Leucorrhoea, which is known as vaginal discharge, is a common physiological condition in females throughout their reproductive years during and even after menopause. Leucorrhoea can be observed in an interval of a few months or years in adolescent and adult females. It is seen in newborn females and can last for 1–2 months. However, when accompanied by pain, irritation, itching, and tissue inflammation, the condition is termed pathological leucorrhoea. In a study, 94.46 per cent of women experiencing leucorrhoea suffer from other gynaecological co-morbidities. These results from a change in the physiological bacterial flora of the vagina because of reproductive tract infections.
The different types of leucorrhoea are listed below:
Physiological leucorrhoea: Excessive vaginal discharge can be considered normal during puberty, ovulation, premenstrual phase of the menstrual cycle, sexual arousal, and pregnancy. Physiological leucorrhoea is characterized by colourless, thin, and relatively odourless vaginal discharge.
Pathological/inflammatory leucorrhoea: Leucorrhoea is considered pathological when the vaginal discharge is reported to be yellow or green along with an unpleasant odour and inflammatory symptoms. Pathological/inflammatory leucorrhoea can be classified as follows:
Infectious leucorrhoea: This can be caused by underlying infections of the reproductive tract such as chlamydia, trichomoniasis, gonorrhoea, and other reproductive tract infections.
Non-infectious leucorrhoea: In this case, vaginal discharge is non-irritant, non-purulent, and does not cause itching or inflammation. Non-infectious leucorrhoea occurs because of the presence of certain foreign bodies such as retained tampons, detergent, or herbal preparations.
Symptoms
Symptoms of leucorrhoea can vary depending on the underlying cause of the conditions. Common symptoms seen during pathological leucorrhoea are listed below:
Symptoms of yeast infections:
Severe itching
Thick and white vaginal discharge
Pain and swelling around genitals
Dyspareunia or pain during sexual intercourse
Symptoms of trichomoniasis:
Yellow or green, watery and frothy vaginal discharge
Unpleasant odour
Dysuria
Symptoms of bacterial vaginosis:
Redness and swelling in the vaginal area
Grey or yellow vaginal discharge
A fishy odour that is reported to be most intense after washing with soap or after sexual intercourse
Dysuria
Leucorrhoea because of gonorrhoea can cause purulent vaginal discharge but is asymptomatic in 50 per cent of patients. While those suffering from trichomoniasis vaginalis infections experience yellow or green discharge with frothing, dysuria, and itching along with dyspareunia. However, only 20 per cent of patients are symptomatic.
Causes And Risk Factors
Causes
The causes of leucorrhoea are listed below:
Causes of physiological leucorrhoea:
Physiological
Foreign bodies such as retained tampons
Vulval dermatitis
Cervical ectopy
Causes of pathological leucorrhoea:
Non-sexually transmitted infection - This includes bacterial vaginosis and candida infections
Sexually transmitted infection - Leucorrhoea is primarily associated with reproductive tract infection caused by Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae.
The presence of a tumour/cancer, fistulae in the cervix, vulva or vagina can cause leucorrhoea.
Risk Factors
The risk factors for leucorrhoea are listed below:
Unprotected sexual contact
Lack of macronutrients and micronutrients
Poor hygiene or self-negligence
Cervical or reproductive tissue injury in pregnant women
Infection of the urinary system
Bacterial or fungal infections
Irritation is because of contraceptives that are inserted into the vagina
Irritation is because of the external contraceptive used by either partner
Diabetes or anaemia
Excessive use of soap and douching altering vaginal pH. This can cause bacterial vaginosis
Lower immunity
Use of steroids or antibiotics
Moreover, factors such as reproductive history, age, poor knowledge of sexual health, and low socioeconomic status influence leucorrhoea.
Prevention
Individuals can easily prevent pathological leucorrhoea by making specific lifestyle changes:
Avoid scented sanitary pads and tampons, feminine hygiene sprays, deodorant or coloured toilet paper.
Avoid douching because it might disturb the normal bacterial flora of the genitals.
