Vaginal discharges
Common in women of childbearing age, a physiologic vaginal discharge is mucoid, clear or white, nonbloody, and odorless. Produced by the cervical mucosa and, to a lesser degree, by the vulvar glands, this discharge may occasionally be scant or profuse because of estrogenic stimulation and changes during the patient’s menstrual cycle. However, a marked increase in discharge or a change in discharge color, odor, or consistency can signal disease and may result from infection, sexually transmitted disease, reproductive tract disease, fistulas, and the use of certain drugs. In addition, the prolonged presence of a foreign body, such as a tampon or diaphragm, in the patient’s vagina can cause irritation and an inflammatory exudate, as can frequent douching and the use of feminine hygiene products, contraceptive products, bubble baths, and colored or perfumed toilet papers.
TopHistory and physical examination
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had a vagi
nal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.
Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 792.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
TopMedical causes
TopAtrophic vaginitis
In this disorder, a scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
TopBacterial Vaginosis
This infection, caused by Gardnerella vaginalis (formerly called Haemophilus vaginalis), results from an ecozogic disturbance of the vaginal flora. It produces a thin, foul-smelling, green or gray-white discharge that adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other mild signs of vaginal irritation may also occur.
TopCandidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
TopChancroid
This rare but highly contagious sexually transmitted disease produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and a fever as high as 102.2° F (39° C) are common.
TopChlamydial infection
This infection causes a yellow, mucopurulent, odorless or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially after menses. Many women, however, remain asymptomatic.
TopEndometritis
A scant serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, low back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
TopGenital warts
These mosaic, papular vulvar lesions can cause a profuse mucopurulent vaginal discharge, which may be foul smelling if the warts are infected. Patients commonly complain of burning or paresthesia in the vaginal introitus.
TopGonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a foul-smelling yellow or green discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
TopGynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
TopHerpes simplex (genital)
A copious mucoid discharge results from this disorder, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
TopTrichomoniasis
This infection can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; an inflamed, erythematous vagina with tiny petechiae; dysuria and urinary frequency; dyspareunia; postcoital spotting; and menorrhagia or dysmenorrhea. About 70% of patients are asymptomatic.
TopOther causes
TopContraceptive creams and jellies
These products can increase vaginal secretions.
TopDrugs
Drugs that contain estrogen, including hormonal contraceptives, can cause a mucoid vaginal discharge. Antibiotics such as tetracycline may increase the risk of a candidal vaginal infection and associated discharge.
TopRadiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
TopSpecial considerations
Teach the patient to keep her perineum clean and dry. Also, tell her to avoid wearing tight-fitting clothing and nylon underwear and to instead wear cotton-crotched underwear and pantyhose. If appropriate, suggest that the patient douche with a solution of 5 tbsp of white vinegar in 2 qt (2 L) of warm water to help relieve her discomfort.
If the patient has a vaginal infection, tell her to continue taking the prescribed medication even if her symptoms clear or she menstruates. Also, advise her to avoid intercourse until her symptoms clear and then to have her partner use condoms until she completes her course of medication. If her condition is sexually transmitted, teach her about safer sex methods.
TopPediatric pointers
Female neonates who have been exposed to maternal estrogens in utero may have a white mucous vaginal discharge for the first month after birth; a yellow mucous discharge indicates a pathologic condition. In an older child, a purulent, foul-smelling and, possibly, bloody vaginal discharge commonly results from a foreign object placed in the vagina; in such cases, consider the possibility of sexual abuse.
TopGeriatric pointers
The vaginal mucosa becomes thin in postmenopausal women because of their decreased estrogen levels. This mucosal thinning combined with a rise in vaginal pH results in decreased resistance to infectious agents and an increased incidence of vaginitis.
TopPictures
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
TopMore About Sexually Transmitted Diseases
Back to disease: Sexually Transmitted Diseases: Introduction
Next Book Extract About Sexually Transmitted Diseases: Vaginal Discharge (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
More Book Extracts: All Online Books for Sexually Transmitted Diseases
TopMore Medical Textbooks Online about Sexually Transmitted Diseases
Review other book chapters online related to Sexually Transmitted Diseases:
