Gynaecological Problems, Vaginal discharge, Leucorrhoea. Pathological Vaginal discharge. Vaginal defence mechanism. Causes, Signs, Symptoms, Investigation, Diagnosis & Treatment of Pathological Vaginal discharge. Useful for all medical students and clinical practitioners.

1. PATHOLOGICAL
Vaginal Discharge
DR. RAMVEER SHARMA
M.D. Ayu.(PT&SR)
PROF.& H.O.D.
Prasuti Tantra & Stree Roga Dep't.
M.M.M .Govt. Ayu. College UDAIPUR
Mob. 9414757932
Email. ramveersharma1960@gmail.com
Patho. Vaginal Discharge
DR. RAMVEER SHARMA

2. Excess
Abnormal Vaginal Discharge
NON INFECTIVE INFECTIVE FOREIGN BODYNEOPLASM
Leucorrhoea
Physiological
Cervical Cause Vaginal Cause
Specific
Pathological
Non - Specific
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

3. Defense Mechanism of reproductive tract
Mechanical (Anatomical) Chemical (Physiological)
Vulval •Apposition of the labia
(close the cleft)
• High resistance of
Vulval, Perineal Skin.
• Appocrine glands
secretion (Fungicidal).
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

4. Mechanical (Anatomical) Chemical (Physiological)
Vaginal • Apposition of Ant. Post.
Wall,
• Transverse rugae.
• Stratified epithelium
devoid of glands.
•Oestrogene –
Proliferation of
epithelium.
• Multi layered
epithelium.
•Glycogen + Doderlein’s
bacilli = Lactic acid
•Acid 3.5 – 4.5 Vaginal
Ph.(Bactericidal)
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

5. Mechanical(Anatomical) Chemical(Physiological)
Cervical •Narrow Endocervical
canal
•Racemosus type glands
•Mucous plug
•Downwards flow of
mucous
•Antibacterial Lysosome.
•Bactericidal effect of
the mucous plug.
•Local Ig. A.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

6. Mechanical (Anatomical) Chemical (Physiological)
Uterine Closer of uterine ostium
due to inflammatory
reaction.
• Cyclic shedding of the
endometrium
Tubal Integrated mucous plicae
and cilia.
•Peristalsis and ciliary
movement of the tube
towards the uterus.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

7. (2) PATHOLOGICAL :-
General causes – 1/3 of all cases.
 Ill health and under nutrition.
 Anaemia,
 Liver dysfunction,
 Chronic Colitis,
 Chronic constipation.
 All causes of pelvic congestion.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

8. Dysfunctional – 7%
 Endocrinal dysfunction.
 Marital disharmony.
 Psychosomatic and psychological trauma
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

9. Genital causes – 2/3 of cases pelvic factors
 Vulval 1% - Growth and Ulcers.
 Vaginal 20% - Vaginitis – Gonorrheal , Monilial, Trichomonal
and Amoebic.
 Cervical 28% - Cervical erosion 20%,
 Post abortal, Puerperal.
 Chronic Cervicitis 7%
 Cervical carcinoma 1%
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

10.  Uterine 1% - endometritis –
 Puerperal, Tubercular, or senile.
 Tumours 1%
 Genital prolepses 10%
 Contraceptives 2% - IUCD - Cu T, Loop, Oral and local
chemical.
 PID. 2%.
 Pregnancy 3%.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

11. Stage of life Causes Pathology Characters of
discharge
Before
Puberty
Foreign body in
vagina
Vulvo
Vaginitis
Mucopurulent
After
puberty
(a) Virgins
Anaemia,
Colitis,
Constipation,
Poor General
Health, Unclean
Personal
Hygiene,
Mild Vaginitis
Transudation
From Vaginal
Mucus
Membrane
Excessive Thin,
Watery,
Cervical
Mucous
Patho. Vaginal Discharge

