Dr. Shivram, Dr. Anjana kumari, Dr. Priyanka Kapoor1
1PG Scholar Department of Organon of Medicine, Dr. MPK Homoeopathic Medical College Hospital & Research Centre (Under Homoeopathy University), Saipura, Sanganer, Jaipur, Rajasthan, India
Vaginal discharge is a common presenting symptom seen by doctors in many services (primary care, gynecology, family planning, and departments of genitourinary medicine). Vaginal discharge may be physiological or pathological.
Although abnormal vaginal discharge often prompts women to seek screening for sexually transmitted infections (STIs), vaginal discharge is poorly predictive of the presence of an STI. This article focuses on the causes and diagnosis of vaginal discharge and treatment of the most common infective causes.
Key words: Leucorrhoea, vaginal discharge, Homeopathy Remedy
Women all over the world at some point in their life experience vaginal discharge called Leucorrhea. It is white (or clear), thin (or thick), sticky and odorless.
Leucorrhea results from the mucus secreted from the walls of the cervix and vagina. It is caused by the increase in levels of hormones, especially estrogen. The presence of leucorrhea indicates that vagina is kept clean and is in healthy condition. Vaginal discharge is composed of mucus secreted from vagina and cervix along with old cells and normal bacterial flora of vagina.
Some women experience leucorrhea more frequently than others. Although, leucorrhea is common and considered normal to occur; however, many woman finds it scary and is uncomfortable. Further, women are embarrassed to discuss this condition with their peers and physician. Hence, leucorrhea becomes a challenge.1
Normal vaginal flora (lactobacilli) colonize the vaginal epithelium and may have a role in defense against infection. They maintain the normal vaginal pH between 3.8 and 4.4. The quality and quantity of vaginal discharge may alter in the same woman in cycles and over time; each woman has her own sense of normality and what is acceptable or excessive for her.
Pathological vaginal discharge:
Vulvo vaginal candidiasis is a common infective cause of vaginal discharge that affects about 75% of women at some time during their reproductive life, with 40- 50% having two or more episodes. Bacterial vaginosis is one of the most common diagnoses in women attending genitourinary medicine clinics. As 50% of cases of bacterial vaginosis are asymptomatic, the true prevalence of this condition in the community is uncertain. Bacterial vaginosis is associated with a new sexual partner and frequent change of sexual partners. A reduced rate of bacterial vaginosis is seen among women in monogamous sexual relationships, but it can occur in virginal women. Increased rates of bacterial vaginosis occur in certain groups of women, such as black African women, lesbians, and smokers.2
Non-infective: Physiological, Cervical ectopy, Foreign bodies, Vulval dermatitis
Non-sexually transmitted infection: Bacterial vaginosis, Candida infections
Sexually transmitted infection: Chlamydia trachomatis, Neisseria gonorrhoeae, Trichomonas vaginalis
Physiological (normal) vaginal discharge: Many women have what they perceive as an abnormal vaginal discharge at some point in their lives, but usually it is just a normal physiological discharge. This is a white or clear, non-offensive discharge that varies with the menstrual cycle.
Cervical ectopy can be associated with a mucous discharge and if symptomatic is widely treated with cryotherapy or diathermy, although evidence to support the effectiveness of these treatments is poor.
Non-sexually transmitted infections cause discharge: Bacterial vaginosis and vulvovaginal candidiasis are common; these conditions are thought to be caused by a disturbance of the normal vaginal flora. They are not sexually transmitted and the male partner does not need to be treated. A retrospective study of patients with vaginal discharge in general practice found that most were managed as candidiasis even though bacterial vaginosis is more common.
Group B Streptococcus is often reported on vaginal swabs, but this organism is not usually thought to cause discharge and only needs treatment in pregnancy.
Sexually transmitted infections present with vaginal discharge: Chlamydia trachomatis, Neisseria gonorrhoea, and Trichomonas vaginalis can present with vaginal discharge but may also be asymptomatic. These infections are associated with an increased risk of HIV transmission, especially in the developing world. Rates of sexually transmitted infections are rising in the United Kingdom and elsewhere, but this observation may be confounded by increased awareness, increased testing, and, importantly, new laboratory techniques. Basic epidemiological data about these infections such as point prevalence, lifetime incidence rate, complication rate, and natural clearance are scarce for the general population.
Chlamydia trachomatis is the most common sexually transmitted infection caused by a bacterium in the UK. Around 5-10% of sexually active women less than 24 years are infected.
