Assessment of vaginal discharge

Vaginal discharge is one of the most common reasons for gynaecological visits. In the US alone, it accounts for about 10 million office visits per year.[1]Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991;165:1168-1176. http://www.ncbi.nlm.nih.gov/pubmed/1951572?tool=bestpractice.com

Physiological vaginal discharge

Normal vaginal discharge in a reproductive-aged woman, also called physiological leucorrhoea, usually consists of 1-4 mL per 24 hours. It is typically transparent, mucousy, and white-to-yellowish. It is typically odourless but can also be slightly malodorous. The character of physiological discharge can vary over time. For instance, it becomes more noticeable with higher oestrogen states (e.g., during pregnancy, or when using oestrogen-progestin contraceptives, or at ovulation). Lactobacilli in the normal vaginal flora maintain normal acidity in vaginal discharge by producing hydrogen peroxide and lactic acid. The normal pH of leucorrhoea in reproductive women (4.0-4.5) creates a hostile environment for pathogens. In premenarchal and postmenopausal women with low oestrogen states, vaginal pH may be 4.7 or more.

Epidemiology

The true prevalence of this condition is uncertain because vaginitis, which encompasses the symptom vaginal discharge, is often asymptomatic, self-diagnosed, and self-treated. A telephone survey revealed that 8% of white women and 18% of black women had at least 1 episode of vaginal symptoms in the previous year.[2]Foxman B, Marsh JV, Gillespie B, et al. Frequency and response to vaginal symptoms among white and African American women: Results of a random digit dialing survey. J Womens Health. 1998;7:1167-1174. http://www.ncbi.nlm.nih.gov/pubmed/9861594?tool=bestpractice.com