Vaginal discharge (leucorrhea) causes, types, treatment, normal or abnormal.

Reviewed by DR. D. DATTA.
Ex. Emergency Medical Officer.

What is vaginal discharge ?

Lower part of the uterus is called cervix. There are glands in cervix and vagina. Glands of cervix and vagina secrete a fluid which is called vaginal discharge.
We know saliva secreted by salivary glands prevents the mouth from becoming dry, removes bacteria from the mouth and keeps it clean. Similarly vaginal discharge prevents dryness of vagina, lubricates it, removes bacteria and old cells and keeps it clean. So vaginal discharge acts as a normal scavenger of genital tract. Not only that, normal pH of vaginal discharge prevents growth of unhealthy bacteria within the vagina.

So vaginal discharge is protective and quite normal for every woman.
But in some situations, it becomes abnormal. Some women having normal vaginal discharge are very much worried about it, they suffer from anxiety about it, because they don’t know that their vaginal discharge is normal. On the other hand, some women having abnormal vaginal discharge don’t seek medical help because either they don’t know that they have abnormal vaginal discharge, or they are very much shy to speak about it to others.
Therefore, we should know about normal vaginal discharge and its normal variations.
Normal vaginal discharge is colorless or white colored. It is odorless or having a subtle odor that is in no way unpleasant or foul smelling. It may be thick and sticky, may be creamy, may be thin like water or stretchable like the white part of egg according to different phases of the menstrual cycle.
Its normal amount varies from person to person, but the average normal amount is 2 to 5 mL per day.
Hormonal levels increase and decrease throughout one’s menstrual cycle. Therefore, the amount and appearance of vaginal discharge also changes.
Let us discuss the normal variations that occur in a woman’s menstrual cycle. On average the length of the menstrual cycle is 24 to 35 days.
Typical length of a woman’s menstrual cycle is 28 days. The first day of the period is day 1 of the menstrual cycle.
On average, menstruation lasts for five days. During the menstrual period blood levels of estrogen and progesterone are very low. So in the first five days due to very low amount of estrogen level there is no vaginal discharge or very scanty vaginal discharge which is mixed with menstrual blood and vaginal discharge can not be separated from menstrual blood at this time.
Sometimes one day before menstruation a small amount of menstrual blood may be mixed with vaginal discharge and make it brownish.
Similarly sometimes one day after menstruation some amount of menstrual blood clot may remain and mix with vaginal discharge and make it slightly brownish or brownish-black. These are normal. Don’t worry about it.
After menstruation estrogen level gradually increases. For the next 3 days after menstruation, that is from 6th day to 8th day it may be scanty, thick and sticky. On 9th and 10th day it becomes creamy, whitish, and cloudy.
From 11th to 13th day the amount of vaginal discharge becomes copious, clear and stretchable like the raw egg white. At this time vaginal secretion of a woman may increase up to 30 times from vaginal discharge of other times. In fact at this time one may need to use a sanitary pad.
In the 28 days menstrual cycle, the 14th day usually corresponds with the day of ovulation. This copious vaginal secretion causes an ideal environment for sperm to swim within vagina to enter the fallopian tube for fertilization. It also helps sperm to survive for a longer period within the genital tract. Some women track their ovulation by this copious stretchable vaginal discharge.
After ovulation if not conceived estrogen decreases and progesterone level increases for about 1 week and again it decreases. Therefore vaginal secretion decreases and becomes scanty, thick and sticky.
There are some other situations where there may be normal increase of vaginal discharge such as pregnancy, sexual arousal and intercourse, use of oral contraceptive pills.
As oral contraceptive pills contain hormones and there is continuous intake of hormones by taking these pills, variation of vaginal discharge with menstrual cycle is lost in these women who uses oral contraceptive pills. .

Which type of vaginal discharges are abnormal?

