Medical maps: vaginal discharge

Clue cells.

Discharge – a mixture of fluid and cells from the vagina – can be physiological or pathological. Discharge is considered distinct from bleeding, or from the release of amniotic fluid during spontaneous/artificial rupture of membranes.

Features of physiological discharge

Physiological discharge is common and may be perceived as pathological by the patient. The term leucorrhoea is used to refer to physiological discharge – it is white, odourless and can be thick or thin. It is associated with high oestrogen states.

Features of physiological discharge.

Leucorrhoea can occur in non-pregnant women immediately prior to ovulation or when using combined hormonal contraceptives (CHC). In newborns, physiological discharge can occur due to in-utero oestrogen exposure.

Leucorrhoea can also occur in pregnancy, especially in the first trimester.

Features of pathological discharge

Pathological discharge can have an infective or non-infective cause. For exam purposes it’s generally going to be an infective aetiology – split into sexually transmitted (chlamydia, gonorrhoea, trichomoniasis) and non-sexually transmitted (candida, bacterial vaginosis) causes.

The discharge might have abnormal consistency (frothy, curd-like), abnormal odour (fishy) or abnormal colour (yellow, green, brown or grey). There may also be symptoms of vaginal itchiness.

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Features of pathological discharge with an infective aetiology.

Summary and medical map

To summarise:

  • Physiological discharge 
    • Non-pregnant
      • Cyclical variation – immediately before ovulation (oestrogen peaks)
      • Use of combined hormonal contraceptives (oestrogen + progesterone)
      • Newborn vaginal discharge (in-utero oestrogen exposure)
    • Pregnancy (especially first trimester)
  • Pathological discharge 
    • Infective aetiology
      • Sexually transmitted
        • Chlamydia (muco-purulent; C. trachomatis)
        • Gonorrhoea (muco-purulent; N. gonorrhoeae)
        • Trichomoniasis (frothy, green and foul smelling; T. vaginalis)
      • Non sexually transmitted
        • Bacterial vaginosis (grey, watery and fishy smelling; G. vaginalis)
        • Candida infection (‘cottage cheese’ discharge, odourless; Candida yeasts)
    • Non-infective aetiology – some examples…
      • Ectropion (yellowish, odourless)
      • Dermatitis (yellowish, can become infected)
      • Retained foreign body (bloody or brown, can become infected)
      • Fistula (rectovaginal caused by complicated childbirth)
      • ~4% of cervical cancer (various appearance; due to sloughed necrotic cells)

Here is the medical map for vaginal discharge:

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Medical map for vaginal discharge. Click to zoom.

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