12. Stage of life Causes Pathology Characters of
discharge
After
puberty
(a) Virgins
Masturbation
Endocrine
Dysfunction -
Vaginal Cervical
Erosion.
Mild Vaginitis
Transudation
From Vaginal
Mucus
Membrane
Excessive Thin,
Watery,
Cervical
Mucous
Patho. Vaginal Discharge

13. Stage of life CAUSES Pathology Characters of
discharge
Nulliparous
Married
Infections-
Gonococcal
Chlamydial,
Trichomonal,
Monilial,
Pyogenic
Vaginitis,
Cervicitis,
Bartholinitis
Profuse,
Mucopurulent
with – Itching
Burning,
Pain and other
Symptoms.
Patho. Vaginal Discharge

14. Stage of life CAUSES Pathology Characters of
discharge
Nulliparous
Married
Retained
IUCD and
Tampons,
Oral pills
Sexual excess
Pelvic
Congestion,
Vagino
Cervicitis
Mucoid Or
Mucopurulent
Infertility Congestion
with D.U.B.
Mucoid Or
Watery
Granulating
tears
Vaginal,
Cervical,
Perineal scars
Serous,
Mucoid, may
be Purulent.
Patho. Vaginal Discharge

15. Stage of life Causes Pathology Characters of
discharge
Post child birth Hormonal
changes
Physiological
Erosion
Mucoid &
watery
Parous women
During child
bearing period
Ill health &
Anaemia
Increased
epithelial
permeability
Mucoid or
Mucopurulent.
Patho. Vaginal Discharge

16. Stage of life CAUSES Pathology Characters of
discharge
Parous women
During child
bearing period
Constipation
& Chronic
dysentery
Congestion &
Vaginitis
Mucoid or
Purulent.
Cervical
erosion
Increased
exudation
Mucoid
Cervical
infections
Chronic
Cervicitis
Mucopurulent,
with slight
discomfort.
Patho. Vaginal Discharge

17. Stage of life Causes Pathology Characters of
discharge
Parous women
During child
bearing period
Trichomonal Vaginitis,
Cervicitis
Mucopurulent,
Copious thick,
Watery, Yellowish
or Greenish,
Sudden and
Profuse, with
Itching
Patho. Vaginal Discharge

18. Stage of life Causes Pathology Characters of
discharge
Parous women
During child
bearing period
Infections
Monilial Vaginitis,
Cervicitis
Mucopurulent,
Curdy White flacks,
Adherent to vaginal
wall
Bacterial Vaginitis,
Cervicitis
Purulent, profuse,
offensive, with pain.
Patho. Vaginal Discharge

19. Stage of life Causes Pathology Characters of
discharge
Parous women
During child
bearing period
•Genital
Prolepses
• Retained
Passary
Vaginitis
Decubitus
Ulcers
Mucopurulent
or Blood
Stained
Excess Vaginal
Medication
Douche Etc.
Chemical
Vaginitis
Mucous Or
Mucopurulent
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

20. Stage of life Causes Pathology Characters of
discharge
Premenopausal Uterine -
Polypi,
Fibroids,
Prolapse,
Carcinoma.
Increased
Congestion
Mucoid Blood
Stained.
Post menopausal Cancer of
Genital Tract,
Prolapse,
Senile
Vaginitis,
Endometritis,
Pyometra
Blood Stained,
Mucopurulent,
Purulent.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

21. Period of life Symptoms Diagnosis
Neonatal Nil True leucorrhoea
Pre menarche Nil Chronic ill health
Offensive Foreign body
With itching Thread worm
Puberty Nil True leucorrhoea
Reproductive life
pill users
Nil True leucorrhoea
Ill health
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

22. Period of life Symptoms Diagnosis
Non pregnant related to
MC
Nil True leucorrhoea,
Anaemia
Any time With
pruritus
Trichomonal, Monilial
Infective vaginitis
Offensive Neoplasm, Foreign body.
During antibiotic
therapy
Pruritus Monaliasis
Diabetes Pruritus Monaliasis
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

