Discharge in women is normal and pathological. Causes and nature of normal discharge in women. Poor hygiene habits

Vaginal discharge in women is one of the most common reasons for visiting a gynecologist. Of course, women normally have discharge every day, but not all of them are normal, some are symptoms of various diseases, including sexually transmitted diseases. So, which discharges in women require treatment, and which are normal and natural.

Physiological discharge

Any gynecologist will confirm that normal discharge in women is not abundant, the color is transparent, maybe mixed with white, and the underwear has a yellow tint. Moreover, vaginal discharge does not cause any discomfort, such as itching, and also does not have a sharp, unpleasant odor.

The secretion of leucorrhoea in women increases significantly at the time of sexual arousal, as well as during and after sexual intercourse. In addition, profuse leucorrhoea is observed in women of reproductive age in the middle of the menstrual cycle. This is related to ovulation. Complaints of abundant mucous discharge in women occur in the first weeks of pregnancy. This does not mean at all that the embryo is in danger; soon the amount of discharge returns to normal. Such changes are associated with changes in hormonal levels.

Changes in vaginal microflora

Thousands of microorganisms live in the vagina of every woman, which constitute the “microflora”. Among them are opportunistic microorganisms that begin to multiply under certain conditions, thereby leading to disease. In this case, we are talking about the 2 most common diseases that are not sexually transmitted and are not venereal - candidiasis and gardnerellosis.

Discharge in women is white, profuse, similar to cottage cheese with a sour odor and accompanied by severe itching, most often caused by an opportunistic pathogen - fungi of the genus Candida. In addition to the discharge, the woman notices swelling of the vulva and redness of the labia. Treatment is carried out only if these symptoms are present and the smear result is poor. There are a number of drugs that are quite effective in combating thrush, which is what people call candidiasis. But it must be taken into account that white discharge in women may appear periodically when favorable conditions arise for the proliferation of the pathogen that causes candidiasis. But more on that below.

Another disease with similar symptoms, but only with it, grayish discharge appears in women with the smell of rotten fish. The disease is called gardnerellosis. The causative agent is gardnerella. Its frequency is approximately equal to candidiasis, and is also diagnosed using a smear on the flora. Less often, green discharge appears in women, frightening in its unusualness.

When diagnosing both candidiasis and gardnerellosis, it is recommended to undergo a full examination for all kinds of sexually transmitted diseases, and especially for hidden infections. Since it is with them that the vaginal microflora most often changes pathologically. Treatment of gardnerellosis at the initial stage is aimed at eliminating pathogenic flora, the second stage is creating a normal environment in the vagina.

Both diseases described above have risk factors, the conditions under which they most often develop.

1. Taking antibiotics.

2. Rare sex without the use of barrier contraception, as well as frequent changes of sexual partners.

3. Use of hormonal contraception.

4. Douching, especially with chlorine-containing solutions (usually used as a prevention of infection with sexually transmitted diseases, it should be noted that this prevention is rather weak).

5. Use of spermicides containing 9-nonoxynol as contraception.

6. Use of lubricants containing 9-nonoxynol.

It should be noted that men can also develop candidiasis and gardnerellosis. And in this case, abundant, thick, transparent discharge in women, grayish or white cheesy, appears in their partners, usually at the same time. But if the partner has all the signs of the disease, but the man does not, he does not need to be treated.

Sexually transmitted diseases

Most infections are characterized by vaginal discharge of one kind or another. We will look at 2 of them, which are quite common.

1. Trichomoniasis. This disease, which often leads to female infertility, is characterized by yellow discharge in women, pain during urination and sexual intercourse, and inflammation of the external genital organs. In men, the symptoms are the same, and they are quite similar to the signs of prostatitis. Treatment if the pathogen (Trichomonas vaginalis) is detected in a smear. Moreover, treatment does not consist in using drugs locally, they are absolutely ineffective, but in taking anti-trichomonas drugs internally.

2. Gonorrhea. One of the most ancient diseases. Its causative agent is gonococcus. Men have clear symptoms, but women usually only have yellow or white discharge, which many women do not take seriously, considering it a manifestation of candidiasis. Another symptom is painful urination, which is mistaken for cystitis. But this disease is very dangerous; it affects not only the genitourinary system, but also joints, skin, liver, heart and other internal organs. Gonorrhea is also diagnosed by laboratory methods.

Menstrual disorders and gynecological diseases

1. Cervical erosion. This fairly common pathology can cause mild intermenstrual bleeding. They do not occur on their own, but due to some mechanical effect on the cervix, for example, as a result of sexual intercourse.

2. Hormonal contraception. Birth control pills, which are quite popular now, have many side effects in the first cycles of taking them. A common side effect is brown discharge in women outside of menstruation. This “daub” does not pose a health hazard. If this side effect is present, the doctor may recommend other birth control pills, change the type of contraception, or simply wait 2-4 months until the side effects disappear on their own, since in this situation they are temporary.

3. Age-related disorders of the menstrual cycle. Delays in menstruation, too long intervals between them or, on the contrary, too short, intermenstrual discharge in women is often brown during the first 1-2 years after the very first menstruation. And vice versa, with the extinction of menstrual function, that is, with the onset of menopause. However, even if you fit into one of these two categories, you should not hope that everything will work out on its own. It is quite possible that the reason is not at all due to age and natural hormonal changes in the body, but to a disease, and not necessarily gynecological. In case of serious menstrual irregularities, it is necessary to consult not only a gynecologist, but also an endocrinologist.

Bloody, brown discharge during pregnancy

They are one of the most dangerous symptoms that cannot be ignored at all stages of pregnancy. Possible reasons are described below.

