Evaluation of vaginal discharge

Vaginal discharge is one of the most common reasons for gynecological visits in the US, accounting for about 10 million office visits per year.[1]Kent HL. Epidemiology of vaginitis. Am J Obstet Gynecol. 1991 Oct;165(4 Pt 2):1168-76. http://www.ncbi.nlm.nih.gov/pubmed/1951572?tool=bestpractice.com

Physiologic vaginal discharge

Normal vaginal discharge in a reproductive-aged woman, also called physiological leukorrhea, usually consists of 1-4 mL per 24 hours. It is typically transparent, mucousy, and white-to-yellowish. It is typically odorless but can also be slightly malodorous. The character of physiological discharge can vary over time. For instance, it becomes more noticeable with higher estrogen states (e.g., pregnancy, use of estrogen-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 leukorrhea in reproductive women (4.0-4.5) creates a hostile environment for pathogens. In premenarchal and postmenopausal women with low estrogen 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 Nov;7(9):1167-74. http://www.ncbi.nlm.nih.gov/pubmed/9861594?tool=bestpractice.com