Vaginal discharge (Leucorrhea) definition
Excessive normal discharge
* Frequently means all genital discharge except bleeding.
* Normal vaginal discharge:
1) Vulva: Glandular secretions e.g. Bartholin, apocrine, and sweat glands.
2) Vagina: Acidic transudation of vaginal mucosa (no glands in vaginal mucosa).
3) Cervix: alkaline mucous discharge (cervical mucus).
4) Endometrium: uterine milk (alkaline fluid rich in nutrients). & Tubes.
Vaginal discharge (Leucorrhea) aetiology:
Excessive normal discharge (true leucorrhea):
1) At puberty: ↑ vascularity (ovarian steroids secreted after puberty).
2) Premenstrual: pelvic congestion (secretory changes and blood supply).
3) Pregnancy: Pregnancy hormones increasing vascularity.
4) Hormonal ectopy: excessive endocervical secretory columnar epithelium.
5) Pelvic congestion: due to habitual constipation & coitus interruptus.
Pathological vaginal discharge (Leucorrhea) :
1) Vaginal pathology: (enumerate causes of vaginitis),
2) Cervical pathology: cervicitis, ulcers, infected tumors & polypi.
3) Uterine pathology:
Gyne. : Necrotic fibroid, discharging pyometra, endometrial carcinoma.
Obstetrics: puerperal endometritis, antepartum rupture of membranes.
4) Tubal pathology: intermittent hydrosalpnix.
5) Pelvic peritoneal pathology: pelvic abscess evacuating vaginally.
Investigation of a case of vaginal discharge (Leucorrhea) :
History:
– Personal history: (age)
– Before puberty: Vulvo-vaginitis of children.
– During childbearing period: infection.
– Postmenopausal: malignancy.
– Present history: criteria of discharge & associated symptoms
♦♦♦ Criteria of discharge:
••• White:
– Excessive mucous discharge & vaginal adenosis.
– Cervical ectopy (hormonal & congenital).
••• Mucopurulent: chronic cervicitis.
••• Purulent:
– Vaginal: vaginitis & neglected pessary.
– Cervical: acute gonorrhea.
– Uterine: endometritis & pyometra.
– Pelvic: pelvic abscess evacuating vaginally.
••• Offensive discharge:
1. Neoplastic:
– Cancer of (cervix, vagina, body -sometimes-), Infected
SMF polyp.
2. Inflammatory:
– Trichomonas vaginitis.
– Endometritis, pyometra, septic abortion & puerperal sepsis.
– Pelvic abscess evacuating vaginally.
••• Blood stained discharge:
1. Neoplastic: (as before)
2.Inflammatory:
– Cervical: vascular ectopy, polypi & ulcers.
– Vaginal: ulcers & senile vaginitis.
••• Serous discharge(watery):
1. Neoplastic: vesicular mole & early genital malignancy.
2. Non-neoplastic:
– Antepartum rupture of membranes
– Intermittent hydrosalpnix.
– Urinary fistula
♦♦♦ Associated symptoms: Pruritus vulvae, dyspareunia & frequency
– Past history
– Recent history
– Recent abortion
– Uterine manipulation
– Marital history: Gonorrhea after sexual intercourse.
– Menstrual history Congestive dysmenorrhea due to pelvic congestion.
Examination:
– General examination:
– Cachexia in malignancy.
– Fever & tachycardia in infection.
– Abdominal examination: pelvi-abdominal swelling as fibroid.
– Local examination:
••• Precautions:
– No sexual intercourse or vaginal douches for 24 hours.
– No lubricant on gloves on the speculum.
••• Steps (done in this sequence):
a) Inspection of the vulva:
– Visible discharge
– Bartholinitis
– Urethritis (milking of the urethra downwards).
b) Dry sterile speculum & discharge is obtained and examined.
c) Inspection of the vaginal wall for vaginitis, ulcers & tumors.
Special investigations: ( ordered according to clinical suspicion)
– If infection is suspected
– Fresh drop test, Stained film, & Culture sensitivity.
– Serology test
– X-ray: detects FB in infant
– If malignancy is suspected: biopsy must be taken.
Vaginal discharge (Leucorrhea) treatment:
of the cause.
Vaginal discharge (Leucorrhea) PPT (power point presentations):
Vaginal Discharge By Maira Shahid & Syed Sami Haider Roll # 234 & 239 Clinical Group
Leukorrhea
APPROACH TO PATIENT WITH VAGINAL DISCHARGE
OBJECTIVES • Introduction • Normal vaginal discharge • Important history • Symptoms and signs • Diagnosis • Treatment • Case presentation
MANAGEMENT OFMANAGEMENT OF VAGINAL DISCHARGE
Max MongelliMax Mongelli Senior Consultant and Associate ProfessorSenior Consultant and Associate Professor Department of Obstetrics & GynaecologyDepartment of Obstetrics & Gynaecology Nepean HospitalNepean Hospital.