Vaginal discharge is a common problem among women. Vaginal discharge is an important function of female reproductive system. Fluid generated by vagina and cervix glands carries along dead cells and bacteria and in the process keeps the vagina clean and helps in preventing infections. 

Normal physiological vaginal discharge is a white or clear, non-odourless discharges that can vary over the time. It is thick and sticky during menstrual cycle but becomes clear, wet and stretchy for a short period during the time of ovulation. It is heavier and more noticeable during pregnancy with contraceptive use and with sexual stimulation. Its volume decreases during menopause due to fall in estrogen levels. 

Abnormal vaginal discharge is characterized by change in colour, consistency, volume, and/or odour and may be associated with symptoms such as itching, soreness, dysuria, pelvic pain, or inter-menstrual or postcoital bleeding.

Causes of Abnormal discharge

Any imbalance of normal bacteria in vagina can affect the smell, color or discharge texture. Abnormal discharge is most commonly caused by infections like bacterial vaginosis and candidiasis; however there can be non-infective causes as well. 

There can be physiological and pathological causes of vaginal discharge. 

Diagnosis 

Past history and examination of the patient is carried out before deciding whether investigations and treatment are required. Few features of vaginal discharge are its onset, duration, menstrual cycle timing, odour, colour, consistency and any aggravating factors. Associated symptoms which include itching, discomfort, pain, dysuria, dyspareunia and irregular bleeding are examined. Even the gynecological history is also examined including parity, smear history, sexual history and current contraception. 

Examination consists of inspection, bimanual examination and obtaining appropriate vaginal swabs. Inspection includes a general external inspection of the vulva and perineal region followed by inspection of the vagina and cervix with the help of speculum. Bimanual examination gives idea about the position, size and mobility of the uterus as well as presence of adnexal masses. Vaginal swab helps in diagnosis of pathogens that are responsible for abnormal discharge.

Symptoms 

You should consult the doctor, especially if a discharge is due to some time changes.  Following are the few characteristic signs that indicate an infective cause of vaginal discharge and may need a medical advice.

• Bacterial vaginosis (BV) is thin, white/grey homogeneous coating of the vaginal walls and vulva that has fishy odour. Normally there is no vaginal or vulval inflammation or soreness, unless there is associated candidiasis. 
• Vaginal candidiasis (VC) is odourless, white, curdy discharge. Examination may reveal erythema, vaginal fissuring ,excoriation of the vulva and/or oedema.
• Trichomoniasis vaginalis (TV) is yellow-green, frothy discharge with a fishy odour. Inflammation of the vulva and vagina or a strawberry appearance of the cervix may be observed on pelvic examination.
• Cervicitis caused by chlamydia (or less commonly by gonorrhea) is characterized by an inflamed cervix which bleeds easily and associated with a mucopurulent discharge.  
• Pelvic inflammatory disease(PID) caused by chlamydia (or less commonly by gonorrhea) is characterized by lower abdominal pain, with our without fever. Cervicitis may be seen and adnexal tenderness and cervical excitation found on bimanual palpation. 

Investigations and Treatment 

• PH Test: PH test is a process of collecting discharge from the lateral wall of the vagina with a swab, and rub it on narrow range pH paper.
• High Vaginal Swab (HVS): It is a self-taken low vaginal swab for gram staining and microscopy/culture/sensitivity is taken from the vaginal and placed in Amies transport medium with charcoal for bacterial culture testing. 
• NAAT Test: For women at risk of Sexually transmitted infections(STI), swab is taken for Nucleic Acid Amplification Test (NAAT) to check for chlamydia and gonorrhea.
• Urine Pregnancy Test: Rules out pregnancy and urine dipstick to exclude urinary tract infection. 

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