Abnormal Vaginal Discharge

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.

How can I tell if I have an abnormal vaginal discharge?

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:

  • Quantity: scant to variable
  • Colour: white to slate grey
  • Consistency: varies from thin to thick
  • Odour: none
  • Blood: none other than the period

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.

What are the causes of abnormal vaginal discharge?

There are numerous causes of abnormal vaginal discharge; some are common, some less common, and others quite rare. While an infection accounts for about two thirds of cases, a noninfectious cause usually accounts for the remaining third.

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.

How is the diagnosis made?

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.

Treatment

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.