The vagina is a passage between the outside of the body and the womb (uterus). Vaginal secretion is acidic, which discourages infections from occurring. This acidic environment is created by the “good” bacteria normally-occurring in the vagina. A healthy vagina produces secretions to cleanse and regulate its own environment. These vaginal secretions form the normal vaginal discharge. Any interference with the delicate balance of vaginal secretions sets up an environment conducive to infection.
Normal Vaginal Discharge
All healthy women would have some vaginal discharge. Normal discharge may appear clear, cloudy white, and/or yellowish when dry on clothing. It may also contain white flecks and at times may be thin and stringy. Changes in normal discharge can occur for many reasons, including menstrual cycle, emotional stress, nutritional status, pregnancy, sexual arousal and medications like oral contraceptive pills.
Changes During The Menstrual Cycle
The menstrual cycle affects the vaginal environment. There is increased wetness and clear transparent egg-white discharge at the time of ovulation (refer fertility awareness). The cyclical nature of the normal discharge is noticeable in most women and can be used as biomarker in managing fertility. Prior to and during menstruation, the vagina is least acidic. Infections, therefore, are most common at this time.
Normal vaginal discharge has several purposes: cleaning and moistening the vagina and helping to prevent and fight infections. Vaginal infections give rise to abnormal discharge. The following changes may indicate a problem:
- Persistent, increased discharge with itching, rash or soreness
- White, clumpy cheesy discharge
- Foul smelly yellow or greenish discharge
- Vaginal discharge mixed with bleeding or spotting
- Burning sensation during or at the end of urination
- Bacterial vaginosis
Most sexually transmitted diseases present with abnormal discharge. One of the most common is Trichomoniasis, which is caused by a parasite. The infection can co-exist with other STDs and the risk increases if the patient has multiple partners.
It is important to realize that most men and some women do not have symptoms which include:
- Increased amount of yellow, green, frothy, discharge with foul smelly odour, like that of a bad fish
- Increased frequency of urination
- Sore and itchy vulva and vagina
Monilia (Yeast) Infection
The vaginal infection is caused by yeast (Candida albicans). It is more common in the following conditions:
- Taking oral contraceptive pill
- Taking antibiotics ("good" bacteria are destroyed by antibiotics, allowing yeast to overgrow)
Treatment consists of antifungal agents in the form of tablets, vaginal creams or suppositories. Over-the-counter treatments are available. Treatment for male partners consists of the use of fungicidal cream on the penis.
The exact cause of bacterial vaginosis is unknown. It is usually caused by a mixture of bacteria. Risk is increased in sexually active women affected by other STDs or who have sex with multiple partners. It is quite contagious, as more than 80% of men are infected when the partner carries an infection. When the delicate balance of the vaginal environment is upset, these bacteria grow in increased amounts. It can coexist with other vaginal infections. Recurrence of bacterial vaginosis is common.
Symptoms include increased amount of grey, white, thin, watery discharge with discomfort and pungent odour. However some women with bacterial vaginosis have no symptom.
Prevention of Vaginal Infections
- Stay healthy; eat well, get enough sleep and drink enough fluids.
- Keep vaginal area clean and dry.
- Wear cotton underwear.
- Wipe from front to back after urination or bowel movement.
- Avoid using deodorant pads or tampons.
- Do not use petroleum jelly or other oils as vaginal lubricants.
- Do not douche as this may destroy the "good" bacteria and upset the balance of the vaginal environment.
- Do not involve in casual sex.
- Have a stable monogamous relationship
- Avoid sexual intercourse until treatment is completed.
- Do not scratch infected or inflamed areas as it can cause further irritation.
- During an infection, use pads rather than tampons if menstruation occurs.
- Avoid irritants, including perfumed or deodorant soaps and antiseptic washes as this may cause chemical or allergic reactions.