23. Period of life Symptoms Diagnosis
Pregnancy Nil True leucorrhoea
Pruritus Monilial vaginitis
Post menopausal Nil Senile vaginitis
Pruritus, offensive Monaliasis,
Pyometra,
Neoplasm
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

24. DIAGNOSIS
Non – Offensive.
Non – Irritant. Physiological
Examination
• General – Ill health
• Local – Inspection – Discharge – Quantity and Characters.
* P/S – Pelvic lesion – Vaginitis, Cervicitis, Erosion, Growth.
* Lab – No. of pus cells ?
Patho. Vaginal Discharge

25. DIFFRENTIAL DIAGNOSIS
Infective :-
1) Trichomonas – Frothy, Yellowish.
2) Monilial – Curdy, white Flakes
3) Cervicitis – Mucoid / Mucopurulent.
4) Herpes – Watery purulent.
5) Foreign Body – Offensive, Copious, Blood Stained.
6) Neoplasm – Serosanguinous, Offensive.
Patho. Vaginal Discharge

26. INVESTIGATION :-
HISTORY :-
 Age, Marriage, Marital life, Parity should be noted.
 H./O. Present illness-
 Characters of the leucorrhoea.
 Its duration, relation with menstruation and pregnancy.
 Vulval irritation itching burning (trichomonal, monilial),
 Onset of discharge- rapidly or insidiously.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

27. INVESTIGATION :-
 Menstrual history(MH),
 Obstetric history(OH) and
 Contraceptive history(CH).
 H./O. – Past illness- Tuberculosis, Anaemia, Dysentery,
Colitis, constipation, Systematic disease,
 Antibiotic therapy,
 Psychiatric illness.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

28. EXAMINATION:-
 Per abdomen (PA)- Enlarged – Pelvic tumour, Inflammatory
lesion.
 Per vaginal (PV) – Inspection of the Vulva, Perineum, Vagina
and Urethra.
 Palpation of cervix, uterus and adneaxae – Inflammation, any
growth and foreign body.
 Per rectum(PR) –in virgins under general anaesthesia.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

29.  Characters of the discharge:- Colour, Odour, Consistency.
 Colour - Curdy white flakes – Monilial infection.
 - Greenish yellow, frothy – Trichomonas vaginalis.
 Consistency – Serous, Mucoid, Mucopurulent, Purulent,
Urinary fecal or blood stained.
 Odour - Offensive – Retained foreign body, Infection,
Neoplasia.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

30.  Vaginal smear – for Trichomonas vaginalis, Monaliasis,
staining and culture.
 No pus cells detected – True leucorrhoea.
 Pus cells are detected – Further investigation for identifies the
organisms, Neoplasia and foreign body by hanging drop
preparation,
 Gram stain and culture.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

31.  Urine - Routine, pus cell and sugar.
 Stool - Routine, ova, parasite cyst and blood.
 Blood - Hb%, TLC, DLC, ESR,VDRL, and sugar.
 X Ray - Chest and pelvis.
 USG lower abdomen - For pelvic lesions.
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

32. TREATMENT:-
 Pathological - treat according to cause.
 Cervical factors – Surgical treatment, electro cautery, cryo
surgery, Trachelorrhaphy.
 Pelvic lesions – appropriate therapy for pathology.
 Pills users - should be stop the pills for a short time
(temporarily).
DR. RAMVEER SHARMA
Patho. Vaginal Discharge

33. HERBAL
•Amalaki seeds powder -A 2-3 grams / day with Honey / Sugar.
•Chandana attar - Five drops off Chandana Attar (Sandal wood
oil)With (Plantain) twice.
•Mango seed powder - 1-2 gms / twice daily
•Fenugreek Seeds - The 2 tsp of fenugreek seeds / twice daily.
•Guava:: Tender leaves
•Walnut leaves - A decoction of fresh walnut.
Patho. Vaginal Discharge

34. DR.RAMVEER SHARMA
Patho. Vaginal Discharge