LEUCORRHEA (Vaginal white discharge)


Definition


Leucorrhea is strictly defined as an excessive 

normal vaginal discharge. The symptom of excessive 

discharge is a subjective one with individual variation, 

while to declare it to be normal and not an infective 

one, requires clinical and laboratory investigations.



Vaginal white discharge (LEUCORRHEA)


The term leucorrhea should fulfil the following 


criteria:

™ The excess secretion is evident from persistent 

vulval moistness or staining of the undergarments 

(brownish yellow on drying) or need to wear a 

vulval pad.

™ It is nonpurulent and nonoffensive.

™ It is nonirritant and never causes pruritus.


PATHOPHYSIOLOGY—


N o r m a l Va g i n a l

Secretion: The origin and nature of the normal

vaginal secretion during the reproductive period has However, a short resume is

presented here.

The physiologic basis involved in normal vaginal

secretion is dependent on the endogenous estrogen

level. With the rising estrogen level, there is abundant

secretory activity of the endocervical glands and

the superficial vaginal epithelium becomes rich in

glycogen 

The mucoid secretion from the cervical glands is

normally small in amount. The carbohydrate radicle

of the glycoprotein mucin is split off and fermented

into lactic acid. If however, the mucus is secreted in

excess, it pours out at the vulva.



           Types of vaginal discharge 



The excessive secretion is due to:

-Physiologic excess

-Cervical cause (cervical leucorrhea)

-Vaginal cause (vaginal leucorrhea)


Physiologic excess: 

The normal secretion is expected

to increase in conditions when the estrogen levels

become high. Such conditions are :

During puberty—Increased levels of endogenous

estrogen lead to marked overgrowth of the endo-

cervical epithelium which may encroach onto the

ectocervix producing congenital ectopy (erosion) →

increased secretion.


During menstrual cycle

™ Around ovulation—Peak rise of estrogen →

increase in secretory activity of the cervical

glands.

™ Premenstrual pelvic congestion and increased

mucus secretion from the hypertrophied endome-

trial glands.

Pregnancy—There is hyperestrinism with increased

vascularity. This leads to increased vaginal transudate

and cervical gland secretion.

During sexual excitement, when there is abundant

secretion from the Bartholin’s glands.

Cervical cause: Non-infective cervical lesion may

produce excessive secretion, which pours out at the

vulva. Such lesions are—cervical ectopy, chronic

cervicitis, mucous polyp and ectropion (cervical

glands are exposed to the vagina).

Vaginal cause: Increased vaginal transudation

occurs in conditions associated with increased

pelvic congestion. The conditions are uterine

prolapse, acquired retroverted uterus, chronic pelvic

inflammation, ‘pill’ use and vaginal adenosis. Ill

health is one of the important causes of excessive

discharge. It produces excess exfoliation of the

superficial cells.




   Diagnosis of vaginal discharge (LEUCORRHEA)



DIAGNOSIS —


Box – I: Evaluation of a Patient with Vaginal Discharge


 History 

 Symptoms

� Discharge

• Duration

• Itching

• Dysuria

• Dyspareunia

• Pelvic pain

� Contraception

� Sexual behavior

� Previous episodes


Physical examination

� Ill health

� Poor nutrition

� Abdominal examination

• Tenderness • Mass

� Vulval inspection

• Discharge-characters 

� Genital ulcers

� Speculum examination

• Pathology • Vagina

• Cervix (ectopy)

• Tenderness

™ Pelvic examination

• Tenderness

• Pelvic mass

• Foreign body


Investigations

 Discharge

� Wet film for

• T. vaginalis 

• Clue cells 

� KoH test

• Whiff test 

• Fungus 

� Discharge for gram staining

� Pap smear 

� Urine for R/E, C/S

� HIV serology 

� Blood tests when PID is suspected



TREATMENT: 


Treatment of vaginal white discharge :


The following guidelines are pres-

cribed to treat a case of leucorrhea.


™ Improvement of general health.

™ Cervical factors require surgical treatment like

electrocautery, cryosurgery or trachelorrhaphy.

™ Pelvic lesions producing vaginal leucorrhea

require appropriate therapy for the pathology.

™ Pill users may have to stop ‘pill’ temporarily, if

the symptom is very much annoying.

™ Above all, local hygiene has to be maintained

meticulously.

™ Treatment for specific infection.



  Vaginal discharge in undergarments 



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