16 MEDICAL BOOKS ONLINE!Full text. Free access (no registration).
VAGINAL DISCHARGE
"Algorithmic Diagnosis of Symptoms and Signs"
[ read ]
Vaginal Discharge
"In a Page: Signs and Symptoms"
[ read ]
Vaginal Discharge
"In A Page: Pediatric Signs and Symptoms"
[ read ]
VAGINAL DISCHARGE
"Differential Diagnosis in Primary Care"
[ read ]
Genital lesions in the male
"Handbook of Signs & Symptoms (Third Edition)"
[ read ]
Vaginal discharge
"Handbook of Signs & Symptoms (Third Edition)"
[ read ]
Introduction: Sexual Disorders
"Professional Guide to Diseases (Eighth Edition)"
[ read ]
Genital lesions in the male
"Professional Guide to Signs & Symptoms (Fifth Edition)"
[ read ]
Vaginal discharge
"Professional Guide to Signs & Symptoms (Fifth Edition)"
[ read ]
Vaginal Discharge
"The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter"
[ read ]
Vaginal Discharge
"Field Guide to Bedside Diagnosis"
[ read ]
Genital lesions in the male
"Signs & Symptoms: A 2-in-1 Reference for Nurses"
[ read ]
Vaginal discharge
"Signs & Symptoms: A 2-in-1 Reference for Nurses"
[ read ]
Vaginal Discharge
"The Diagnostic Approach to Symptoms and Signs in Pediatrics"
[ read ]
Vaginal discharge
"Nursing: Interpreting Signs and Symptoms"
[ read ]
Genital lesions, male
"Nursing: Interpreting Signs and Symptoms"
[ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9
Common in women of childbearing age, a physiologic vaginal discharge is mucoid, clear or white, nonbloody, and odorless. Produced by the cervical mucosa and, to a lesser degree, by the vulvar glands, this discharge may occasionally be scant or profuse because of estrogenic stimulation and changes during the patient’s menstrual cycle. However, a marked increase in discharge or a change in discharge color, odor, or consistency can signal disease and may result from infection, sexually transmitted disease, reproductive tract disease, fistulas, and the use of certain drugs. In addition, the prolonged presence of a foreign body, such as a tampon or diaphragm, in the patient’s vagina can cause irritation and an inflammatory exudate, as can frequent douching and the use of feminine hygiene products, contraceptive products, bubble baths, and colored or perfumed toilet papers.
TopHistory and physical examination
Ask the patient to describe the onset, color, consistency, odor, and texture of her vaginal discharge. How does the discharge differ from her usual vaginal secretions? Is the onset related to her menstrual cycle? Also, ask about associated symptoms, such as dysuria and perineal pruritus and burning. Does she have spotting after coitus or douching? Ask about recent changes in her sexual habits and hygiene practices. Is she or could she be pregnant? Next, ask if she has had a vagi
nal discharge before or has ever been treated for a vaginal infection. What treatment did she receive? Did she complete the course of medication? Ask about her current use of medications, especially antibiotics, oral estrogens, and hormonal contraceptives.Examine the external genitalia and note the character of the discharge. (See Identifying causes of vaginal discharge, page 792.) Observe vulvar and vaginal tissues for redness, edema, and excoriation. Palpate the inguinal lymph nodes to detect tenderness or enlargement, and palpate the abdomen for tenderness. A pelvic examination may be required. Obtain vaginal discharge specimens for testing.
TopMedical causes
TopAtrophic vaginitis
In this disorder, a scant, watery white vaginal discharge may be accompanied by pruritus, burning, tenderness, and bloody spotting after coitus or douching. Sparse pubic hair, a pale vagina with decreased rugae and small hemorrhagic spots, clitoral atrophy, and shrinking of the labia minora may also occur.
TopBacterial Vaginosis
This infection, caused by Gardnerella vaginalis (formerly called Haemophilus vaginalis), results from an ecozogic disturbance of the vaginal flora. It produces a thin, foul-smelling, green or gray-white discharge that adheres to the vaginal walls and can be easily wiped away, leaving healthy-looking tissue. Pruritus, redness, and other mild signs of vaginal irritation may also occur.
TopCandidiasis
Infection with Candida albicans causes a profuse, white, curdlike discharge with a yeasty, sweet odor. Onset is abrupt, usually just before menses or during a course of antibiotics. Exudate may be lightly attached to the labia and vaginal walls and is commonly accompanied by vulvar redness and edema. The inner thighs may be covered with a fine red dermatitis and weeping erosions. Intense labial itching and burning may also occur. Some patients experience external dysuria.
TopChancroid
This rare but highly contagious sexually transmitted disease produces a mucopurulent, foul-smelling discharge and vulvar lesions that are initially erythematous and later ulcerated. Within 2 to 3 weeks, inguinal lymph nodes (usually unilateral) may become tender and enlarged, with pruritus, suppuration, and spontaneous drainage of nodes. Headache, malaise, and a fever as high as 102.2° F (39° C) are common.
TopChlamydial infection
This infection causes a yellow, mucopurulent, odorless or acrid vaginal discharge. Other findings include dysuria, dyspareunia, and vaginal bleeding after douching or coitus, especially after menses. Many women, however, remain asymptomatic.
TopEndometritis
A scant serosanguineous discharge with a foul odor can result from bacterial invasion of the endometrium. Associated findings include fever, low back and abdominal pain, abdominal muscle spasm, malaise, dysmenorrhea, and an enlarged uterus.
TopGenital warts
These mosaic, papular vulvar lesions can cause a profuse mucopurulent vaginal discharge, which may be foul smelling if the warts are infected. Patients commonly complain of burning or paresthesia in the vaginal introitus.
TopGonorrhea
Although 80% of women with gonorrhea are asymptomatic, others have a foul-smelling yellow or green discharge that can be expressed from Bartholin’s or Skene’s ducts. Other findings include dysuria, urinary frequency and incontinence, bleeding, and vaginal redness and swelling. Severe pelvic and lower abdominal pain and fever may develop.
