Vaginal discharge
Common in women of childbearing age, physiologic vaginal discharge is mucoid, clear or white, nonbloody, and odorless. Produced by the cervical mucosa and, to a lesser degree, by the vulvar glands, this discharge may occasionally be scant or profuse due to estrogenic stimulation and changes during the patient’s menstrual cycle. However, a marked increase in discharge or a change in discharge color, odor, or consistency can signal disease. The discharge may result from infection, sexually transmitted disease, reproductive tract disease, fistulas, and certain drugs. In addition, the prolonged presence of a foreign body, such as a tampon or diaphragm, in the patient’s vagina can cause irritation and an inflammatory exudate, as can frequent douching, feminine hygiene products, contraceptive products, bubble baths, and colored or perfumed toilet papers.
History and physical examination
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had vaginal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
Medical causes
Atrophic vaginitis
With atrophic vaginitis, a thin, scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
Bacterial vaginosis
Bacterial vaginosis (formerly called Gardnerella vaginalis and Haemophilus vaginalis) results from an ecozogic disturbance of the vaginal flora. Causing a thin, foul-smelling, green or gray-white discharge, it adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other signs of vaginal irritation may occur but are usually minimal.
Candidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine, red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
Chancroid
Chancroid — a rare but highly contagious sexually transmitted disease — produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and fever to 102.2° F (39° C) are common.
Chlamydial infection
Chlamydial infection causes a yellow, mucopurulent, odorless, or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially following menses. Many women remain asymptomatic.
Endometritis
A scant, serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, lower back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
Genital warts
Genital warts are mosaic, papular vulvar lesions that can cause a profuse, mucopurulent vaginal discharge, which may be foul-smelling if the warts are infected. Patients frequently complain of burning or paresthesia in the vaginal introitus.
Gonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a yellow or green, foul-smelling discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
Gynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul-smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
Herpes simplex (genital)
A copious mucoid discharge results from herpes simplex, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
Trichomoniasis
Trichomoniasis can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; a red, inflamed vagina with tiny petechiae; dysuria and urinary frequency; and dyspareunia, postcoital spotting, menorrhagia, or dysmenorrhea. About 70% of patients are asymptomatic.
Other causes
Contraceptive creams and jellies
Contraceptive creams and jellies can increase vaginal secretions.
Drugs
Drugs that contain estrogen, including hormonal contraceptives, can cause increased mucoid vaginal discharge. Antibiotics, such as tetracycline, may increase the risk of a candidal vaginal infection and discharge.
Radiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
Special considerations
Teach the patient to keep her perineum clean and dry. Also, tell her to avoid wearing tight-fitting clothing and nylon underwear and to instead wear cotton-crotched underwear and pantyhose. If appropriate, suggest that the patient douche with a solution of 5 T of white vinegar to 2 qt (2 L) of warm water to help relieve her discomfort.
If the patient has a vaginal infection, tell her to continue taking the prescribed medication even if her symptoms clear or she menstruates. Also, advise her to avoid intercourse until her symptoms clear and then to have her partner use condoms until she completes her course of medication. If her condition is sexually transmitted, instruct her on safe sex methods.
Pediatric pointers
Female neonates who have been exposed to maternal estrogens in utero may have a white mucous vaginal discharge for the first month after birth; a yellow mucous discharge indicates a pathologic condition. In the older child, a purulent, foul-smelling, and possibly bloody vaginal discharge commonly results from a foreign object placed in the vagina. The possibility of sexual abuse should also be considered.
Geriatric pointers
The postmenopausal vaginal mucosa becomes thin due to decreased estrogen levels. Together with a rise in vaginal pH, this reduces resistance to infectious agents, increasing the incidence of vaginitis.
Pictures
Book Source Details
- Book Title: Handbook of Signs & Symptoms (Third Edition)
- Author(s): Springhouse
- Year of Publication: 2006
- Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2006 Lippincott Williams & Wilkins.
Other Book Chapters Related to Vaginal bleeding
Read excerpts from these other book chapters related to Vaginal bleeding:
Medical Books Excerpts
- Metrorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Menorrhagia
- "Professional Guide to Signs & Symptoms (Fifth Edition)" (2006)
- [ read ]
- Dysmenorrhea
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Menorrhagia
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
- Vaginal Discharge
- "The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter" (2000)
- [ read ]
Copyright Details: Handbook of Signs & Symptoms (Third Edition), Copyright © 2008 Williams & Wilkins.
More About Causes of Vaginal bleeding
» Next page: Vaginal bleeding, postmenopausal (Handbook of Signs & Symptoms (Third Edition))
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