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26 December 2017 | Feature Article

Genital Discharge In Females., Know When To See The Doctor

Genital Discharge In Females., Know When To See The Doctor

FEMALE GENITAL DISCHARGE
Normally, glands lining the vagina and cervix, secrete clear mucoid fluid which flows out of the vagina. The color and thickness of the fluid vary throughout the menstrual cycle. Problems arise when the discharge gets copious, smells bad or changes color.

The characteristics of the discharges, and associated symptoms vary with the causative factors.

NEWBORN PERIOD.
While inside the womb, hormones from the mother cross the placenta to the baby's genital lining, helping the lining to proliferate. After delivery, the hormonal level falls, and this cause the lining to slough off. The newborn would have a greyish-white vaginal discharge. Sometimes the discharge may be stained with blood, or even grossly bloody.

No treatment is required, the discharge resolves by 10 days of age.

PRE-PUBETAL PERIOD
Non-specific causes of genital discharge
Certain chemicals cause symptoms of genital burning or swelling.

Discharge could, also, be due to irritation from bubble bath, sand. The use of nonabsorbent, occlusive clothing such as nylon undergarment, tight bathing suits do irritate the vulva, leading to skin breakdown and infection. Candida infections can rise under such circumstances.

Other causes of discharge include poor perineal hygiene and foreign bodies.

Some young girls, out of curiosity, (sometimes with history of sexual abuse), do insert objects in their genitals. They may have genital pain, foul smelling discharge, painful micturition.

Removal of the foreign bodies cure the symptoms.
PUBERTAL & POST PUBERTAL
Increases in hormonal levels leads to increase mucus production and this leads to clear mucoid discharge. Mucus secretions increase after sex, and midway through the menstrual cycle. The secretions have high protein content, and when absorbed onto underwear, causes yellow staining.

Abnormal vaginal discharges may include the following:

BACTERIAL VAGINOSIS. (BV)
This discharge, gives a fish odor.
Lactobacilli are bacteria living in the female genital tracts. They keep the growth of other genital bacteria in check, by creating acidic environment, as they secrete lactic acid, and also, Hydrogen peroxide. Menstrual bleeding makes the environment in the genital tracks, more alkaline, leading to overgrowth of the previously suppressed anaerobic bacteria. This can lead to a whitish discharge with PH greater than 4.5.

  • Risk of getting B.V
  • Having multiple sexual partners,
  • Douching,
  • Smoking,

FEATURES:
Homogenous, thin white discharge, evenly coating the genital wall, is characteristic. There is no itch, no pain associated with the discharge.

The discharge emits a strong fish-like odor, especially, after sex.

PREVENTION:
Avoid sex, or,
Limit number of sex partners
Do not douche.
N.B BV is not heterosexually transmitted, but may be transferred between, female sex partners

Treatment: a course of Metronidazole helps.
You can’t drink alcohol, while taking metronidazole. Wait for at least, 24 hours after completing the metronidazole course.

VAGINAL CANDIDIASIS. ("White")
Yeast, normally live in the genitals. They, under favorable conditions, multiply to cause genital yeast infections.

Symptoms of genital yeast infections:
Vaginal itch or vaginal soreness
Features of vaginal candidiasis:
White milky or thick cheesy and clumpy discharge. When severe, there may be complaints Genital soreness

Painful micturition and
Painful intercourse.
The vulva may be reddish, swollen with excoriations and several red spots.

Discharge PH is about 4.5
Who gets vaginal candidiasis?
Factors that predispose to candida infections include:

Oral contraceptive, birth control pills, use,
Antibiotics use, and
Diabetes.
Prevention:
Wear cotton underwear to reduce the chances of getting a yeast infection.

Treatment: Fluconazole single dose treatment, usually clears the discharge after 4-5 days.

Fluconazole could be taken once weekly, for diabetic patients with recurrent infections.

Vaginal creams, suppositories and intravaginal tablets are also available and are equally effective.

SEXUALLY TRANSMITTED VAGINAL DISCHARGES.
For those, who are sexually active, vaginal discharge could be related to STDs, and their sexual partners, do need treatment, at the same time.

GONORRHEA and CHLAMYDIA
Sexually transmitted, affecting both men and women.

FEATURES:
Burning sensation when urinating.
Yellowish vaginal discharge. Discharge is not profuse, and has no foul or fishy odor.

Persons has no vulva lesions.
Vaginal bleeding between periods.
Treatment: Sexual contacts do need to be treated simultaneously with Ceftriaxone muscular injection, and oral course of Azithromycin.

Wait, at least 7 days, after treatment, before having sex.

Prevention:
Use latex condoms, when having sex
Make sure your sex partner has tested Negative for gonorrhea.

TRICHOMINIASIS
Any woman can get Trichomoniasis vaginalis. Older women are more likely than younger women, to have been infected with trichomoniasis. 70% of infected persons, have no symptoms.

FEATURES:
Itching, soreness of the genitals
Pain on voiding urine,
Lower abdominal pain, and
Post coital bleeding.
The discharge could be of any color: white, gray, yellow-greenish and appears

Frothy, foul smelling with
PH 5.2-5.5.
In severe cases, there is swelling and excoriations on the vulva and infection could involve the Bartholin glands causing Bartholinitis.

Treatment: An oral course of Metronidazole. All sexual contacts must be treated at the same time. Avoid alcohol until for at least, 24 hours after completing the course of metronidazole

PERSISTENT DISCHARGE.
A teenager who has persistent discharge that is unresponsive to treatment may not be complying with treatment or may have become re-infected, by an untreated partner. If such is not the case, and Trichomoniasis, Chlamydia and Neisseria are excluded, A trial of sitz baths, use of cotton as opposed to nylon underwear and attention to perenial hygiene helps.

HOME PH MONITORING DISCHARGE FLUID
Home PH test strips, help to evaluate the discharge.

Hold the PH test paper against the wall of the mid-vagina, for a few seconds.

Normal vaginal PH is 3.8-4.5. If your vaginal PH is above 4.5, it is not a yeast infection. Bacterial vaginosis and Trichomoniasis are more likely and you need to see your doctor for treatment. In yeast infection, the PH is normal or lower.

Candida albicans : PH =4.5
Bacterial vaginosis: PH > 4.5
Trichomoniasis vaginalis: PH 5.2- 5.5

Disclaimer: "The views/contents expressed in this article are the sole responsibility of Alex Sarkodie MD and do not neccessarily reflect those of Modern Ghana. Modern Ghana will not be responsible or liable for any inaccurate or incorrect statements contained in this article."

Author: Alex Sarkodie MD
Stories: 45 Publication(s)
Column: AlexSarkodie

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