1. Hormonal changes. Surely, you have heard from experienced women that menstruation can occur during pregnancy. This phenomenon is very rare, but does occur in some expectant mothers. Moreover, spotting appears only in certain weeks, with the same regularity as menstruation. It is because of this rare feature of the female body that in areas where medical care was poor, pregnancy was sometimes determined on the basis of symptoms such as visual enlargement of the uterus (abdomen), movement of the child and a vertical stripe (pigmentation) on the abdomen, appearing only in the middle of the term .

2. Ectopic pregnancy. In the early stages, you need to think about this diagnosis if brown or bloody discharge appears. If the test is positive but you have discharge, see your doctor. During an early examination, the doctor is unlikely to be able to determine where the fertilized egg is developing - in the uterus or not. But on an ultrasound everything becomes clear. If hCG is above 1000 mU/ml, the pregnancy is more than 4 weeks (from the first day of the last menstrual cycle), but there is no fertilized egg in the uterus, there is reason to suspect an ectopic pregnancy. Another distinctive feature is the slow growth of hCG.

3. Frozen pregnancy. It is less dangerous than ectopic, but still requires prompt diagnosis. One of the main signs of a frozen woman is, again, spotting, which intensifies when a miscarriage begins. When frozen, the fetal heartbeat is not detected on ultrasound, hCG stops growing, and its concentration in the blood and urine decreases.

4. Threatened or incipient miscarriage. Scanty brown discharge may be a sign of a hematoma formed as a result of detachment. This condition does not require treatment. If you notice scarlet blood on your underwear and the discharge is quite profuse, you need urgent hospitalization. This is the only way to save a pregnancy. Miscarriage cannot be avoided if the cervix has already dilated and there is a large detachment of the chorion or placenta.

This is what different types of vaginal discharge mean. And these are by no means all of their possible reasons. Don't forget to visit your gynecologist regularly (at least once a year).

There is no woman in the world who would not be concerned about the nature of the discharge from her genital tract. Among them there are those that are part of female physiology, and some may indicate the presence of sexually transmitted diseases in the body or an inflammatory process. To protect yourself, it is better to consult a gynecologist and get tested for vaginal microflora and bacteriological culture. Therefore, many are interested in which discharge is considered normal and which is a reason to visit a doctor

Normal discharge and menstrual cycle

Discharge in healthy women appears from the moment of puberty and is present until the onset of menopause. Another name for vaginal discharge is leucorrhoea. They vary depending on the phase of the menstrual cycle. The amount and color of leucorrhoea depends on the concentration of the hormone estrogen in the blood. Let's look at what normal discharge looks like during different periods of the female cycle.

So, in the first phase of the female cycle (about 1-14 days), the discharge is usually the most scanty - about 1-2 mg per day. This amount of leucorrhoea leaves a spot with a diameter of 2-3 cm on the panty liner. During this period, vaginal discharge is normal if it has a transparent or whitish tint. They are usually odorless or have a slightly sour odor.

At the end of the first period, ovulation occurs, which lasts 1-2 days. As for vaginal discharge, the norm is an increase in its abundance compared to the first phase. Their amount is about 4 mg per day, and the diameter of the spot on the pad can reach 5-6 cm. Leucorrhoea is similar to chicken protein - it is also transparent and has a viscous and slimy character. Such secretions provide a favorable environment for the movement of sperm towards the egg.

The second half of the menstrual cycle is characterized by a comparative decrease in the amount of leucorrhoea. These secretions become thicker and have a jelly-like or creamy character. As menstruation approaches, the amount of leucorrhoea increases and its color becomes whitish. Thus, in the run-up to your period, white discharge is normal. Naturally, provided that they do not cause discomfort, itching or burning.

Normal female discharge and various factors

It is also necessary to know what normal discharge should be depending on the influence of various life situations:

Leucorrhoea is a consequence of pathological secretion of the genital organs and a manifestation of disease in various parts of the female reproductive system. It is important to establish the source of increased secretion.

Types of discharge in women

There are vestibular, vaginal, cervical, uterine and tubal leucorrhoea.

Vestibular leucorrhoea is usually mucous, most often caused by inflammatory processes of the external genitalia or large glands. The secretion of the sebaceous and sweat glands can accumulate in the folds of the vulva, which leads to irritation. Vestibular leucorrhoea is detected relatively rarely.

Vaginal discharge is more common. A small amount of liquid content (0.5 - 1 ml) contained in the vagina of healthy women is transudate from the blood and lymph vessels of the subepithelial layer and the secretion of the glands of the cervix, absorbed by the vaginal mucosa, due to which healthy women do not notice vaginal discharge .

When pathogenic microbes are massively introduced into the vagina, hormonal and immune homeostasis are disrupted, the vaginal biocenosis is disrupted and vaginal discharge appears.

The cause of vaginal discharge can also be extragenital diseases (pulmonary tuberculosis, acute infectious diseases, hyperthyroidism), the course of which is accompanied by a decrease in the hormonal function of the ovaries and changes in the vaginal mucosa. Increased “secretion” of the vagina is sometimes caused by local infection, helminthic infestation, the presence of a foreign object in the vagina (often in children), prolapse of the genital organs, and the formation of genitourinary and enterogenital fistulas.

Vaginal discharge also appears as a result of exposure to mechanical (frequent coitus, foreign objects), chemical (irrational use of chemical contraceptives), thermal (douching with hot solutions), and allergic factors.

By nature they distinguish:

purulent (gonorrhea, nonspecific bacterial infection, ureoplasmosis),
curdled (infection with yeast fungi of the genus Candida, thrush),
foamy (trichomoniasis, anaerobic microflora),
mucous membranes (viral infection),
mucopurulent or serous-purulent (chlamydia) vaginal discharge.

