Written by : Dr.M.D.Mazumdar, MD
Women with vaginal discharge without itching can bear it for many years without complaining.
But vaginal discharge with itching tends to be much more uncomfortable.
Vaginal itching may be so severe that it may be difficult to control. And when it occurs in public, it can lead a woman almost to tears.
It is not uncommon to find a woman heading for the nearest washroom just to scratch herself in private.
Causes of Vaginal Discharge with Itching
There are three main causes of vaginal discharge with itching:
Other less common causes are:
- Postmenopausal Vaginitis : Postmenopausal vaginitis occurs mainly due to a deficiency of estrogen after menopause - this causes the vaginal cells to be more susceptible to infections.
- Secondary infection of wounds, abrasions, burns and tumours in any part of the lower genital tract.
- Generalised itching all over the body due to causes like jaundice may appear to cause vaginal itching with discharge, although the discharge may be due to a normal physiological discharge.
as seen on a slide under
Trichomonas Vaginitis or Trichomoniasis as it is also called, is a sexually transmitted disease caused by a parasite, the Trichomonas Vaginalis.
The organism can be found both in the male prostate, prepuce of the penis and urethra as well as the vagina of the female. The male partner is usually symptom free.
Signs and Symptoms of Trichomonas Vaginitis
- Severe Itching: The main characteristic and the chief complaint of the patient is severe itching. The itching may be all over the vulva but is more in and around the vagina.
The labia minora and the vagina may become swollen and painful from the inflammation and constant scratching, so much so, that sexual intercourse may become difficult and painful. Sometimes, even walking and sitting may cause discomfort and pain.
- Vaginal Discharge: The first symptom is usually a sudden onset of thick vaginal discharge often described as purulent (like pus). It can be greenish, yellowish or creamish in colour. It is usually bubbly and frothy in character. In rare cases, vaginal discharge may be minimal or scanty.
- Pain: There may be pain around the external genital region. The genitals may feel hot and extremely sore with a dull,throbbing pain .
- On passing urine: Pain is worse while passing urine as the acidic urine flows over the inflamed vulva. Many women resort to splashing cold water on the vulva with minimal relief. There may also be an urge to pass urine frequently.
- During the period: Itching and vaginal discharge is more just after the menstrual period ends.
- On examination: On examination, the vagina may be seen to be fiery red in colour and congested. There may be excoriation of the skin and scratch marks all over the vulva due to the constant itching.
Treatment of Trichomonas vaginitis
- The drug of choice is Metronidazole. It is usually prescribed as 500mg tablets (1 tab to be taken two times a day for 5 days or 375 mg three times a day for 5 days). It is very effective in curing up the infection.
The sexual partner has to be treated at the same time to prevent reinfection.
- Other drugs that act on Trichomonas are Tinidazole and Nimorazole.
- Anti-inflammatory and painkilling drugs like Ibuprofen or Acetaminophen may also need to be prescribed.
Candidiasis, also called vaginal thrush or yeast, is caused by a fungus called Candida albicans.
Candida albicans is normally present in the vagina, the skin around the anus as well as the mouth to a greater or lesser degree in many women. It loves an environment with a rich source of glucose and an acid medium.
It becomes pathogenic when the level of glucose in the body increases, as in pregnancy, while taking oral contraceptive pills and in diabetic patients. It can also occur when the patient is on a course of broad spectrum antibiotics which destroy normal vaginal organisms.
as seen on a slide
under a microscope
The symptoms of candidiasis decreases during menstruation when the acidity of the vagina is temporarily reduced or by douching the vagina with a solution of sodium bicarbonate. But the main infection is not cured and recurs after some time.
Signs and Symptoms of Candidiasis
- Vaginal Itching: the main symptom of vaginal yeast infection is severe itching. The itching is out of all proportion to the amount of vaginal discharge seen. The scratching can leave the vulva inflamed, sore and oedematous.
- Vaginal Discharge: The discharge is typically thick, white and cheesy. Some patients describe it as curdy and somewhat dry.
The discharge tends to be sticky and may cling to the vaginal walls. On peeling off, it leaves a reddish area that may occasionally bleed (rare).
- Smell: Infection with yeast may sometimes produce what is called a "fishy smell".
- Sexual Intercourse: Sexual intercourse may be painful and difficult due to the inflamed vaginal walls.
- On examination: The vulva is seen to be red and inflamed. Signs of scratching may be evident around the vaginal opening.
On examination with a speculum inside the vagina, thick, curdy white discharge is seen clinging to the vaginal walls. Occasional red areas will show where the discharge has fallen off.
Diagnosis of Candidiasis (Yeast infection)
The diagnosis of candida albicans is made by examining the vaginal discharge under a microscope to show the presence of the hyphae and spores characteristic of candida.
The advantage of a microscopical examination is that it will also reveal the presence of Trichomonas vaginalis, if present. Simultaneous treatment of both the organisms can be done.
- Antifungal ointments: A course of antifungal ointments to be applied over a period of days is the right treatment. Miconazole or clotrimazole, available as both creams and tablets, may be used. If tablets are to be taken, 1 tablet is to be inserted deep inside the vagina every night for a minimum of 3 nights or, if the infection is severe, for 6 nights. The dosage can be increased to 2 tablets per day - 1 tablet to be inserted at night and 1 tablet to be inserted in the morning.
Antifungal creams of both miconazole or clotrimazole can be applied twice daily inside the vagina for a period of 1 week.
Combination packs of Miconazole 7-Day and 3 day Treatment regimes are also available. These contain pre-filled applicators to be applied inside the vagina as well as an external cream to be applied on the vulva.
- Anti-inflammatory tablets: Tablets like Ibuprofen and Acetaminophen, will decrease the pain and inflammation of the genital area.
- General Measures to Control Vaginal Discharge with Itching
General measures like controlling sugar in the urine (home test kits can be used) in diabetics, temporarily discontinuing birth control pills and eliminating any other suspected cause of increasing the sugar level in the body is to be taken.
In pregnancy, only locally applied creams like miconazole or clotrimazole can be used, applied twice daily inside the vagina for a period of 1 week.
Improving the general condition of the woman will contribute to her ability to resist infections.
Supplements of various nutrients should be taken to boost the immune system of the body. Vitamins like B-Complex Capsules, High strength Multivitamin Capsules, Iron capsules to correct anaemia and Folic Acid tablets should be taken.
Other sypplementary vitamins and minerals that increase the resistance of the body to infections of various types are Vitamin C 500 mg tablets taken once daily and Acidophilus to increase the growth of healthy lactobacillus in the vagina, increase the acidity of the vagina and prevent infections. Zinc tablets also increase the body's immunity to infection.
Gonorrhea is a sexually transmitted disease caused by the organism, Neisseria gonorrhoeae.
It is caused by sexual intercourse with an infected person. Rarely, it can also occur due to use of a contaminated object like a vibrator. Although, the disease causes a thick, purulent vaginal discharge, itching is minimal or sometimes even absent.
For signs and symptoms, mode of spread and treatment of the disease, see Sexually transmitted Disease - Gonorrhoea.