Avoid using detergents, fabric softeners, and spermicidal gels, which can be irritating to the genital area.
Have a healthy nutrition-rich diet to prevent any weakness or nutritional deficiencies.
There must be a balance of exercise and rest in the daily lifestyle.
Maintain sanitary hygiene
Certain studies reported a lower prevalence of leucorrhoea among women taking oral contraceptives because of their higher oestrogen levels.
Diagnosis
Women should visit a gynaecologist if they observe any changes in the frequency, amount, colour and odour of the vaginal discharge to diagnose the underlying cause of the condition. The diagnosis includes the following procedures:
Medical history: Preliminary diagnosis includes investigating the patient’s gynaecological history, which provides information regarding the use of contraceptives, sexual history, smear test history, and parity.
Inspection: This includes an external examination of the perineal region and vulva and an internal examination of the cervix with a speculum.
Vaginal discharge examination: This method comprises examining a sample of vaginal discharge using a microscope.
High vaginal swab (HVS): This is not a routine test and is only performed in conditions such as abnormal discharge during pregnancy or postpartum.
Endocervical swab (ECS): This is a test to distinguish between gonorrhoea and chlamydia as the causative agent for leucorrhoea.
pH testing: pH testing of the vagina helps in discriminating between the causative agents. Bacterial vaginosis and trichomonas vaginalis infections can show a pH measure of >4.5. The pH of the vagina for vulvovaginal candidiasis is <4.5.
Nucleic Acid Amplification test (NAAT): This is a highly sensitive test to determine the trace numbers of microorganisms in a sample by amplifying their genetic material.
Treatment
The World Health Organization recommends symptomatic treatment of one or more of all of the five common venereal infections: Chlamydia trachomatis infection, gonorrhoea, and trichomoniasis, which are sexually transmitted infections and bacterial vaginosis and candidiasis because of alterations in the normal bacterial flora of the vagina.
Because the vagina is moist and covered at all times, it is highly susceptible to infections. However, for many women, discussing the problem of foul-smelling discharge even with their medical practitioner can be embarrassing; therefore, many prefer home remedies to prescription medication.
The conventional treatment would be a dose of antibiotics such as povidone, natamycin or nystatin. The medicines should only be used when prescribed by a doctor.
Follow-up - It is recommended depending on the causative agent and severity of the condition. For bacterial vaginosis, a recurrence rate of 15%–20% is observed. Leucorrhoea caused by vaginal candidiasis can recur in patients with poorly controlled diabetes.
Management of partner - Informing the partner is important for any reproductive tract infections. Unprotected sexual intercourse can easily transmit infections. Condom use is the primary method for preventing infection. Circumcised men are less likely to transmit the infection to their partners. Avoiding sexual contact until the complete absence of symptoms is recommended.
Lifestyle Management
Certain sanitary hygiene habits can ensure the prevention of leucorrhoea or its severity. Wipe the virginal area thoroughly from front to back after using the toilet. This prevents the introduction of pathogens into the vaginal area. Furthermore, using loosely fitted cotton underpants, daily bathing, and pat dry the genital area is recommended. Abnormal vaginal discharge is entirely treatable; however, it may sometimes periodically reoccur. Some women suffer from frequent yeast infections. Vaginosis can keep coming back; if so, talk to your doctor. It could mean you require a more extended treatment period.
Prognosis And Complications
Prognosis
Usually, leucorrhoea has a good prognosis.
Complications
Vaginal discharge is strongly associated with other gynaecological problems. Physiological and non-infectious pathological leucorrhoea can be treated with primary care. For patients with the recurrence of discharge or conditions such as HIV, diabetes or leucorrhoea during pregnancy should visit a specialist to prevent additional complications.
Alternative Treatment
Leucorrhoea can be managed by alternate forms of medicine such as Ayurveda and homoeopathy. The principle of ayurvedic treatment is primarily based on its etiopathogenesis. It includes general or specific treatment depending on the condition based on the use of drugs with a predominance of kashaya rasa and Kapha-shamak property. Balya chikitsa plays an essential role to prevent the incidence and treating the present disease.
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