Discharges are:

odorless (ureoplasmosis, chlamydia, viral infection),
with a sour smell (yeast mushrooms)
or the smell of rotten fish (anaerobic infection).

Overproduction of secretion from the cervical glands is the cause of the appearance of cervical leucorrhoea in endocervicitis of various etiologies, erosions, ruptures, polyps, cancer, cervical tuberculosis and other processes accompanied by impaired secretion of the cervical glands and the introduction of pathogenic microflora. Unlike vaginal leucorrhoea, cervical leucorrhoea is thick and depends on the phase of the menstrual cycle.

Uterine leucorrhoea caused by endometritis, submucosal fibroids, polyps of the mucous membrane, malignant tumors, the presence of foreign objects or intrauterine contraceptives in the uterus.

Tubal leucorrhoea is observed relatively rarely and is a consequence of the periodic secretion of secretions accumulated in the fallopian tube. Among the causes of the appearance of tubal leucorrhoea are malignant neoplasms, inflammatory diseases of the fallopian tubes, accompanied by the formation of hydro- or pyosalpinx. Tubal leucorrhoea is characterized by periodicity, appearing in the first phase of the menstrual cycle.

Vaginal discharge can be described depending on:

Consistencies (thick, pasty, watery)
Colors (clear, cloudy, bloody (brown), white, yellow, green)
Odor (normal, odorless, unpleasant odor)

Some amount of vaginal discharge is normal, especially during childbearing years. This discharge may be white or yellowish when exposed to air. These are normal variations.

The amount of mucus produced by the glands of the cervix varies during the menstrual cycle. It depends on the amount of estrogen circulating in the body. Vaginal discharge that differs in color, smell, consistency, or significantly increases or decreases in size may indicate hidden problems - infections.

Causes of increased vaginal discharge (lubrication)

It must be remembered that an increase in the volume of leucorrhoea is considered physiological in the following cases:

in connection with the menstrual cycle (on the eve and in the first days after menstruation) due to hyperemia, increased permeability of the vascular wall, increased blood supply and congestion in the pelvic area;
during pregnancy due to congestion of the pelvic organs, congestive hyperemia and loosening of the tissues of the genital organs,
during sexual intercourse as a result of a sharp change in hemodynamics in the pelvis, especially at the time of orgasm, since blood flow to the genitals increases, cervical mucus is pushed out, and the secretion of the glands of the vestibule of the vagina increases.

The following situations may increase the amount of normal vaginal discharge:

Emotional stress
Ovulation (production and release of an egg from the ovary in the middle of the menstrual cycle
Pregnancy
Sexual arousal

The appearance of unusual vaginal discharge may be due to:

Atrophic vaginitis (seen in women who have gone through menopause and have low estrogen levels
Bacterial vaginosis (BV) - The number of bacteria that normally live in the vagina decreases, resulting in a gray discharge and fishy odor that gets worse after intercourse. BV is not usually transmitted through sexual contact.
Cervical or vaginal cancer (rare)
Desquamative vaginitis and lichen planus
Forgotten tampon or foreign body
Other infections and sexually transmitted infections (STIs)

Measures to prevent discharge

To help prevent and treat vaginal discharge:

Keep your genitals clean and dry.
Don't shower too often. Although many women feel cleaner if they shower after menstruation or intercourse, this can make vaginal discharge worse because the water removes the good vaginal bacteria that exist to protect against infection. Vaginal douching can also lead to infection in the uterus and fallopian tubes and is never recommended.
Eat yogurt with live cultures or take Lactobacillus acidophilus tablets when you are on antibiotics to avoid yeast infections.
Use condoms to avoid getting or spreading STIs.
Avoid using feminine hygiene sprays, perfumes, or powders on the genital area.
Avoid wearing very tight pants or shorts, which can cause irritation.
You need to wear cotton underwear. Avoid wearing underwear made of silk or nylon, as these materials are not very absorbent and restrict airflow. This may increase sweating in the genital area, which can cause irritation.
Use pads rather than tampons during your period.
Keep your blood sugar levels well controlled if you have diabetes.

Please note that if your vaginal discharge is caused by a sexually transmitted disease, your sexual partner(s) should also be tested, even if they are asymptomatic. Refusal to have your partner examined can lead to recurrent infections and pelvic inflammatory disease or infertility.

When you need to see a doctor urgently

Call your doctor right away if you have vaginal discharge or:

Fever or pain in the pelvic or abdominal area.
You have had a sexual partner with gonorrhea, chlamydia or other STIs.
You have increased thirst and appetite, unexplained weight loss, increased frequency of urination, or fatigue - these may be signs of diabetes.

Urgent consultation is also necessary if:

A child who has not yet reached puberty has vaginal discharge.
You think that the discharge may be the result of treatment - an allergy.
You are concerned that you may have an STI.
Your symptoms get worse or last longer than a week despite home care.
You have sores or other injuries to your vagina or vulva (external genitalia).
If you experience a burning sensation when urinating or other symptoms of urinary dysfunction, you may have a urinary tract infection.

Medical history questions that are relevant to diagnosis:

When did the changes or abnormal vaginal discharge begin?
Do you have the same amount and type of vaginal discharge throughout the month?
What is the discharge (color and consistency)?
Is there a smell?
Do you have pain, itching or burning?
Does your sexual partner also notice discharge?
Do you have multiple sexual partners or sexual partners you have only known recently?
What type of contraception do you use?
Do you use condoms?
Is there a product that reduces discharge?
Do you have other symptoms such as abdominal pain, vaginal itching, fever, vaginal bleeding, rash, genital warts or lesions or changes when urinating, such as difficulty, pain, or blood?
What medications are you taking?
Do you have any allergies?
Have you recently changed the detergents or soaps you usually use?
Do you often wear very tight clothes?
When was your last Papanicolaou (Pap) smear? Have you had abnormal smears before?

