Written by : Dr.M.D.Mazumdar, MD
All women have vaginal discharge at some time or the other in their lives. This vaginal discharge may be normal - that is, it may be due to a normal physiological process in the body.
Vaginal discharge is termed abnormal or pathological when the discharge is due to some disease process.
Most women are unaware of the causes of normal vaginal discharge and may get unduly distressed. Some may even present themselves at the doctor's chambers for treatment.
Increased vaginal discharge is normal at some time during the menstrual cycle due to increased cervical secretions.
The vagina is the passage that connects the internal reproductive organs with external female anatomy or the Vulva. The glands of the vagina and cervix secrete small amounts of fluid to cleanse out the vagina of any pathogenic organism. Some of this fluid may leak out and cause a normal vaginal discharge.
The ph of the vagina is normally acidic, preventing disease-producing organism from growing. This ph is maintained by a variety of organisms that grow normally in the vagina. Of these, one of the commonest organism is Doderlein's bacilli, a type of lactobacilli.
The normal vaginal discharge also contains tissue fluids, old vaginal and cervical cells, WBC's, glycogen, electrolytes, proteins and lactic acid.
Normal Vaginal Organisms
as seen on a slide under
Vaginal Discharge without Itching
Vaginal discharge without itching may be:
- Normal or Physiological.
- Abnormal or Pathological- due to some disease process.
Normal Vaginal Discharge without Itching
Normal vaginal discharge that occurs at various times in a woman's life is thin and clear or faintly cloudy. It turns yellowish when dry. It may sometimes be seen as a stringy discharge sticking to your underwear. It does not smell and does not cause itching or burning of the vagina.
Although many people use the term ‘leucorrhoea’ synonymously with all types of vaginal discharge, it should be restricted to mean an excessive amount of normal discharge.
Usually the amount of vaginal discharge is such as to just moisten the vaginal opening and to occasionally leave a stain on the undergarments. But it can be increased at certain times:
- During ovulation: The term "Ovulation" is used to describe the release of an ovum from a woman's ovaries once in every menstrual cycle. Fertilization of an ovum by sperm causes pregnancy.
At around the time of ovulation, the level of oestrogen in the body increases, stimulating the glands of the cervix. These secrete large amounts of clear, watery fluid. The main function of this cervical discharge is to help any sperm deposited in the vagina to swim up through the uterus. This secretion is usually copius, thin and watery, clear with occasional specks of white. and quite stretchable.
Since, ovulation occurs about 14 days after your last menstrual period, you will notice that your secretions also increases at around this time.
- Just before the menses / periods : You will sometimes notice that your vaginal discharge increases a day or two before your period begins. The discharge becomes gradually brownish or reddish as the bleeding starts. The day the vaginal discharge becomes brownish is counted as the first day of your period.
- During pregnancy : During pregnancy, the level of oestrogen and progesterone increases in the body. These hormones are needed to maintain the pregnancy and help the baby to grow. They also stimulate the glands of the cervix to secrete large amounts of fluid, especially in the early part of pregnancy. These fluids then appear as copious vaginal discharge during pregnancy that is thick and whitish. The discharge is sticky without any smell.
- During sexual excitement : Sexual excitement causes the secretion of a thin watery fluid that wets and lubricates your vagina to make penetration of the penis and the sexual act easier.
- At birth : Many newborn female babies have a mucoid vaginal discharge lasting for the first few days of birth. This is in response to the stimulation of their genital organs by maternal oestrogen while they were still in the uterus. The oestrogen level gradually decreases and then disappears. The vaginal discharge also disappears at the same time.
- At Puberty : Excessive vaginal discharge may be seen in young girls at and around the time of puberty. This is because of the increasing levels of the hormones oestrogen and progesterone at this time. It usually decreases spontaneously as the menstrual cycle becomes established.
- Oral Contraceptive Pills : The oestrogen and progesterone in the birth control pills stimulate the cervical glands, leading to an excessive vaginal discharge in some woemn.
Pathological Vaginal Discharge without Itching
Vaginal discharge without itching can sometimes be in response to some disease process in the body.
Although this vaginal discharge can be clear or whitish, presence of infection can cause the colour to change to greenish or yellowish or creamy. If there is presence of pus, it will be thick and mucoprulent (mucous mixed with pus) or purulent (similar to pus). Infection will cause the vaginal discharge to be foul-smelling.
