Vaginal discharge what you need to know
By Dr Brighton Chireka
Vaginal discharge is a very common problem for most women. Vaginal discharge can be normal physiological or abnormal due to other problems. Most women get worried as they try to find answers. I have heard some saying that they are not sexual active so why should they have vaginal discharge. Some go to the extend of using detergents to clean their private parts. Is that really necessary? This article is going to address these burning questions that most women have with regard to vaginal discharge.
In the UK the most common causes of vaginal discharge are the normal physiological discharge, Bacterial Vaginosis ( famously known as BV) and candidal infections. A normal physiological discharge is white or clear , non offensive discharge that varies with the menstrual cycle.
The same applies in Zimbabwe as shown by the Zimbabwe STI Aetiology study by Kees Rietmeijer et al in 2014. The study showed that Bacterial Vaginosis and yeast infections were the most common causes of female genital discharge syndromes. You can read about the study below
Study By Rietemeijer et al
What are the causes of vaginal discharge
Let’s look first at causes which are not due to infection
Non infective causes of vaginal discharge
Newborn babies may have a small amount of vaginal discharge. This is due to the level of hormones from their mums still in their blood system. This should disappear by the age two weeks . No need to panic but see your doctor if it persists or there are signs of trauma or injury ( worried about missing sexual abuse in babies)
During the productive years of women , the levels of hormones (chemicals in the blood) such as oestrogen and progesterone fluctuate a lot . This fluctuation affect the quality and quantity of vaginal discharge. Initially when the oestrogen is low the mucus from the neck of the womb (cervix) is thick and sticky. It becomes clearer, wetter and more stretchy as the oestrogen rises.
At menopause ( when women have stopped having periods) the normal amount of vaginal discharge decreases. This is due to the falling levels of oestrogen.
Other non infective causes
–Some growth on the cervix such as polyps can cause non effective discharge
-foreign bodies such as retained tampons
-rash on the vulva called vulval dermatitis
-cancer of the cervix , uterus or ovary can all cause vaginal discharge
-fistulae can also cause discharge to be noticed in the vagina
Non sexually transmitted infections
Bacterial Vaginosis (BV) – most commonly seen is sexual active women
Candidal infections(yeast infection) –caused by the overgrowth of Candida albicans
Sexual transmitted infection
Symptoms depend on the cause. It is very important to be very clear about the nature of the discharge. Mention its colour, whether it’s smelling, how it started and how long you have had it . Also do not forget to mention how thick it is (consistency)
Symptoms that suggest the discharge is abnormal include
– A discharge that is heavier than usual
– A discharge that is thicker than usual
– Pus-like discharge
– White and clumpy discharge
– Greyish , greenish, yellowish or blood-tinged discharge
– Foul-smelling ( fishy or rotting meat ) discharge
– A discharge accompanied by bloodiness , itching , burning , a rash or soreness
Let’s look at discharge caused by BV and by Candidiasis ( yeast infection)
Bacteria Vagininosis – causes thin , profuse and fishy- smelling discharge without itch or soreness.
Candidiasis(yeast infection) – thick, typically curd like , white , non-offensive discharge which is associated with vulval itchiness and soreness. May cause pain on having sex and on urination.
Sexual transmitted infection vaginal discharge
– Chlamydia trachomatis – may cause copious pus like vaginal discharge but it is asymptomatic in 80% of women
– Trichomonas Vaginalis – may cause an offensive yellow vaginal discharge which often a lot and frothy. It is usually associated with vulval itchiness and soreness, pain on passing water , abdominal pain and some discomfort on having sex.
– Neisseria gonorrheae- may present with a pus like vaginal discharge but it is asymptomatic in up to 50% of women.
In the UK the finding of STI calls for screening for other STIs including HIV and also sexual contact tracing for testing and appropriate treatment. This means all your sexual contacts will be traced so that there are screened and tested if found to be infected.
Treatment of Vaginal discharge
Treatment depends on the diagnosis and also guidelines in your country . Your doctor will treat you with the appropriate medication so see one if you have any worrying vaginal discharge . Normal physiological discharge does not need any treatment.
BV is mostly treated with metronidazole or clindamycin but this can vary depending on local guidelines
Vaginal and oral azole anti fungal are usually used to treat vaginal candidiasis (yeast infection) . Recurrent candidiasis can be a problem and is defined as 4 or more episodes annually. There is need to rule out diabetes and also to avoid offending behaviours such as douching the vaginal, wearing tight nylon pants, long term antibiotics. 90% of women remain disease-free during treatment with 150mg fluconazole every three days followed by 150mg once a week for 6 months.
Retained foreign bodies such as broken condoms , tampoons can cause discharge and the treatment involves their removals followed by treatment with antibiotics
Untreated , some Vaginalis infections can spread to the upper part of the reproductive organs and cause more serious illness and in the long term lead to infertility.
A retained foreign body such as a tampon has the potential of leading to toxic shock syndrome. Toxic shock syndrome (TSS) is a rare but life-threatening bacterial infection caused by Staphylococcus aureus and Streptococcus pyogenes bacteri.
One theory is that if a tampon is left in the vagina for some time, as is often the case with the more absorbent types of tampons, it can become a breeding ground for the bacteria.
Should I clean my vagina
Vaginal practices (VP) which include douching with water , detergents , using fingers or inserting things into the vagina are performed by women worldwide. The reasons range from hygiene to trying to make the vagina tight. VPs may directly increase HIV risk by causing abrasions in the vaginal epithelium or mucosal inflammation that may lead to recruitment of HIV target cells. VPs may also indirectly increase HIV risk by disrupting vaginal flora, leading to bacterial vaginosis (BV); BV is an established risk factor for HIV acquisition. You can check on the research below.
Vaginal Practices Research In Zimbabwe
The vagina is self-cleansing, so there is no need to wash inside it (called douching). Douching can upset the natural balance of bacteria and fungi in your vagina and lead to thrush or bacterial vaginosis.
Vaginal soreness and abnormal vaginal discharge can also be caused by overusing perfumed soaps, bubble baths and shower gels. Never clean your vagina with anything strongly perfumed. Use a mild soap and warm water to gently wash around your genitals. The message is that you do not need to wash the vagina, you just need to clean the area around it (vulva) using a plain, un-perfumed soap.
I hope the article has been useful to many women and I encourage you to share with your friends and also do not forget to leave me a comment.
This article was compiled by Dr Brighton Chireka who is a GP and a Health Commissioner in South Kent Coast in the United Kingdom. You can contact him at: firstname.lastname@example.org and can read more of his work on his blog at DR CHIREKA’S BLOG
Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Dr Chireka has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. Views expressed here are personal and do not in any way , shape or form represent the views of organisations that Dr Chireka work for or is associated with.