Diagnostic tests that may be performed include:

Culture (smear culture) of the cervix
Analysis of vaginal discharge under a microscope
Papanicolaou smear (PAP)

Treatment of vaginal discharge

Treatment depends on the underlying disease. Suppositories or creams and antibiotics may be prescribed. Medicines taken by mouth may be needed to treat certain fungi or trichomoniasis infections. Your sexual partner may also need treatment.

The more a woman learns about her body, the calmer and more confident she feels in a variety of life situations. To avoid unnecessary worry and not make far-fetched diagnoses, let’s figure out what is normal and when to suspect something is wrong.

What is normal vaginal discharge?

During puberty (10-12 years), the glands of the cervical canal begin to secrete mucus, which mixes with dead epithelial cells and microorganisms living in the vagina (lactobacillus, Doderlein bacilli, streptococci, fungi, mycoplasma, ureplasma, etc.). By moisturizing the mucous membrane, these secretions prevent the proliferation of pathogenic bacteria, protect against infections and promote self-cleaning of the vagina. The first discharge is usually scanty, colorless or whitish, does not smell of anything, or has a faint yellowish tint and a subtle sour odor (the result of the action of lactic acid bacteria).

As soon as the girl's pregnancy begins, the amount, color and consistency of vaginal discharge will change depending on the phase of the cycle. Let's look at the normal options using the example of a 28-day menstrual cycle.

The first phase of the menstrual cycle (1-12 days after the end of menstruation): the discharge is scanty, liquid or mucous. The consistency is mostly homogeneous, less often with an admixture of small lumps. Color - transparent, whitish or yellowish. The smell is sour or absent.

Ovulation (13-15 days after the end of menstruation, mid-cycle): discharge becomes abundant (up to 4 ml/day). The consistency is viscous mucus. Color - transparent, whitish, light beige.

The second phase of the menstrual cycle (15-16 days - the beginning of the next menstruation): there is less discharge than during the ovulation period. Their consistency resembles liquid cream or jelly. Color - whitish, yellowish, transparent. The appearance of brown spotting indicates the onset of menstruation.

Why does the discharge change?

The nature of discharge from the genital tract can change under the influence of hormonal factors, without being a symptom of any pathology. For example, the beginning of sexual activity or a change of partner becomes a hormonal stress for the female body. In the process of “getting used to” the new microflora, vaginal discharge becomes more abundant and changes color and consistency.

Women who are sexually active have noticed that the nature of the discharge changes during and after sexual intercourse. The increase in their number is associated with excitement and blood flow to the vessels of the vagina, as a result of which mucous drops are secreted directly by the walls of the vagina. This natural lubrication facilitates insertion of the penis into the vagina, making sexual intercourse natural and painless for both spouses.

Vaginal discharge may also change as a result of taking it. The drugs inhibit the onset of ovulation, therefore, while taking them, the amount of discharge decreases. A similar process occurs after childbirth, during breastfeeding.

In pregnant women, heavy discharge is caused by increased blood supply to the uterus and vagina. In later stages, this is also associated with the discharge of cervical mucus immediately before childbirth. If a woman notices the appearance of heavy liquid discharge, she should consult a doctor, as this may indicate that her water has broken.

After childbirth, normal discharge is lochia - a mixture of mucus, blood and dead tissue of the lining of the uterus, reminiscent of heavy periods with clots. Typically, lochia discharge occurs within 1-2 months after the birth of the child.

Signs of pathology

It is impossible to make a diagnosis on your own based on the nature of vaginal discharge. Moreover, without appropriate tests and clinical examination, a gynecologist will not be able to do this. But there are several simple signs that will signal a possible disease:

The appearance of discomfort, itching, burning in the vagina.

Foamy discharge that is yellow, white or greenish in color.

Copious discharge of white or yellowish cheesy lumps, causing irritation of the genitals.

Copious discharge with an unpleasant fishy odor, which intensifies during sexual arousal.

Yellow discharge, accompanied by difficulty urinating, pain in the lower abdomen.

Thick purulent discharge mixed with blood, with a strong unpleasant odor.

Bloody discharge that appears between periods.

Watch your body, study it, visit your gynecologist regularly, and pathological vaginal discharge will not bother you.

Maria Nitkina

Vaginal discharge- this is the result of the secretory activity of glandular structures, mainly located in the vagina. To a lesser extent, the glands of the overlying genital organs participate in the formation of vaginal secretions. Physiological vaginal discharge is present in all women and girls after puberty, and in postmenopause their amount is minimal.

In the mucous membranes lining the walls of the vestibule of the vagina, as well as the cervix, there are glands that constantly produce a small amount of secretion for irrigation, protection and cleansing of the vagina. The presence of such discharge in the vagina is necessary and is not a pathology. A change in the nature of the usual discharge occurs due to harmless reasons or signals serious problems.

Physiological vaginal discharge is not too abundant, does not cause discomfort to the woman and does not affect the condition of surrounding tissues. Vaginal discharge is considered normal if it meets several criteria:

- they are liquid or mucous, transparent or slightly cloudy, less often jelly-like;

- the amount of discharge does not exceed their usual norm for a particular woman;

- do not have a pronounced unpleasant odor;

- do not cause irritation and inflammation of the surrounding mucous membranes, accompanied by itching, pain or discomfort.

We can say that the “normality” of the amount and consistency of vaginal discharge is primarily determined by the woman herself, since the concept of “normal” can vary significantly. For some women, increased or scanty amounts of vaginal discharge are considered normal if their character does not change throughout life and if they are not accompanied by pathological symptoms.