Vaginal discharge due to a disease process like infection invariably causes itching as well. But sometimes only vaginal discharge without itching can occur in certain specific infections or due to other causes. Some of these conditions are :
Lymphogranuloma Venereum: Caused by the organism, Chlamydia trachomatis, this is a type of sexually transmitted disease. It causes thick pus-like foul-smelling discharge with painless ulcers in the vulva.
Bacterial Vaginosis: Bacterial vaginosis is caused by a bacteria called Gardnerella. This bacteria is a normal inhabitant of the vagina but multiplies in number when the body's immunity to diseases decreases for some reason. It causes a typical fishy odour that is more evident after sex or during the menstrual period.
Cervical erosion : Cervical Erosion is a condition where the normal squamous mucosa of the cervix changes to a columnar mucous memebrane, usually in response to an increased oestrogen level of the baby, e.g. in pregnancy, in women who take birth control pills. Since the columnar mucous membrane contains glands, there is an increase of vaginal discharge.
Vaginal Adenosis : The normal squamous mucosa of the vagina may be replaced by columnar mucosa in some areas of the vagina. These patches of columnar mucosa contain glands that have a white mucoid secretion.
Foreign body : Sometimes, a foreign body like a tampon or a condom may be forgotten and left inside the vagina for days. Very young girls may also insert small objects like beads or pebbles inside the vagina while playing. These can stimulate the cervical glands to produce more mucous in an attempt to get rid of them, causing increased vaginal discharge.
Tumours of the genital tract: Most tumours in the lower genital tract, e.g. a cervical polyp, cause a white or creamy continuous vaginal discharge which does not smell. But infections of the tumour by bacteria can change the nature of the secretions to a foul smelling, yellowish or greenish discharge.
Congestion of the pelvic organs : can occur due to prolonged ill health, anxiety states, very hot weather, not being active for a long time. This can result in increased vaginal discharge that is thick, white and sticky.
Secondary infection : Secondary infections of wounds, abrasions, burns and tumours in any part of the lower genital tract can cause increased vaginal discharge. Itching can occasionally occur in the presence of infection.
Treatment of Vaginal Discharge without Itching
Treatment of vaginal discharge depends on the cause.
If the discharge is due to a normally occurring event in the body like ovulation, then it should be explained to the patient. She should be reassured about the same.
If the vaginal discharge is very copious in amount and causes discomfort, use of thin panty liners or vaginal pads will keep the genital area dry and prevent infections.
If the cause of the increased vaginal discharge is diagnosed, then the cause is treated.
- Chlamydia trachomatis: In infection by chlamydia trachomatis, the drug of choice is one of the tetracycline group of drugs. Tablet Doxycycline (100mg tab - 1 tablet two times a day for 10 days) is usually prescribed.
- Bacterial Vaginosis- Metronidazole is the drug of choice. 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. It is wiser for the sexual partner to be treated at the same time to prevent reinfection.
- Infections - Antibiotics for the specific infections and anti-inflammatory medicines like ibuprofen 200 mg tablets ( 1 tablet to be taken three times a day after food)are prescribed.
- Cervical erosion - The area affected by cervical erosion needs to be cauterised either by heat or extreme cold.
- Tumours like cervical polyps - All tumours, including cervical polyps have to be
- Oral Contraceptive pills - Birth control pills containing lower dosage of oestrogens or those formulated to imitate the body's normal levels of oestrogen should be taken.
- General measures: General measures like controlling urine sugar (home test kits can be used), temporarily discontinuing oral contraceptives and eliminating any other suspected cause of increasing the sugar level in the body is to be taken.
Improving the general condition of the woman will contribute to her ability to resist infections.
This can be done by taking supplements of various vitamins- Vitamins like B-Complex Capsules, High strength Multivitamin Capsules, Iron capsules to correct anaemia and Folic Acid tablets should be taken.
Other supplementary vitamins and minerals that increase the resistance of the body to infections of various types are Vitamin C 500 mg tablets taken once daily, Acidophilus to increase the growth of lactobacilli and help prevent growth of gardnerella and Zinc tablets to increase the body's immunity to infection.
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