Vaginal discharge

Question 1

What are 3 types of causes of vaginal discharge and give at least 3 examples per cause?

Answer 1

Physiological:

1) Oestrogen-related –> puberty, pregnancy, COCP
2) Cycle related –> maximal mid-cycle (cervical mucus production during ovulation) and premenstrual
3) Sexual excitement and intercourse

Pathological:

1) Non-sexually transmitted infection i.e BV, candida
2) STI i.e gonorrhoea, chlamydia

Non-infective:

1) Foreign body i.e tampon
2) Malignancy
3) Atrophic vaginitis (often blood-stained)
4) Cervical ectropion
5) Fistula
6) Allergic reaction

Question 2

Medical history when asking about vaginal discharge?

Answer 2

1. Characteristics of discharge (onset, duration, colour, odour)
2. Associated symptoms (itching, burning, dysuria, dyspareunia)
3. Relationship of discharge to menstrual cycle
4. Precipitating factors i.e sex, pregnancy
5. Hygiene practices (douches, bath products, talcum powder)
6. Non infectious disease i.e foreign body, ectopy, malignancy

Question 3

Examination when dealing with vaginal discharge?

Answer 3

External genital inspection
Speculum
Bimanual examination

Question 4

Investigations

Answer 4

Triple swab
Saline wet mount and gram staining (usually found only in GUM clinics)
Vaginal pH measurement
Coloscopy (if abnormal cervical appearance)