definition of vaginal discharge: secretions from the vagina.

naturally they can be thick, pasty

(metel l creme patissiere), or thin. can be clear, cloudy, bloody, white, yellow, or green. can be
odorless or has a bad odor.
Normally: clear mucus. can be yellow or white. and varies in concentration during the cycle
depending on hormonal levels. increases during ovulation, stress, OCP, pregnancy, or naturally
when aroused. varies from person to person.

white or clear, thick, mucus-like, and mostly odorless vaginal discharge every day
depends on the age:
pediatric vaginal discharge: may be normal but you MUST rule out sexual abuse.
- infectious vulvovaginitis: malodorous, yellow-green, purulent discharge. caused by strep a most
commonly, candida, and std (indicator of sexual abuse).
- non-infectious: contact dermatitis, and eczema.
- foreign objects;
- sarcoma botryoides > bunch of grapes within the vagina.
important questions to ask the patient (reproductive age):
OPQRST: since when did you notice a change in the discharge

- color, texture, concentration (relative to previous), and SMELL!

- are you sexually active? if yes, is it protected sex? dyspareunia? do you have an IUD inserted?
-

does your sexual partner have any infection, is he a new sexual partner, any change of sexual
habits? did you have a pap smear? when was your last one?
are you pregnant? > when was your LMP?
are there any associated symptoms? abdominal, back, or pelvic pain? itching? polyuria?
dysuria? redness? burning? swollen vulva?
do you take any meds?
fever?

Physical exam:
examine outer and inner. check for swelling, redness, check if there is any vaginal discharge now,
differential diagnosis:
- bacterial vaginosis: polymicrobial, whitish, clear, or grey discharge, pH>4.5, gives fishy odor
when mixed with 10% KOH. Diagnose using the AMSEL criteria (vaginal pH greater than 4.5,
positive whiff test, milky discharge, and the presence of clue cells on microscopic examination of
vaginal fluid).
- fungal vaginal infection
- candidiasis: Pruritus (typical thrush-like plaques form of discharge; pseudohyphae showed
on 10%KOH, pH<4.5)WHITE, THICK, LACK OF ODOR. sx: burning, dysuria,
dyspareunia. signs of inflammation in the vagina with edema, and vulvar excoriations
(vulvar inflammation plus vaginal discharge or with microscopic examination of vaginal
secretions in 10 percent potassium hydroxide solution. Vaginal pH is usually normal (4.0 to
4.5))
- trichomonas (STD). green-yellow foamy kind of discharge. Asx symptoms: dyspareunia,
dysuria, vaginal soreness. strawberry cervix on PE, inflammation is more prominent in
trichomonas, you see cervical and vaginal inflammation, even vulvar erythema. signs and
symptoms are not reliable to diagnose (trichomonads seen microscopically in saline, more
leukocytes than epithelial cells, positive whiff test, and vaginal pH greater than 5.4). thats why
when you treat for bacterial vaginosis, include metronidazole to eradicate trichomonads if found.
treat partner as well.
- Gonorrhea STD: (greenish-yellow PURULENT discharge with dysuria, can be asymptomatic)
- Atrophic vaginitis: estrogen deficiency, produces symptoms of vaginal dryness, itching,
irritation, discharge, and dyspareunia (systemic and topical estrogen treatments). YELLOW,

GREENISH, LACK OF ODOR. vagina mildly erythematous and easily traumatised. labia
minora irritable and friable. might lead to skin conditions explained below
forgotten tampon or foreign object > causes infection > increased secretion with foul
discharge
creams, chemicals that may irritate the vagina
cancer of the cervix or vagina
skin conditions: desquamative vaginitis (lining of the vagina becomes inflamed, yellow or green
yellow vaginal discharge accompanied by dyspareunia and vulvar irritation; can be due to
autoimmune or low estrogen levels can trigger it), and lichen planus: most likely also present on
other sites of the body first and then spread to vagina.