The external characteristics of the discharge are also not always interpreted correctly by patients. Sometimes the discharge changes its appearance when interacting with air and leaves marks on the underwear of a “not its” color. If the discharge comes into contact with chemicals found in hygiene products, it can also change its appearance. During a gynecological examination, the nature of the vaginal contents is assessed more reliably.

As a rule, in most healthy women the daily amount of fluid in the vagina does not exceed 2 ml, and its composition is dominated by lactobacilli and squamous epithelial cells. Representatives of conditionally pathogenic microflora are present in the vagina in minimal quantities (about 2%): gardnerella, mycoplasma, anaerobic bacteria, staphylococci, streptococci and fungi. To prevent unwanted microflora from multiplying, a constant acidic environment with a pH of 3.8 - 4.5 is maintained in the vagina with the help of lactobacilli.

The nature of vaginal contents can be affected by:

— Natural cyclical hormonal fluctuations affect vaginal discharge, changing not only its quantity, but also its consistency. On the eve of menstruation, the amount of vaginal discharge increases and it becomes more viscous.

The most popular reason for visiting a gynecologist is heavy and unpleasant vaginal discharge of an unusual type. Leucorrhoea can have a wide variety of colors (from white to red), consistency (jelly, “cottage cheese” or foam) and be accompanied by unpleasant sensations and pain. In some cases, leucorrhoea is the only symptom of the disease.

The amount of discharge is an important indicator in the diagnosis of diseases. Complaints about strong vaginal discharge do not quite correctly characterize the nature of leucorrhoea. Discharge does not have “strength”, it only has quantity, so it is more correct to replace strong vaginal discharge in the formulation of complaints with heavy vaginal discharge.

As a leading symptom, pathological vaginal discharge accompanies a huge number of gynecological diseases, but most often (60-70%) they appear with inflammatory diseases of the genitals.

Diagnosis of the causes of leucorrhoea most often does not cause difficulties; a simple laboratory study of quantitative and qualitative changes in the composition of vaginal secretions (“flora smears”) helps to determine the source of the disease.

Therapy for pathological vaginal discharge involves eliminating the source of the disease and restoring normal parameters of the vaginal environment.

Causes of vaginal discharge

When they say “vaginal discharge,” they mean pathological discharge - leucorrhoea, and not normal vaginal contents, because, as a rule, a woman does not notice the usual vaginal discharge.

At the heart of the pathological process in the vagina, leading to the appearance of discharge (or leucorrhoea), there is a single trigger mechanism - a change in the quantitative composition of the microflora and the acidity of the vaginal environment. The vaginal mucosa is in a state of constant self-renewal due to the desquamation of “old” cells and the proliferation of new cells. Lactobacilli interact with the surface cells of the vaginal epithelium, they break down the glycogen they contain into lactic acid and hydrogen peroxide, resulting in an acidic environment in the vagina. Unwanted microflora cannot multiply in an acidic environment, so its amount in the vagina remains minimal.

The vaginal epithelium is hormonally dependent, therefore the state of the vaginal environment is affected by cyclic hormonal changes in the body: estrogens provide the mucosal cells with glycogen, and gestagens help the surface layer of cells to be rejected in time. Thus, a biphasic ovulatory cycle helps maintain a constant vaginal environment. Dyshormonal disorders in the body can provoke pathological vaginal discharge.

However, leucorrhoea does not always mean that the disease is localized specifically in the vagina. Based on the place of origin, they are distinguished:

- Vaginal leucorrhoea. They appear more often than others and accompany inflammatory, infectious diseases or.

- Pipe leucorrhoea. Appear against the background of inflammation in the fallopian tubes. The walls of the inflamed fallopian tube become swollen, their lumen narrows, the inflammatory secretion accumulates in the tube, and then pours into the uterus in portions and enters the vagina through the cervical canal. If the contents of the tube enter the ovary, symptoms of adnexitis appear.

- Uterine leucorrhoea. They occur predominantly during inflammatory processes in the endometrium.

— Cervical (cervical) leucorrhoea is the result of increased secretion of the cervical glands during inflammation.

— Vestibular leucorrhoea is produced by the glands of the vestibule of the vagina.

In girls, in 55% of cases, the appearance of leucorrhoea is not associated with gynecological pathology and is caused by metabolic, allergic or endocrine disorders in the body. During active puberty, the amount of vaginal discharge may increase, but it is physiological. Only 30% of girls and adolescents have pathological vaginal discharge, and most of it is infectious in nature.

During pre- and postmenopausal periods, leucorrhoea is associated with atrophic processes in the mucous membranes or cancer. Sometimes the appearance of leucorrhoea in elderly patients is associated with prolapse of the genital organs.

Leucorrhoea against the background of foreign bodies in the vaginal cavity can be profuse, purulent and have an unpleasant odor. Staying hygienic tampons, a vaginal ring (pessary) in the vagina for too long, as well as foreign objects introduced from outside can cause leucorrhoea.

There is probably not a single woman who has not experienced changes in the nature of vaginal discharge, but not every one of them required medical help. The presence of provoking factors does not always lead to the appearance of leucorrhoea. In healthy women with a good immune system and normal hormonal status, deviations from the normal parameters of the vaginal environment are compensated by the body’s internal resources. However, sexually transmitted infections in even the healthiest patients require therapy.

White vaginal discharge

The appearance of vaginal discharge may not always reliably indicate the true cause of its appearance. Physiological vaginal discharge sometimes has a whitish tint, but due to its small amount, a woman may not know what it looks like and begins to pay attention to it only when its amount increases due to natural causes: in the middle of the menstrual cycle, after stress or intimacy and so on. As a rule, in such cases, in addition to the discharge, the patient is not bothered by any other subjective sensations, and after examination it is not possible to establish the presence of a pathological process.

