Vaginal discharge is one of the most common reasons for gynecological visits in the US, accounting for about 10 million office visits per year.
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.
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.
- Herpes simplex virus (HSV) infection
- Streptococcal vaginitis in adults
- Genital schistosomiasis
- Entamoeba gingivalis plus intrauterine device (IUD)
- Inadequate hygiene
- Foreign body in adults
- Contraceptive vaginal ring-related
- Atrophic vaginitis
- Postpuerperal atrophic vaginitis; lochia
- Behcet syndrome
- Desquamative inflammatory vaginitis
- Erosive lichen planus
- Cervical cancer
- Carcinoma of the fallopian tube
- Pinworm infection
- Streptococcal vaginitis in children
- Sexual abuse
- Transmitted maternal birth canal infection
- Prolapsing fibroid
- Vaginal fistula
- Lymphoma of genital tract
Professor of Clinical Obstetrics and Gynecology
Clinician Educator Track
VGL declares that she has no competing interests.
Dr Veronica Gomez-Lobo would like to gratefully acknowledge Dr Isabelle Guichard, a previous contributor to this topic. IG declares that she has no competing interests.
Department of Obstetrics and Gynecology
Virginia Commonwealth University
DC declares that he has no competing interests.
Consultant in Sexual and Reproductive Health
Lewisham Primary Care Trust
Waldron Health Centre
LB was a member of the group that produced the 2006 Faculty of Sexual and Reproductive Health guidance on the management of women with vaginal discharge presenting in non-GU setting.
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