Discharge Per Vagina: Normal and Abnormal

Discharge Per Vagina: Normal and Abnormal

 

VAGINAL DISCHARGE can be Haemorrhagic or Non – Haemorrhagic in nature with varied aetiologies. Under Haemorrhagic category – regular, optimum bleeding and absence of any associated complaint during menstruation is normal. Similarly, under non-haemorrhagic category- whitish, mucus-like, odourless, non-irritating discharge in small quantity is absolutely normal. This discharge is required to keep vagina moist and infection free because of its acidic pH. It is body’s mechanism to remove old cells and debris, keeping the reproductive tract clean and healthy.

Non- Haemorrhagic Discharge per vaginum is one of the common complaints presented by the patient to her Doctor but around 30% of them do not require any treatment, because of its physiological nature. No pathology present!!

How to differentiate between the normal and abnormal??

This discharge originates from cervix or vagina exclusively. Normal Cervical discharge is thick and viscid; endocervix being the primary source. Whereas, vaginal mucosa secrete water as a transudate along with a few desquamated epithelial cells under normal conditions. Minimally though, but Uterus and Vulva too contribute to this discharge. The sources being secretory columnar epithelium inside uterus and Bartholin’s glands, Skene glands, Sweat glands and Sebaceous glands from vulva.

Stages of life where physiological discharge predominates

• Neonates and Infants – influence of maternal oestrogen on vaginal epithelium which takes around 3-4 weeks to get metabolised
• Puberty – unopposed oestrogen activity leads to the discharge which subsides with the onset of cyclic progesterone activity. Considered as the hallmark of impending menarche.
• Phases of Ovulation Cycle – Not all but mostly females undergo the following transitions

• Yellowish-white, cloudy – before ovulation
• Clear, stretchy, slippery – during ovulation
• Thick, white, sticky, small amount – after ovulation

• Sexual excitement – secretion of Bartholin’s Glands
• Pregnancy – increased vascularity, pelvic congestion and cervical hyperplasia are the reason

 

Disturbance in normal vaginal pH and estrogen alters normal Vaginal Flora, which facilitates overgrowth of pathogens leading to profuse discharge and associated symptoms like lumbago, pruritus vulva, burning sensation etc. making the condition pathological; termed as LEUCORRHOEA.

Factors responsible for the alteration are:

• Inappropriate usage of Feminine hygiene products
• IUCDs
• Vaginal medications
• Excessive intake of Antibiotics
• STDs
• Unhygienic intercourse and multiple sexual partners
• Stress etc.

The Point to keep in mind is, Leucorrhoea is an indication of an underlying disease and not a disease itself. This symptom at times become so prominent that the actual cause behind it gets overlooked, viz.,

• Bacterial vaginosis
• Vaginal candidiasis
• Trichomonas vaginitis
• Vaginitis of infancy
• Atrophic vaginitis
• Presence of a foreign body
• Neoplasm

 

Key differentiating features among the three commonest causes

 

	Bacterial vaginosis	Vaginal candidiasis	Trichomonas vaginitis
Discharge	Thin, white & homogenous	Curd-like	Frothy
Odour	Fish smelling discharge     < after intercourse	Non-offensive	Offensive
Itching	Present occasionally	With Soreness	With Irritation
Inflammation	Absent	Present with fissures and oedema	Present with vulval redness
Per Vaginal Examination	Nothing significant	Satellite lesions in vagina &/or on vulva	Strawberry lesions on cervix
Vaginal pH	>4.5	<4.5	>4.5
Associated complaints	Burning micturition	Superficial dyspareunia	Dysuria with low abdominal discomfort
Predisposing factors	Douching IUCD Smoking Multiple sexual partners Unprotected intercourse	Antibiotics Uncontrolled diabetes Douching Local irritants Tight synthetic innerwear	Multiple sexual partners STDs Smoking Lack of barrier contraceptives

 

Diagnostic Criteria

Below are a few useful clinical tips to help diagnose the case and choose the best treatment &/or prevention measures

• On the basis of age:

• In children, it is usually due to gonorrhoeal vulvovaginitis. The discharge is profuse, continuous and purulent

• In reproductive age group, sexual transmission is the main factor
• Yeast infections frequently cause vulvovaginitis during the later months of pregnancy, and may be responsible for thrush in the new born too
• During climacteric, leucorrhoea usually results from senile vaginitis, characterised by alkaline discharge, which is moderate in amount and purulent; the vulvar and vaginal tissues are sensitive and inflamed

 

• Based on the source of origin:

• From Cervix, profuse before and after menses
• From Uterine cavity, usually blood-tinged
• From Fallopian tubes, though rare, but a hydrosalpinx intermittently evacuates into the uterus and is responsible for a profuse, gushing watery discharge

• According to manner of discharge:

• The leucorrhoea from vaginitis and cervicitis is usually continuous
• Discharge from a partially obstructed structure occurs periodically
• Discharge from a Skene’s duct abscess and a Bartholin’s gland is small in amount and intermittent
• Discharge from a strictured cervix with pyometra or a hydrops of the tube, is gushing, profuse and intermittent

• According to character of discharge:

• If the discharge is watery and relatively odourless, one must be sure that it is not urine
• Thick, white, pasty discharge accompanied by marked pruritus vulva is characteristic of candidiasis
• Thick, white, pasty discharge without itching are only an excess in the normal desquamation of vaginal epithelium. This occurs most frequently in stressed, highly-emotional & over-sexed individuals
• Mucus or a mixture of mucus and pus is characteristic of discharge from the cervix.
• A frankly purulent discharge is most often the result of a Trichomonas vaginalis vaginitis, but may arise from a Skene’s duct abscess, a Bartholin’s gland abscess or a pyometra.
• A fetid, watery, blood-tinged, painful discharge often arises from a necrotic tumour, usually CA cervix, which might be confirmed by bleeding on contact and friable tissue on palpation.

