WHAT'S THAT VAGINAL DISCHARGE?
What is Vaginal Discharge? What’s normal and what’s not??
Vaginal discharge is fluid that comes out from the vagina. It’s very normal to have discharge — some women have more than others, and the color, amount, and type varies depending on where you are in your menstrual cycle.
For example, when you are ovulating, it’s normal to have a very thick, gel-like, stretchy and stringy cervical mucous like an egg white (called “spinnbarkeit”) which comes out from the vaginal. Ovulation fertility kits usually recommend looking for this.
There are other glands that can produce fluids too, such as the Bartholin’s and Skene’s glands.
This post will talk about ABNORMAL discharge, which usually means there’s an infection of some kind going on in the vagina. A vaginal infection is called “Vaginitis”.
It can be a Sexually Transmitted Infection (STI) such as Gonorrhea or Chlamydia or Trichomonas, or it can be an infection that doesn’t relate to sexual activity at all.
Doctors can do tests by sending off swabs of the discharge to the laboratory, but also we can look at the discharge directly under a microscope in the office, called a “Wet Prep” test to get a diagnosis faster.
We often like to do a pelvic exam (using the same tool we use to collect a pap smear, a speculum) so we can get more information, such as how the cervix (opening of the uterus) looks, but if that makes you nervous or uncomfortable, we can also give you a cotton swab so you can collect the sample yourself.
The 3 infections we can diagnose with a “Wet Prep” are:
1. BACTERIAL VAGINOSIS ("BV")
BV is caused by an overgrowth of bacteria that is naturally in the vagina. It classically has a “fishy” smell. This can happen to anyone, even without sexual activity!!
We diagnose it under the microscope by looking for “Clue Cells” (cells studded with bacteria). It’s normal to have 20% Clue Cells on the slide, but more than that would suggest BV.
We treat BV with a medication called Flagyl, which can be taken as a pill or a gel you put in the vagina, for 5-7 days. It’s important to AVOID ALCOHOL while taking this medication since it can make you very sick if you drink while taking it!!
2. TRICHOMONIASIS ("TRICH" -PRONOUNCED "TRICK")
Trich is a Sexually Transmitted Infection (STI). It classically results in a yellowish-green, frothy discharge.
Trichomonas are little protozoan parasites that we can see under the microscope… sometimes they are even still moving/wiggling.
It can also cause your cervix (the opening to your uterus) to become red and dotted with small dots of bleeding. This is known as a “Strawberry Cervix” and almost always means a Trich infection. We can see this if we do a pelvic exam with a speculum.
Thankfully, this is also treatable. It’s the same treatment as BV – a 5-7 day course of Flagyl. Once again, it’s important to NOT DRINK ALCOHOL while taking this medication since it can make you very sick!!
3. YEAST/FUNGAL INFECTION
Last but not least, we have the Yeast/Fungal infection. This is caused by an overgrowth of the normal Candida Albicans Yeast, a type of Fungus, which lives naturally in the vagina.
Yeast infections can be caused by taking antibiotics, having a suppressed immune system such as in HIV or Diabetes, or many other factors.
The discharge is usually THICK and WHITE, like Cottage Cheese. It usually also causes itching and sometimes redness of the vulva and vagina.
It’s treated with anti-fungal medicines. You can try one over the counter first without needing a doctor’s prescription, called Monistat. If that doesn’t work, your doctor will prescribe you usually Fluconazole, which is a 1 time dose, with 1 refill/re-dose if your symptoms do not improve after 3 days.
All these vaginal infections (Vaginitis) can be helped by using condoms/barrier methods during sex, since your partner will carry bacteria and yeast on their bodies as well which can throw off the balance of yours.
You can also decrease your chances of getting them by practicing good “Vulvar/Vaginal Hygiene” – lifestyle habits that can make a big difference!!
Contrary to popular belief, the Vagina is a SELF-CLEANING ORGAN – using scented soaps, perfumes, or douching will just throw off the natural balance of bacteria and yeast/fungus in there!!
This chart is directly from UpToDate.com, one of the most trusted sources doctors consult and need a subscription for! You can search for and find free reading material at any time by going to Uptodate.com/patient
While these are the only 3 infections we can diagnose with the “Wet Prep” test, we shouldn’t forget that other infections can cause changes in the vaginal discharge.
These are Gonorrhea and Chlamydia, both Sexually Transmitted Infections (STIs). They can cause yellow or green discharge, or no change at all.
These can cause INFERTILITY thus they are incredibly important to catch and treat early!! There is no way to make a diagnosis of these the same day, but your doctor can do a swab of the cervix (it requires a pelvic exam with a speculum though) or you can give a urine sample in a cup.
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