In pregnant women, physiological discharge before childbirth becomes whitish, abundant and thicker. Unlike leucorrhoea, they are not accompanied by discomfort and do not require treatment.

A pathological process can be suspected if the patient complains of atypically thick and unpleasant white vaginal discharge accompanied by itching, burning or a feeling of discomfort. Such discharge most often indicates excessive proliferation of fungal microflora, that is, the appearance of vaginal candidiasis. The source of the disease is Candida fungi. They may be present in small quantities in the vagina, and their growth is inhibited by lactobacilli. If the normal composition of the vaginal microflora is disrupted, the fungi begin to actively vegetate, displacing beneficial microorganisms.

Vaginal candidiasis is accompanied by characteristic symptoms. Patients complain of abundant and thick white vaginal discharge. Characteristic white inclusions in the form of crumbs or flakes give the whites of candidiasis a resemblance to cottage cheese or sour milk (hence the second name of the disease - “thrush”). The discharge is always accompanied by severe itching, which intensifies in the evening and often does not subside throughout the night, not allowing the woman to rest.

Upon examination, the vaginal mucosa always shows signs of severe inflammation (swelling and redness) with characteristic white “films”. Attempts to remove such plaque are accompanied by severe trauma to the mucous membrane and the appearance of blood. Heavy discharge irritates the inflamed mucous membrane of the vagina and vulva, causing a burning sensation. If the inflammatory process spreads to the urethra, the patient may experience complaints associated with urinary disorders.

Often, patients with vaginal candidiasis can clearly indicate the cause of leucorrhoea. The most common of these is the incorrect use of antibiotics.

Vaginal candidiasis can also have a chronic form, then all the symptoms are mild, and the first place is taken by complaints of cheesy white leucorrhoea (sometimes even without itching).

The diagnosis of vaginal candidiasis is usually not difficult. The presence of cheesy discharge, characteristic signs of fungal inflammation in the vagina and the detection of Candida fungi in smears allow you to quickly make the correct diagnosis.

Therapy for vaginal candidiasis involves the use of antifungal drugs and restoration of normal vaginal pH. Successful treatment of candidiasis does not guarantee relapse of the disease.

Yellow vaginal discharge

Most leucorrhoea is accompanied by inflammation in the vagina. Severe inflammation develops against the background of a decrease in the ability of the vaginal mucosa to resist infection, that is, pathogenic microflora. An infectious process in the vagina can be provoked by “own” microorganisms (the case when opportunistic microbes become the cause of the disease) or pathogens from outside (genital infections).

A sign of an infectious process in the genitals is a yellow, purulent discharge. Long-term purulent discharge acquires a greenish tint.

Abundant, watery, yellow or yellow-green vaginal discharge may indicate trichomoniasis. The disease is caused by Trichomonas and is venereal. In addition to leucorrhoea, the patient is bothered by pain, itching, burning and urinary dysfunction. A distinctive sign of trichomonas inflammation is the foamy appearance of leucorrhoea and an unpleasant, stale odor. If the disease is not cured on time, it becomes chronic.

Creamy purulent discharge is characteristic of a serious sexually transmitted disease - gonorrhea. The disease is acute, with severe symptoms of inflammation and fever. Inflammation in gonorrhea quickly rises to the overlying genital organs, causing symptoms of endometritis or adnexitis. If the infection spreads to the fallopian tubes, they “stick together” due to the accumulation of inflammatory fluid, so one of the unfortunate consequences of gonorrhea is.

Leucorrhoea does not always indicate the presence of a pathological process in the vaginal area. Inflammation of the uterus or appendages is also accompanied by pathological discharge. Most often, with acute endometritis, profuse purulent vaginal discharge is accompanied by severe fever and pain.

It should be noted that leucorrhoea can have a yellowish tint of different origins. To establish the exact cause of their appearance, it is necessary to conduct a laboratory study of the composition of the vaginal contents. A large number of leukocytes in a smear always indicates intense inflammation, and identification of a specific pathogen indicates the cause of the disease.

Brown vaginal discharge

Blood colors vaginal discharge in all shades of red - from scarlet to dark brown. The presence of a small amount of blood in vaginal discharge can always be suspected by its characteristic color. Typically, dark brown vaginal discharge indicates the presence of a source of minor bleeding in the genital tract, when a small amount of blood has time to oxidize and break down before it comes out.

The most common cause of brown discharge is menstrual irregularities. Typically, the patient experiences spotting, dark, brown vaginal discharge of varying duration during any period between menstruation. Sometimes such discharge replaces normal menstruation.

The appearance of slight brown spotting vaginal discharge is not always a sign of disease. In some women, they are observed while taking hormonal contraceptives (especially low-dose ones) or an intrauterine device. As a rule, the appearance of such discharge is short-term and is not accompanied by any subjective unpleasant sensations. If spotting brown discharge bothers a woman constantly, it is necessary to consult a specialist.

Some women decide on the method of contraception on their own and choose a hormonal drug on the advice of friends or a pharmacist at the pharmacy. Continuous spotting between menstruation in such cases may indicate that the drug has been chosen incorrectly. Each hormonal contraceptive contains a certain ratio of sex hormones (estrogens and gestagens). It is not the same for different drugs and is selected individually, based on the age and hormonal status of the patient, so you should not rely on independent choice.

Intrauterine contraception (“spiral”) in some cases provokes spotting:

- in the first time after the insertion of the IUD, the uterus perceives it as a foreign body and tries to free itself;

— the uterine mucosa at the site of “attachment” of the spiral may be slightly injured.