Vaginal yeast infection (Vaginal candidiasis) – Vaginal discharge with white cottage cheese appearance is due to yeast infection, a fungal infection.
It is associated with intense itching, burning sensation around the vaginal opening and vulva. Sometimes there is redness and Swelling. It is not associated with any foul smell. There may be painful sexual intercourse. It is not sexually transmitted.
Normally there is yeast in vagina but when it outgrows due to some reason this type of vaginal discharge occurs.
It may be due to
poor hygiene,
taking antibiotics for a prolonged period that kills healthy vaginal bacteria, and yeast overgrow, 
diabetes, 
pregnancy, 
use of oral contraceptive pills, 
suffering from conditions that lower body immunity, 
even excessive stress can cause it.
This is easily treatable by oral and local antifungals but may recur, so maintain hygiene properly.
Bacterial vaginosis – Greyish or greyish-white, thin watery, fishy smelling discharge may be due to bacterial vaginosis. Smell increases during or after sexual intercourse.
It may be associated with the itching and burning sensation of vagina. It may be sexually transmitted or may be due to changes in normal vaginal bacterial balance due to some reason such as douching.
It is treated by antibiotics.
Trichomoniasis (Trich) infection – Frothy, yellow or green watery discharge with bad odor associated with itching, and burning may be due to Trichomoniasis infection.
There may be painful urination and pain during intercourse. It is almost always sexually transmitted. It is the most common non-viral sexually transmitted disease. In 70 % of women there may be no symptoms, but they can transmit the disease.
It is usually treated by an antibiotic metronidazole. Sexual partner must be treated. Abstain from sex for one week after completion of treatment to prevent recurrence.
Gonorrhea – Thin watery or creamy greenish or greenish-yellow vaginal discharge associated with pain and burning sensation during passing urine may be due to gonorrhea.
There may be lower abdominal pain, intermenstrual bleeding, heavy menstrual bleeding, sometimes bleeding after sex and pain during sex, there may be associated fever.
It is sexually transmitted. 50 percent of women may not have any symptoms, but they can transmit the disease. Gonorrhea can also infect rectum, throat and eyes when infected vaginal fluid or semen come in contact.
This type of vaginal discharge should not be ignored because it may lead to pelvic inflammatory disease and infertility.
It is treated with antibiotics. Sexual partner must be treated simultaneously. Abstain from sex for one week after completion of treatment.
Chlamydia infection – yellowish color discharge may contain mucus or pus due to chlamydia infection. Sometimes it may be greenish yellow. It may be smelly. It may be associated with painful and burning sensation during passing urine, bleeding between periods and painful sexual intercourse.
It is sexually transmitted. 80% of Chlamydia infected women may not have any symptoms, but they can transmit the disease. If untreated it may lead to pelvic inflammatory disease, infertility or ectopic pregnancy.
It is treated with antibiotics. Sexual partner must be treated simultaneously. Abstain from sex for one week after completion of treatment.
Bloody or brown intermenstrual bleeding, bleeding after menopause and bleeding after sexual intercourse may be cause of concern. In these situations, one must consult a doctor. Cervical or endometrial cancer, cervical polyp must be excluded.

When  you should visit a doctor?

Blood-tinged vaginal discharge,
abnormal smell of vaginal discharge,
altered colored such as yellow, green or grey vaginal discharge,
sudden excessive increase of amount of vaginal discharge,
pain in pelvic area (tummy and thighs),
Pain, burning sensation, itching or other discomfort in and around the vagina.
fever associated with vaginal discharge,
rash in vagina with or without discharge.

How to prevent abnormal vaginal discharge?

Wash the vaginal area with water and mild soap once a day. Don’t wash inside the vagina.
Don’t use scented items or cosmetics in the vaginal area, may use pure coconut oil.
No douching because it changes pH balance in vagina and unhealthy bacteria overgrow.
Wipe front to back after passing stool or urine to prevent shifting of bacteria in anal region to vaginal region.
Wear cotton undergarments to prevent moisture accumulation.
Use loose skirts and plazo. Avoid tight fitting clothes like jeans. 
When detergent is used to wash clothes, it is to be thoroughly washed with water to remove excess detergent.
Avoid tampons and synthetic pad, use cotton sanitary pad.
Consume green, yellow leafy vegetables.
Control diabetes.
Take probiotics, yogurt is a good source of probiotics.
Safe physical relationship. If you have a latex allergy, then don’t use latex condoms.
After intercourse clean your private parts thoroughly with water. 
If you suffer from vaginal discharge that is sexually transmitted, then treat your partner simultaneously and avoid sex one week after completion of treatment.