a thick, yellow discharge, smell and soreness. Treating TV is important because it can increase the risk of getting another sexually transmitted infection and occasionally causes complications in pregnancy.
TV can be easily seen under the microscope and although difficult to culture, new DNA tests make it easy to identify. Treatment consists of specific antibiotics and it important that your sexual partners are treated too to prevent reinfection.
Cytolytic vaginosis (CV) is a less common, non-infectious cause of abnormal vaginal discharge. It is thought that CV is caused by an overgrowth of Lactobacilli (LB), which in turn leads to a lowering of the pH and thus excess acidity of the vagina. This then damages the lining cells of the vagina and can lead to symptoms. Symptoms include; discharge, itch, discomfort and painful sex. It can be seen that the symptoms are very similar to those which occur with thrush and patients have often undergone many anti thrush treatments to no avail.
Diagnosis involves examining a vaginal sample microscopically to identify the features and damaged cells. Culture is performed to rule out thrush.
Treatment is directed towards increasing the pH and stopping all antifungals.
This refers to inflammation of the vagina which can occur when oestrogen levels decrease. Decreased oestrogen levels leads to a number of changes in the vagina which includes thinning of the lining which becomes more delicate and easily traumatised, a rise in the pH, and reduced secretions. It is the the most common cause of an abnormal vaginal discharge in postmenopausal women.
Symptoms include a thin, yellow discharge which occasionally can be blood stained, itching, soreness and painful sex.
Diagnosis is usually straight forward, based on the history, examination and tests.
Treatment consists of vaginal lubricants and moisturizers and, replacing the oestrogen as necessary. Creams, tablets and a ring can be used.
Desquamative Inflammatory Vaginitis (DIV) is a less common cause of vaginal discharge but can be a disabling condition especially when symptoms are severe. It is characterised by a yellow discharge, painful sex, and none of the usual infections are identified. It can mimic atrophic vaginitis in post-menopausal women.
The cause is not fully known but it is thought that there is an immune link.
Diagnosis can be difficult as some doctors are not familiar with the condition and many clinics do not routinely look for it. The vagina is inflamed and the top layers of the vaginal lining are lost. A number of tests including biopsy are done to confirm the diagnosis.
Treatment is empiric but includes antibiotics, steroid and oestrogen creams.