Such discharge should not last long or be accompanied by discomfort or pain. Otherwise, it is necessary to decide on its removal.

Minor brown discharge may appear briefly after douching or overly aggressive sexual intercourse due to microtrauma of the mucous membrane. Spotting brown or pink discharge from the vagina after an abortion or cauterization of cervical erosion also indicates the presence of injuries to the mucous membranes of the vagina and uterus. As a rule, such discharges are temporary and disappear on their own.

Sometimes spotting is accompanied by pain or fever, which indicates an infectious-inflammatory process in the genitals.

Pathological discharge from sexually transmitted infections may contain a small amount of dark blood. The intense inflammatory process caused by sexually transmitted infections destroys the surface epithelium of the vagina with the formation of microtraumas.

Some gynecological diseases are accompanied by intermenstrual spotting vaginal discharge: uterine fibroids, and endometrial fibroids.

The appearance of brown discharge against the background of a delay in the next menstruation may indicate a very dangerous condition -. Sometimes, in addition to spotting, there are signs of normal (uterine) pregnancy and abdominal pain of varying intensity. Often this condition is mistaken for a threatening miscarriage. An interrupted ectopic pregnancy threatens the patient’s life and requires immediate surgical intervention.

Sometimes, in late pregnancy, the source of slight dark vaginal discharge can be dilated vessels of the cervix, in other cases they signal a threat of miscarriage.

Clear vaginal discharge

Transparent vaginal discharge without color or odor in a small amount corresponds to the concept of normal. Typically, they look like clear mucus or egg white. The viscosity and amount of vaginal discharge depends on the composition of the vaginal microflora, the content of sex steroids and some individual characteristics of the body.

There is no strict standard for discharge. In some women, an increased amount of discharge is observed constantly and is not accompanied by diseases.

Physiological secretions predominantly contain epithelial cells and lactobacilli. If there are many epithelial cells, they give the discharge a whitish tint.

Sometimes clear discharge begins to bother a woman constantly, leaves stains on her underwear or is accompanied by unpleasant subjective sensations; in this situation, the reason for such changes should be understood.

A slight presence of fresh blood is indicated by short-term pink vaginal discharge. Therapeutic and diagnostic manipulations can provoke minor violations of the integrity of the mucous membrane; blood from the surface of microtraumas enters the vaginal secretion and turns it pink.

“Cauterization” or “freezing” of cervical ectopia is accompanied by the formation of a dense crust, healthy tissue grows under it, then the wound surface heals completely, and the crust is rejected. This process may be accompanied by pink vaginal discharge of a short duration.

Mucous discharge from the vagina

Light vaginal discharge of a mucous type without pathological impurities and odor, which does not cause itching, burning or discomfort, is the norm. Sometimes mucous discharge becomes more viscous and stringy, and in appearance resembles egg white.

The mucous appearance of vaginal discharge is due to the cervix.

Clear and thick cervical (or cervical) mucus forms in the cervix, sometimes called a “plug.” It is produced by the cells of the cervical canal mucosa and performs important functions:

- prevents unwanted bacteria from entering the uterus, performing a barrier role;

- thanks to the mucous cervical secretion, sperm entering the vagina are “transported” to the uterus.

The composition and acidity of cervical mucus correlates with normal vaginal secretions, and its viscosity is controlled by sex steroids. To ensure that sperm can easily enter the uterus, at the time of ovulation the density of cervical mucus decreases and it flows into the vagina. Therefore, the amount of vaginal mucous discharge during ovulation increases.

The consistency and amount of cervical mucus is directly dependent on the level of sex hormones. Methods for studying the state of cervical mucus at different periods of the cycle, especially during ovulation, in women with infertility help determine the presence of dyshormonal disorders.

The Billings method is based on studying the viscosity of cervical mucus at different periods of the cycle. At the end of the next menstruation, the vagina is “dry” - there is practically no discharge. Towards the middle of the cycle, the mucous discharge becomes so viscous that it can be easily stretched between two fingers. The period of ovulation (middle of the cycle) is accompanied by an increase in vaginal discharge, it becomes liquid. Then the discharge becomes viscous again, and then disappears completely. If the cervical mucus indicators do not change, we can assume. This method cannot reliably determine the presence of hormonal abnormalities and is indirect.

Bloody vaginal discharge

The only normal time for bleeding from the vagina is during menstruation. The source of menstrual bleeding is the extensive wound surface of the uterine cavity, formed after rejection of its outer mucous layer.

Discharge of blood from the vagina, not associated with menstrual bleeding, always indicates the presence of a disease. Important diagnostic criteria are the duration of bleeding and their quantity. As a rule, a single small amount of red vaginal discharge can provoke:

- Sexual contact, especially if the partner has cervical pathology - erosion or.

— Diagnostic procedures: taking smears, aspiration biopsy of the endometrium, diagnostic curettage, laparoscopy, and so on.

— Mechanical disruption of the integrity of the integumentary epithelium during douching, use of a gynecological speculum during examination, or insertion of the uterine ring during prolapse of the genital organs. Much less often, the vaginal mucosa is damaged by foreign bodies in the uterus.

— Inflammatory changes in the vagina make the mucous membrane easily vulnerable, so they can sometimes be accompanied by slight bleeding.

— A slight discharge of scarlet blood from the vagina after an abortion is associated with injury to the mucous membranes of the uterus and cervical canal. Normally, their intensity should decrease until they completely stop on their own.

The most common causes of significant vaginal bleeding are:

— Menstrual cycle disorders. In the absence of ovulation, the cyclic processes of the uterus and ovaries are disrupted, which leads to the appearance of intermenstrual bleeding.

