Chronic Vaginal Discharge
Normal physiological vaginal discharge is produced from mucus loss from the glands of the cervix and from fluid discharge from the vaginal walls. Many normal bacteria and yeast live normally in the vagina (normal flora) and don’t cause symptoms.
What is Chronic Vaginal Discharge?
Normally the vagina is acidic because the normal protective bacteria (lactobacilli) produce lactic acid.
It is normal to notice changes in vaginal discharge during the normal menstrual cycle, especially an increase around ovulation (mid-cycle) due to changes in hormone levels.
Similarly changes (an increase in discharge) occur with normal pregnancy and with oral contraception use, both due to an increase in oestrogen levels. Some women have an increase in the normal amount of vaginal discharge due to a condition called an ectropion. An ectropion is an excess amount of glandular tissue that grows out on to the outer part of the cervix, rather than just being in the canal of the cervix. This is a normal variant and can be associated with excess vaginal discharge.
Chronically abnormal discharge can be due to numerous infections and inflammations.
What are the most common causes of excessive discharge?
A common cause of excessive discharge is bacterial vaginosis due to a reduction in protective bacteria and an increase in certain normal bacteria called anaerobes. Candida or monilia is due to a fungus which is normally present in small amounts and an excess results in an abnormal discharge.
Trichomonas (due to a parasite), chlamydia and gonorrhoea cause discharge and are considered sexually transmitted diseases.
Desquamative inflammatory vaginitis is a rare vaginal inflammatory disorder of unknown cause often associated with a heavy pus-like discharge. It is not a sexually transmitted disease.
Normal physiological discharge is usually white or clear in colour. Abnormal discharge can be creamy, yellow, or green, blood stained and have an odour (especially bacterial vaginosis).
Symptoms and treatment?
Symptoms can include itch, burning, pain and dysuria (pain on passing urine). The diagnosis requires a complete history and examination as well as swabs for analysis to diagnose any infection.
The treatment will depend upon the cause. Chronic infections often require long-term preventive treatment.
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