Homoeopathic Approach

In § 94 (F.N.2), Master Hahnemann has described the important aspects of case taking while addressing any chronic complaints in a female. For the females suffering from leucorrhoea, he has guided there itself what needs to be ascertained in order to grab the whole picture “……. If there is leucorrhoea, what is its nature, what sensations attended its flow, in what quantity it is, and what are the conditions and occasions under which it occurs?”

“…….. whether there is leucorrhoea before menstrual discharge or after its termination”

Miasmatic Background

Miasmatic approach towards a disease is broader than it seems as there cannot be a patient who presents with a single miasm in this era of complex diseases but there can be a predominating miasm. Below are a few striking features of Leucorrhoea classified on miasmatic background –

	Psora	Sycosis	Syphilis	Pseudo-Psora     (Tubercular)
Character	Scanty and bland	Profuse	Acrid and putrid	Profuse and purulent
Consistency		Thin	Stringy	Watery or starchy
Odour		Pungent like Fish brine	Offensive	Musty
Colour		Greenish-yellow		Yellowish or blood-tinged
Modalities	< Night			< Before & after menses
Concomitants		With mental weakness	With depression	With poor vitality

Best cure would ensue with “Cessat effectus, Cessat causa”

Owing to the multiple aetiologies, it becomes difficult at times to treat the condition satisfactorily. Apart from physical health, it affects the mental and social health of the female unless treated properly. Sexual partner too needs to be investigated & treated.

Therefore, it becomes important to keep in view multidimensional effect of the disease and associated complaints. Until the source of discharge has been found and its cause has been determined, one will only be groping in the dark with ill-devised treatment.

Clinically significant Rubrics

Homeopathic Materia Medica & Repertory

By J T Kent

• Leucorrhoea,

• acrid, excoriating, eats holes in linen : Iod.
• alternating with mental states : Murx.
• black : Croc., sec.
• coition, after : Nat-c., sep.
• constant : Am-m.
• greenish, water : Sep.
• menses, smelling like : Caust.
• milky, menses, during : Phos.
• offensive, cheese, like old : Hep., sanic.
• offensive, fish-brine, like : Sanic.
• offensive, sour : Hep., nat-p.
• offensive, sweetish : Calc-p., merc-c.
• scanty menses, with : Calc-p., caust
• thick, as paste, white : Bor.
• white, stains linen yellow : Chel.

Repertory by O E Boericke

• Leucorrhoea,

• Flesh coloured, like washing of meat, non-offensive : Nit. ac.
• Intermittent : Con., Sul.
• Climaxis [At] : Psor., Sang.
• Better from washing with cold water : Alum.
• Urine, contact of [From] : Kreos., Merc., Sul.
• Diarrhoea, with : Puls.
• Warm water running [Feeling as if] : Bor.
• Haemorrhage, obstinate, intermittent, with : Kreos.
• Hepatic derangement, costiveness, with : Hydr.
• Moth spots on forehead, with : Caul., Sep.
• Metrorrhagia, following : Mag. m.

Bœnninghausen’s characteristics materia medica & repertory
By C. M. Boger

• Leucorrhoea,

• Bloody, red : Chin., Lyc.
• Children, in : Bar-c., Calc., Calc-p., Carb-v., Caul., Merc.
• Headache, with : Nat-m.
• In clots : (Ambr.)
• Eruption, causing : Lil-t.
• Exhausting : Stann.
• Labour-like pains, with : Bell., Ign., Kali-c.
• Gushes, in : Calc., Sil.
• Hypogastrium, tension in, with : Graph.
• Ichorous : Sabin.
• Nauseous odour of : Merc-c.
• Putrid : Kreos., Nit-ac.
• Shreddy : Bor., Kali-bi.
• Starch-like : Sabin.
• Thighs, with excoriation of : Chin., Ferr.
• Water, like : Nat-c., Sep.
• Stitching, in parts, with : Sep.
• Trembling, with : Alum.
• Weakness, with : Alum., Bar-c., Kali-bi., Kreos.

Prevention

Prevention is proven to be better than cure under any circumstance. Following are a few ways in order to protect oneself from the hardships of symptoms associated with Leucorrhoea:

• Practice routine hygiene
• Cotton innerwear should be preferred
• Tight pantyhose not to be worn, especially synthetic ones
• Irritant chemicals and douches should be avoided
• Adopt safe sex practices
• Good immune system protects

Dr Sakshi Gupta

Homoeopathic Consultant

Counselling Psychologist

Organising Secretary, DHMA, India

Member (Board), HWC, USA

Co-Editor, Exploring Homoeopathy (Newsletter)

About the Author:

Dr Sakshi Gupta is a Practicing Homoeopath and a Counselling Psychologist at Delhi, India with experience of around 10 years. She is an integral part of Homoeopathic Organisations in India as well as USA. Has delivered lectures at seminars and webinars; also, written articles for various reputed Medical Journals and Websites.