— Polyps of the cervical canal and endometrium provoke bleeding of varying intensity if they reach large sizes, are injured or undergo decay.

— Uterine fibroids of significant size prevent the muscular wall of the uterus from contracting properly and cause prolonged menstruation or intermenstrual bleeding.

— Bleeding with severe inflammation of the uterus and appendages is associated with a disruption of the normal hormonal status of the body under the influence of infection.

— With endometriosis, the discharge is only sometimes abundant and bright, but is always associated with menstruation.

Acyclic bleeding can accompany some non-gynecological pathologies: diseases of the blood coagulation system,.

Sudden heavy bleeding against the background of a sharp deterioration in health appears in emergency conditions that threaten the life and health of a woman. Most often these are:

— Submucous (submucosal) fibroids of the uterine body. Sometimes fibroids grow into the uterine cavity in the form of a node, causing severe bleeding and pain. The most dangerous complication of submucosal fibroids is uterine inversion.

— Retention of parts of the fertilized egg after a medical abortion or spontaneous miscarriage. Pieces of remaining tissue prevent the uterus from contracting, causing bleeding. A similar situation occurs after childbirth, when a piece of the placenta remains in the uterus.

— Interrupted ectopic pregnancy.

— Complications of pregnancy: premature spontaneous termination of pregnancy, placental abruption.

— Postpartum hemorrhage associated with rupture of the soft tissues of the vagina and/or cervix, especially when they are sutured incorrectly or at the wrong time.

If untimely bleeding occurs, you should immediately visit a doctor.

Vaginal discharge with odor

Microorganisms present in the vagina during their life processes release chemical compounds with different odors. In healthy women, there is an individual, subtle odor in the area of the external genitalia. Normally, he should not bother a woman. Increased vaginal odor often signals problems.

The simplest reason for the appearance of unpleasant-smelling discharge is a violation of the rules of intimate hygiene. If they disappear after normal hygiene procedures, there is no need to worry.

The smell of vaginal discharge is perceived differently by patients, since everyone’s sense of smell is not equally developed. However, there is a group of diseases that have a characteristic, unique smell of vaginal discharge.

Discharge from sexually transmitted infections has an unpleasant odor. With trichomoniasis, an unpleasant, pungent odor accompanies copious, foamy discharge.

The sour odor of vaginal discharge in vulvovaginal candidiasis is caused by Candida fungi.

One of the most common diseases with a characteristic vaginal odor is bacterial vaginosis, characterized by the appearance of copious homogeneous vaginal discharge with a very specific smell of stale fish. Bacterial vaginosis does not have a specific pathogen; it develops against the background of a quantitative change in the composition of the vaginal microflora with the participation of opportunistic microorganisms.

Under the influence of unfavorable factors in the vagina, the number of lactobacilli decreases and the pH changes, which is fertile ground for the development of dysbiosis. Instead of lactobacilli, opportunistic microflora begins to multiply in the vaginal environment; the more of it, the more pronounced the symptoms of the disease, including vaginal odor.

The unpleasant odor of vaginal discharge in patients with bacterial vaginosis is associated with the activity of anaerobic bacteria: they produce amines. As amines break down, they release a “fishy” odor. If the disease occurs in an erased form, the amine test reveals a specific vaginal odor: the contents of the vagina are mixed with an alkali solution, which destroys amines, and a “fishy” odor is obtained.

Despite the heavy discharge, during examination for bacterial vaginosis there are no signs of local inflammation; this serves as an important diagnostic sign.

To save the patient from bacterial vaginosis, it is necessary to eliminate unwanted microflora and restore normal biocenosis in the vagina.

Discharge of urine from the vagina

Urine discharge from the vagina always indicates the presence of a genitourinary fistula. Urogenital fistulas in women are a pathological formation (course) between the vaginal cavity and the bladder. Much less common are genitourinary fistulas between the bladder and uterus.

The cause of the formation of a genitourinary fistula is often incorrect obstetric and gynecological operations, during which a rupture of the wall of the vagina or uterus occurs with perforation (formation of a hole) in the bladder.

The appearance of genitourinary fistulas may be preceded by criminal abortion.

Very rarely, perforation of the uterus during a medical abortion leads to the formation of a genitourinary fistula. As a rule, this situation arises if the patient has a pronounced infectious process in the uterus.

Genitourinary fistulas can be of a traumatic nature and occur against the background of serious injuries to the genital organs of a non-gynecological nature.

If a violation of the integrity of the vaginal walls is diagnosed at the time of its occurrence (for example, during surgery), then it is immediately eliminated surgically. In some cases, sharp surgical instruments leave damage invisible to the eye, and pathological symptoms appear much later.

The most characteristic symptom of a genitourinary fistula is the discharge of urine from the vaginal cavity. If the external opening of the fistula is located next to the opening of the urethra, it is difficult to recognize it, and the discharge of urine is mistaken for incontinence.

Continuous leakage of urine into the vagina causes inflammation of the mucous membrane with toxic compounds. Signs of severe inflammation appear – , . Long-term inflammation of the mucous membranes of the vagina provokes the development of a purulent process. In this case, vaginal discharge becomes purulent and acquires an unpleasant odor. A long-standing vaginal infection through the fistula cavity can enter the urinary tract and cause.

Diagnosis of genitourinary fistulas begins with a vaginal examination, which makes it possible to detect the opening of the genitourinary fistula and pronounced changes in the vaginal mucosa. Ultrasound and urological examinations help clarify the diagnosis. Urogenital fistulas are eliminated surgically.

In conclusion, I would like to note that almost all newly appeared and disturbing vaginal discharge requires an attentive attitude, namely an immediate trip to the gynecologist.