This document discusses abnormal vaginal discharge, including its definition, prevalence, causes, examination, and treatment. Some key points: 1. Abnormal vaginal discharge is defined as excessive discharge not associated with menstruation, offensive or malodorous discharge, or yellowish/mucopurulent discharge. 2. Approximately 1/3 of females may complain of abnormal vaginal discharge, which can occur at any age. Many clinics report 70% of pregnant women experience it due to infection. 3. Causes include physiological changes, infections like bacterial vaginosis, candidiasis, and trichomoniasis, chemical irritation, and foreign bodies. Examination involves history, appearance, pH

1. By Dr.Hafsa Asim
VAGINAL DISCHARGE

2. • Vaginal discharge is the most common
presenting complaint of females attending obs
department.
• Excessive vaginal discharge may be
physiological or Pathological.

3. DEFINITION
Abnormal vaginal discharge (AVD) is defined as any one
of the three presentations,
• 1. Excessive vaginal discharge not associated with
menstruation; pre, mid and post period.
• 2. Offensive or malodorous discharge
• 3. Yellowish or mucopurulent discharge

4. PREVALANCE
It has been estimated that approximately
1/3 rd of female patients may complain of
abnormal vaginal discharge.
It can occur in females of all ages,from neonatal to the
post menopausal period and it is quite common during
pregnancy.
Many clinics have reported that 70% of pregnant women
manifest Abnormal vaginal discharge due to lower genital
tract infection.

5. NORMAL DISCHARGE
• Floccular in consistency
• Whitish and non malodourous
• Normal pH is acidic ranging from 3.5 to 4.5 due to
Lactobacilli which convert glycogen to lactic acid
• Secondary fermentation of endocervical mucus by
vaginal flora also contribute to low pH.

6. Normal Flora :
i. Lactobacilli : • Found in 96% of women
ii. Concentrations 105 to 108 / ml.
iii. Protective effect by interfering with adherence to epithilial cells
iv. Facultative organisms : • Diphtheroids – streptococci – E.coli –
ureapalasma urealyticum – mycoplasma hominis i. Anaerobic
organisms : • Peptostreptococci – bacteroid - fusobacterium

7. CAUSES FOR VAGINAL DISCHARGE
• PHYSIOLOGICAL :
AGE-DEPENDENT :
1.NEONATE AND INFANT
2.PRE-PUBERTY
3.CHILD BEARING
4.POST MENOPAUSAL

8. • EXCESSIVE SECRETION :
1.PREGNANCY
2.SEXUAL AROUSAL
PATHOLOGICAL :
A) NON-INFECTIVE CHEMICAL IRRITATION –Antiseptics,bath additives
deodorants,detergent spermicides,douches, perfumed soaps.
B) FOREIGN BODIES IUCD,RETAINED MATERIALS,RETAINED TAMPONS
RETAINED SHEATHS GYNAECOLOGICAL CONDITIONS ENDOCERVICAL
C) INFECTIVE CAUSES CERVICITIS
1.HERPES GENITALIS
2.MUCOPURULENT CERVICITIS— a) Gonococcal b) Non gonococcal- Chlamydia
positive and Chlamydia negative VAGINITIS 1.BACTERIAL VAGINOSIS 2.VAGINAL
CANDIDIASIS 3.VAGINAL TRICHOMONIASIS

9. • CHILD BEARING AGE :
Causes for increased vaginal secretion during child bearing age is as
follows:
1.Mid cycle stimulation of endo cervical glands by oestrogen
2. EXOGENOUS-Semen of recent ejaculation
3. Mid cycle discharge is sufficient to keep the vagina moist and
usually does not stain the under garments.It may be associated with
Mittelshmerz or mid cycle unilateral pelvic discomfort.

10. • POST MENOPAUSAL PERIOD
There is atropy of vaginal epithelium due to diminished
estrogen secretion
Thin,serous discharge,occasionally blood stained and
associated with itching and burning.
Small areas of granulation and ulceration
along with slight vaginal bleeding may develop
.Most common cause of Abnormal
Vaginal discharge is Atropic vulvovaginitis.

11. EXAMINATION

12. HISTORY:
Source of discharge must be determined.
Perineal discharge could originate from vagina, cervix, urinary tract and rectum
Ascertain the following attributes of the discharge: quantity, duration, colour,
consistency and odour. Symptoms include : itching or burning . External
Dysuria, Dyspareunia
Obtain history of the following: • Prior similar episodes • Sexually transmitted
infection • Sexual activities • Birth control method • Last menstrual period •
Douching practice • Antibiotic use • General medical history •
Systemic symptoms such as lower abdominal pain, fever, chills, nausea, and
vomiting

13. PHYSICAL EXAMINATION
Appearance of discharge.
Erythema and edema of vaginal mucosa
pH levels
Diagnostic Tools:
pH : Nitrazine paper ,Wet prep: microscopic examination of
discharge ( clue cells of BV)
KOH prep: dissolves cellular debris leaving pseudohyphae of
candida.
Whiff test: Fishy odor of BV Culture

14. Bacterial Vaginosis Medication:
Oral: metronidazole 500mg bid for
7 days, or clindamycine 300mg bid for 7 days.
2. Vaginal: metronidazole gel 0.75% bid for 5 days, or
clindamycine cream 2% for 7 days.
NO TREATMENT OF SEXUAL PARTNER IS NEEDED

15. • Candida medication
Clotrimazole 1% cream 5g intravaginally for 7-14 days OR 2% for 3 days
OR
Miconazole 2% for 7 days OR 4% for 3 days
OR
Tioconazole 6.5% single application
OR
Butoconazole 2% single application
OR
Terconazole 0.4% for 7 days OR 0.8% for 3 days
ORAL AGENT:
Fluconazole 150mg orally single dose

16. • Trichomonas Vaginitis Medication
Metronidazole 2g orally single dose
OR
Tinidazole 2g orally single dose
Alternative regimen
Metronidazole 500mg orally twice a day for 7 days