Chlamydia infections will result in pelvic inflammatory disease. This has recently been challenged by a large observational study, which reported that only 5.6% of women developed this disease, and by a small prospective study that reported an even lower rate of 1%. Clearly this has implications for information given to patients and screening programmes.3
- Change in color, consistency and odor. Yellow or green, thick, milky discharge with a bad odor
- Persistent and abundant vaginal discharge
- Pain during micturition
- Pain in the pelvic region and calves
- Lethargy and weakness
- Itching in the genital region
- Spot on the undergarments
- Physical examination of the vaginal region for injuries.
- Microbiological culture tests are performed to diagnose the exact underlying cause of the infection. The presence of gram negative diplococci indicates of the bacterial infections; while presence of spores and mycelia are indicative of fungal infections.
- Pap smear and biopsy of cervix to check for cervical cancer.
- Blood tests and urine tests to detect infections.
- Vaginal and cervix pH is determined. Vaginal pH is 4.5 and it is increased in bacterial infections and trichomoniasis.
- PCR is used to detect antigens of Trichomonas.
- Pre-term birth
- Erosion of the cervix
- Scarring of the fallopian tubes
- Pain in the lower abdomen
- Excessive douching of the vaginal area should be avoided to maintain the normal flora and pH balance of the vaginal area.
- Use of scented perfumes and soaps with strong odor for cleaning vaginal area should be avoided.
- Use of cotton panties, instead of synthetic panties, is advised to prevent sweat from being retained in genital region.
- The undergarments should be washed with antibiotic solution and should be thoroughly dried in sun. Wearing clean panties is a mandatory.
- Drink at least 3 liters of water to flush out the toxins from your body.
- It is necessary to restrict sexual activity with multiple partners to avoid infection and associated leucorrhea.
- Females with leucorrhea should avoid eating excess of meat, fish, eggs, fermented products, bread and sweets. Instead a diet designed for leucorrhea is recommended which involves consuming plenty of fruits and vegetables.
Diet and Lifestyle Advice:
- Drink plenty of water. Stay well hydrated.
- Eat more of fresh fruits and vegetables.
- Include bananas, cranberry juice, oranges, lemons, black plums, okra, leafy greens, onions, yoghurt in your diet.
- Eat complex carbs (like whole grains, brown rice, oats, etc), lean protein (fish, yoghurts, nuts, sprouts, etc) and low-fat dairy products.
- Wear loose, cotton clothes and garments.
- Exercise daily. Start with morning walks daily morning.
- Avoid stress. Stress and strain since it may affect the hormonal level and may increase secretions. Try yoga.
- Avoid simple carbs like white rice, white bread, maida, refined products, etc.
- Avoid foods that will aggravate this problem or increase your chances of getting leucorrhoea so avoid all heavy, oily, fried, sugary, spicy, and sour foods.
- Avoid tea, coffee, alcohol, aerated drinks.
- Avoid non-vegetarian food.
- Avoid wearing tight-fitting clothes.
- Avoid wearing synthetic or nylon underwear.1
Aesculus Hippocastanum- Prolapus uteri and acrid, dark leucorrhoea, with lumbo-sacral backache and great fatigue, from walking.
Agnus Castus- Leucorrhoea; transparent, but staining lines yellow; passes imperceptibly from the very relaxed part.
Alumina– Leucorrhoea acrid, profuse transparent, ropy, with burning; worse during daytime, and after menses. Relieved by washing with cold water.
Ambra Grisea- Leucorrhoea: thick, bluish-white mucus, especially or only at night.
Ammonium Carbonicum- Leucorrhoea: watery, burning from the uterus; acrid, profuse from the vagina; excoriation of vulva.
Ammonium Muriaticum- Leucorrhoea; like white of egg, preceded by griping pain about the navel; brown, slimy, painless, after every urination.
Arsenicum Album– Leucorrhoea, acrid, burning, offensive, thin. Pain as from red-hot wires; worse least exertion; causes great fatigue; better in warm room.
Borax Veneta– Leucorrhoea like white of eggs, with sensation as if warm water was flowing.
Bovista Lycoperdon– Leucorrhoea acrid, thick, tough, greenish, follows menses. Cannot bear tight clothing around waist.
Calcarea Carbonica– Leucorrhoea, milky. Burning and itching of parts before and after menstruation; in little girls. Discharge from vaginitis is milky and acrid or thick and yellow.
Carbo Animalis- Exhausting Leucorrhoea.
Causticum– Leucorrhoea at night, with great weakness.
Cocculus Indicus– Purulent, gushing leucorrhoea between menses; very weakening, can scarcely speak. So weak during menstruation, scarcely able to stand.
Conium Maculatum- Leucorrhoea; ten days after menses; acrid; bloody; milky; profuse; thick; intermits.
Graphites- Leucorrhoea; acrid, excoriating; occurs in gushes day and night; before and after menses.
