What Is The Cause Of Chronic Vaginal Discharge?

Dear Mirror Doctor,

I am a 28-year-old lady with an 11-year-old son. Ever since I gave birth to my son, I started having vaginal discharges. Ten years ago, I went for a test and I was told that I had Candida albicans.

I was treated but it recurred within a short period. I was tested a second time and I was told that I had a mixed infection with Klebsiella and Candida. I was treated and ever since then, I have had to treat this discharge times without number within the past years.

Sometimes, it itches and I feel sore down there and the discharge becomes thick, cheese like but after some antibiotics, the itch stops but the discharge persists.

At other times, I find cuts around my vagina and the labia even up to the joint between my vagina and my thigh. The discharge is whitish and smells. I am tired of it and I have decided to ignore it but I just can’t get it out of my mind.

I always rush to the bathroom for a quick wash of my vagina before I could make love to my husband. In the absence of water, I have to clean myself up or I’m always wet. I feel terrible when my man pulls out of me with his organ all white from the discharge.

I am at a loss and I don’t know what to do anymore. Please help me. I have also been treated for PID before but the discharge still persists. All these years I have been sexually active and at one time my man and I had to take Diflucan. It stopped for a while but recurred shortly.

I have not been sexually active for five months now but it still persists. I dry my pants in the sun and wear cotton panties like the doctor recommended. I take my bath sometimes thrice in a day and I am generally a neat person. Help me please. If it will be of any help, I have also had several abortions within the last 10 years.

Mama, Accra

Dear Mama,

In reproductive aged women, normal vaginal discharge consists of one to four mL fluid in 24 hours, which is white or transparent, thick, and mostly odourless.

Normally, the cervical glands produce a clear mucous secretion that drains downward, mixing with bacteria, discarded vaginal cells, and other secretions from the Bartholin gland at the opening of the vagina.

These substances may turn the mucus a whitish colour, and the discharge turns yellowish when exposed to air.

There are times throughout the menstrual cycle that the cervical glands produce more mucus than others, depending on the amount of oestrogen produced.

The discharge becomes more noticeable such as during pregnancy, when using oestrogen-progestin contraceptives or at mid-menstrual cycle close to the time of ovulation. The vaginal discharge may be slightly offensive and accompanied by irritative symptoms.

In the vagina of every female is a complex and intricate balance of micro-organisms that keeps each other in check. These organisms are known as the normal vaginal flora. Important organisms found there include lactobacilli, corynebacteria, and yeast or fungi.

The pH of the normal vaginal secretions is 4.0 to 4.5 which create an acidic environment, hostile to growth of pathogens and inhibits adherence of bacteria to vaginal epithelial cells.

The vagina is also self cleansing, i.e. it is able to clean itself and does not require people inserting things or their fingers into their vagina to clean their vaginas.

Age, phase of the menstrual cycle, sexual activity, contraceptive choice, pregnancy, presence of foreign bodies, and use of hygienic products or antibiotics can disrupt the intricate balance of micro-organisms in the vagina and cause some organisms to overgrow.

Each woman should know what her normal vaginal discharge should look like so that she will be better placed to notice qualitative or quantitative alterations when they begin.

The quantity and quality of vaginal discharge in healthy women vary both across the population and in an individual woman during her menstrual cycle.

Vaginal discharge is a very common condition in women. Unfortunately, most diseases of the genital tract present with a vaginal discharge which pose a diagnostic challenge for the doctor.

Infections of the vagina, cervix, uterus and fallopian tubes present with a discharge. Non-infectious causes, such as chemicals or irritants (e.g., spermicides or douching), hormone deficiency, and, rarely, systemic diseases may present with a vaginal discharge.

It is important for the doctor to consider other medical conditions such as diabetes mellitus, dermatological condition, such as dermatitis or lichen sclerosus, immunosuppression, for example, HIV infection, frequent antibiotic use, and long-term steroid treatment in looking for causes of persistent vaginal discharge.

Most women see every discharge as candida commonly referred to as ‘white’ and often resort to frequent self-diagnosis and treatment. Sometimes, these infections are wrongly treated or inadequately treated, which could rather worsen the condition.

Mama, you seem to have a mixed infection which probably has affected the upper genital tract, which may be the cause of the persistent vaginal discharge.

Your frequent abortions could have introduced other germs into your genital tract. You have also not helped yourself by not pursuing the full investigation and treatment of the vaginal discharge.

Your doctor is in the best position to make a correct diagnosis of the discharge, which is usually made based on your symptoms, physical or vaginal examination and results of blood, urine test and vaginal cultures.

Your doctor will give you the appropriate drugs to treat the identified infection. You will, however, need to be patient with your doctor.