Leucorrhea is excessive, offensive, or abnormal vaginal discharge, which is non-purulent, non-irritant, and never causes pruritus.
Etiology (Causes) of Abnormal
Vaginal Discharge
1. Physiological Causes
- Puberty
(Hormonal changes)
- Menstrual cycle variations
- Pregnancy
(Increased estrogen levels)
- Sexual excitement (Cervical mucus secretion)
2. Cervical Causes
- Cervical erosion
- Chronic cervicitis
- Mucus polyp
- Cervical ectropion
3. Vaginal Causes
- Excessive vaginal discharge
- Foul-smelling discharge (suggests infection)
- General examination findings
- Pelvic inflammation
- Speculum examination reveals cervical/vaginal pathology
Types of Abnormal Vaginal Discharge
1. Physiological Vaginal
Discharge
- Normal milky white, odorless,
and non-irritating secretion.
2. Infectious Vaginal
Discharge
·
Candidiasis (Candida albicans)
- Thick, curdy, white discharge
- Associated with itching, vaginal
soreness
- Common in diabetics and
immunocompromised individuals
- Treatment:
Antifungals (Fluconazole, Clotrimazole)
·
Bacterial Vaginosis (Gardnerella
vaginalis)
- Fishy-smelling, thin, grayish-white discharge
- Clue cells on microscopy
- Treatment:
Metronidazole
·
Trichomoniasis (Trichomonas
vaginalis)
- Yellow-green frothy vaginal discharge
- Strawberry cervix on examination
- Treatment:
Metronidazole
·
Chlamydial Vaginitis (Chlamydia
trachomatis)
- Mucopurulent vaginal discharge
- Treatment:
Tetracyclines (Doxycycline)
3. Allergic / Irritant
Discharge
- Due to soaps, detergents, latex condoms
- Causes itching, irritation
4. Neoplastic Causes
- Cervical intraepithelial neoplasia (CIN)
- Cervical cancer (Foul-smelling, blood-stained discharge)
Investigations for Abnormal Vaginal
Discharge
1.
Speculum Examination
o Appearance of discharge
o Cervical/Vaginal lesions
2.
Microscopy (Wet Mount, Gram
Staining)
o Clue cells → Bacterial vaginosis
o Motile trichomonads → Trichomoniasis
o Budding yeast → Candidiasis
3.
Culture & Sensitivity (For bacterial infections)
4.
pH Testing
o Normal vaginal pH: 3.8 – 4.5
o Bacterial vaginosis → pH > 4.5
o Candidiasis → Normal pH
5.
Pap Smear (For Cervical Dysplasia
Screening)
Treatment & Management
1. General Measures
- Improvement of General Health
- Maintenance of Perineal Hygiene
- Avoiding Irritants (Soaps, Perfumed Products)
2. Specific Treatment
- Bacterial Vaginosis: Metronidazole 500 mg BD for 7 days
- Trichomoniasis: Metronidazole 2 g single dose
- Candidiasis:
Clotrimazole vaginal pessary or Fluconazole 150 mg single dose
- Chlamydia Infection: Doxycycline 100 mg BD for 7 days
Keynote Symptoms of Abnormal Vaginal
Discharge
- Excessive white, yellow, or greenish discharge
- Foul-smelling or fishy odor
- Itching, burning, or irritation in the vaginal area
- Weakness, backache, or pelvic discomfort
- Associated menstrual irregularities or pain during intercourse
1. Sepia
Indications:
- Profuse, yellowish-green,
offensive leucorrhea
- Associated with weakness,
bearing-down sensation, and irritability
Keynote Symptoms:
- Weakness and dragging-down sensation in the
pelvis.
- Aversion to sexual intercourse.
- Leucorrhea worsens after exertion.
- Mood swings, irritability, and exhaustion.
- Worse from cold air and better with exercise.
Indications:
- Thick, creamy, milky-white
leucorrhea, especially in young girls
- Discharge increases before
menstruation and is non-irritating
Keynote Symptoms:
- Leucorrhea worsens before periods.
- Symptoms constantly change in intensity.
- Better in open air and worse in warm rooms.
- Weepy, emotional nature, seeks comfort.
- No thirst even during fever or illness.
Indications:
- Profuse leucorrhea like
milk, especially in overweight women
- Leucorrhea accompanied by
chilliness and weakness
Keynote Symptoms:
- Cold, sweaty feet and hands.
- Leucorrhea worsens after exertion.
- Craving for eggs and indigestible things.
- Easily fatigued and overwhelmed by stress.
- Sensitive to cold and damp weather.
Indications:
- Foul-smelling, acrid,
excoriating vaginal discharge
- Causes intense burning and
itching in the vaginal area
Keynote Symptoms:
- Leucorrhea causes soreness and irritation.
- Profuse, offensive discharge leaving stains on
clothing.
- Worsens between periods and after intercourse.
- Painful urination due to excoriating discharge.
- Worse from cold and better from warmth.
Indications:
- Thick, fishy-smelling,
greenish vaginal discharge
- Associated with chronic
pelvic inflammatory disease (PID)
Keynote Symptoms:
- Vaginal discharge is offensive and profuse.
- Worse at night and after sexual activity.
- History of recurrent urinary or vaginal
infections.
- Intense desire for nighttime activity.
- Burning sensation in the urethra and vagina.