Hydrastis Canadensis- Leucorrhoea: ropy, thick, yellow; hanging from os in long strings; pruritus.
Iodium- Leucorrhoea; acrid, corrosive, staining and corroding the linen; most abundant at time of menses.
Kalium Arsenicosum– Cauliflower excrescences of os uteri, with flying pains, foul smelling discharge, and pressure below pubis.
Kalium Bichromicum– Yellow, tenacious leucorrhoea. Pruritus of vulva, with great burning and excitement. Prolapsus uteri; worse in hot weather.
Kalium Iodatum– Corrosive leucorrhoea, with subacute inflammatory conditions of the womb in young married women.
Kreosotum– Corrosive itching within vulva, burning and swelling of labia; violent itching between labia and thighs. Burning and soreness in external and internal parts. Leucorrhoea, yellow, acrid; odor of green corn; worse between periods. Vaginitis with watery, thin, worse in the morning and when standing up.
Lycopodium Clavatum– Leucorrhoea, acrid, with burning in vagina.
Magnesium Muriaticum- Leucorrhoea: after exercise; with every stool; with uterine spasm; followed by metrorrhagia; two weeks after menses for three or four days.
Medorrhinum– Sensitive spot near os uteri. Leucorrhoea thin, acrid, excoriating, fishy odor. Sycotic warts on genitals. Ovarian pain, worse left side, or from ovary to ovary.
Mercurius Solubilis– Leucorrhoea excoriating, greenish and bloody; sensation of rawness in parts. Stinging pain in ovaries. Itching and burning; worse, after urinating; better, washing with cold water. Morning sickness, with profuse salivation.
Millefolium- Leucorrhoea of children from atony.
Muriaticum Acidum– Menses appear too soon. Leucorrhoea. During menses, soreness of anus. Ulcer in genitals.
Murex Purpurea- Leucorrhoea: < mental depression, happier when leucorrhoea is worse.
Natrium Muriaticum– Vagina dry. Leucorrhoea acrid, watery. Bearing-down pains; worse in morning. Prolapsus uteri, with cutting in urethra. Vaginitis with discharge resembling egg-white, which itches and makes the vagina feel dry and irritated.
Nitricum Acidum– Leucorrhoea brown, flesh-colored, watery, or stringy, Offensive.
Nux Moschata– Leucorrhoea muddy and bloody. Suppression, with persistent fainting attacks and sleepiness.
Petroleum– Leucorrhoea, profuse, albuminous.
Phosphoricum Acidum– Itching; yellow leucorrhoea after menses. Milk scanty; health deteriorated from nursing.
Phosphorus– Leucorrhoea profuse, smarting, corrosive, instead of Menses.
Psorinum- Leucorrhoea: large, clotted lumps of an intolerable odor; violent pains in sacrum; debility; during climaxis.
Pulsatilla Pratensis– Leucorrhoea acrid, burning, creamy. Pain in back; tired feeling.
Sabina– Leucorrhoea after menses, corrosive, offensive. Discharge of blood between periods, with sexual excitement.
Sanguinaria Canadensis- Leucorrhoea at climaxis.
Sanicula Aqua- Leucorrhoea with strong odor of fish brine.
Secale Cornutum- Leucorrhoea; green, brown, offensive.
Sepia Officinalis– Pelvic organs relaxed. Bearing-down sensation as if everything would escape through vulva; must cross limbs to prevent protrusion, or press against vulva. Leucorrhoea yellow, greenish; with much itching. Violent stitches upward in the vagina, from uterus to umbilicus.
Silicea Terra– A milky, acrid leucorrhoea, during urination. Itching of vulva and vagina; very sensitive. Discharge of blood between menstrual periods.
Stannum Metallicum– Leucorrhoea, with great debility.
Sulphur– Pudenda itches. Vagina burns. Much offensive perspiration. Leucorrhoea, burning, excoriating. Nipples cracked; smart and burn.
Syphilinum- Leucorrhoea: profuse, soaking through the napkins and running down to the heels.
Thlaspi Bursa Pastoris- Leucorrhoea: bloody, dark, offensive; some days before and after menses.4,5,6
Physiological leucorrhea is normal and generally not a thing of concern. Pathological leucorrhea definitely requires medical attention and needs to be treated to prevent complications.
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- M Helen. ABC of sexually transmitted infections Vaginal discharge – causes, diagnosis, and treatment. BMJ 2004 May [cited 2019 1 April]. 2004; 328: 1306. Available from: https://www.bmj.com/content/328/7451/1306.
- S Des, M Catriona. Vaginal discharge. BMJ Int. [cited 2019 April 2]. 2007; 335: 1147-51. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2099568.
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