TopGynecologic cancer
Endometrial or cervical cancer produces a chronic, watery, bloody or purulent vaginal discharge that may be foul smelling. Other findings include abnormal vaginal bleeding and, later, weight loss; pelvic, back, and leg pain; fatigue; urinary frequency; and abdominal distention.
TopHerpes simplex (genital)
A copious mucoid discharge results from this disorder, but the initial complaint is painful, indurated vesicles and ulcerations on the labia, vagina, cervix, anus, thighs, or mouth. Erythema, marked edema, and tender inguinal lymph nodes may occur with fever, malaise, and dysuria.
TopTrichomoniasis
This infection can cause a foul-smelling discharge, which may be frothy, green-yellow, and profuse or thin, white, and scant. Other findings include pruritus; an inflamed, erythematous vagina with tiny petechiae; dysuria and urinary frequency; dyspareunia; postcoital spotting; and menorrhagia or dysmenorrhea. About 70% of patients are asymptomatic.
TopOther causes
TopContraceptive creams and jellies
These products can increase vaginal secretions.
TopDrugs
Drugs that contain estrogen, including hormonal contraceptives, can cause a mucoid vaginal discharge. Antibiotics such as tetracycline may increase the risk of a candidal vaginal infection and associated discharge.
TopRadiation therapy
Irradiation of the reproductive tract can cause a watery, odorless vaginal discharge.
TopSpecial considerations
Teach the patient to keep her perineum clean and dry. Also, tell her to avoid wearing tight-fitting clothing and nylon underwear and to instead wear cotton-crotched underwear and pantyhose. If appropriate, suggest that the patient douche with a solution of 5 tbsp of white vinegar in 2 qt (2 L) of warm water to help relieve her discomfort.
If the patient has a vaginal infection, tell her to continue taking the prescribed medication even if her symptoms clear or she menstruates. Also, advise her to avoid intercourse until her symptoms clear and then to have her partner use condoms until she completes her course of medication. If her condition is sexually transmitted, teach her about safer sex methods.
TopPediatric pointers
Female neonates who have been exposed to maternal estrogens in utero may have a white mucous vaginal discharge for the first month after birth; a yellow mucous discharge indicates a pathologic condition. In an older child, a purulent, foul-smelling and, possibly, bloody vaginal discharge commonly results from a foreign object placed in the vagina; in such cases, consider the possibility of sexual abuse.
TopGeriatric pointers
The vaginal mucosa becomes thin in postmenopausal women because of their decreased estrogen levels. This mucosal thinning combined with a rise in vaginal pH results in decreased resistance to infectious agents and an increased incidence of vaginitis.
TopPictures
Copyright Details: Professional Guide to Signs & Symptoms (Fifth Edition), Copyright © 2006 Lippincott Williams & Wilkins.
TopMore About Sexually Transmitted Diseases
Back to disease: Sexually Transmitted Diseases: Introduction
Next Book Extract About Sexually Transmitted Diseases: Vaginal Discharge (The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
More Book Extracts: All Online Books for Sexually Transmitted Diseases
TopMore Medical Textbooks Online about Sexually Transmitted Diseases
Review other book chapters online related to Sexually Transmitted Diseases:
16 MEDICAL BOOKS ONLINE!Full text. Free access (no registration).
VAGINAL DISCHARGE
"Algorithmic Diagnosis of Symptoms and Signs"
[ read ]
Vaginal Discharge
"In a Page: Signs and Symptoms"
[ read ]
Vaginal Discharge
"In A Page: Pediatric Signs and Symptoms"
[ read ]
VAGINAL DISCHARGE
"Differential Diagnosis in Primary Care"
[ read ]
Genital lesions in the male
"Handbook of Signs & Symptoms (Third Edition)"
[ read ]
Vaginal discharge
"Handbook of Signs & Symptoms (Third Edition)"
[ read ]
Introduction: Sexual Disorders
"Professional Guide to Diseases (Eighth Edition)"
[ read ]
Genital lesions in the male
"Professional Guide to Signs & Symptoms (Fifth Edition)"
[ read ]
Vaginal discharge
"Professional Guide to Signs & Symptoms (Fifth Edition)"
[ read ]
Vaginal Discharge
"The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter"
[ read ]
Vaginal Discharge
"Field Guide to Bedside Diagnosis"
[ read ]
Genital lesions in the male
"Signs & Symptoms: A 2-in-1 Reference for Nurses"
[ read ]
Vaginal discharge
"Signs & Symptoms: A 2-in-1 Reference for Nurses"
[ read ]
Vaginal Discharge
"The Diagnostic Approach to Symptoms and Signs in Pediatrics"
[ read ]
Vaginal discharge
"Nursing: Interpreting Signs and Symptoms"
[ read ]
Genital lesions, male
"Nursing: Interpreting Signs and Symptoms"
[ read ]
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
More About This Book: Title: Professional Guide to Signs & Symptoms (Fifth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2006 ISBN: 1-58255-510-9
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