Leucorrhea

Introduction Leucorrhea is a viscous white liquid that flows out of the vagina. It is a mixture of vestibular glands, cervical glands, endometrial secretions and vaginal mucosa exudates, and shed vaginal epithelial cells. Made. The leucorrhea contains lactobacilli, lysozyme and antibodies, so it has the effect of inhibiting the growth of bacteria. During the sexual behavior, the vaginal discharge will increase, which will have a lubricating effect on the vagina and facilitate sexual life. Generally, the vaginal discharge increases in the middle menstrual period, and is thin and transparent; after ovulation, the leucorrhea becomes viscous, turbid and less. Both leucorrhea and pre-pregnancy leucorrhea increased. Non-primate mammals appear during estrus.

Cause

Etiology classification

First, physiological leucorrhea

Second, pathological vaginal discharge

(1) Non-inflammatory

(two) inflammatory leucorrhea

1. Bacterial vaginosis

2. Trichomonas vaginitis

3. Fungal vaginitis

4. Senile vaginitis

5. Gonorrhea vaginitis

6. Chronic cervicitis or cervical erosion

(C) the irritant of the guide

(four) cancerous self-contained

(5) Other vaginal discharges

mechanism

(1) Physiological bring

Physiological vaginal discharge, including from the size of the labia, vestibular gland, vaginal exudate and cervical gland secretions, and a small amount secreted by the endometrium. It is a white, flocculent, partially liquid with varying amounts and traits that vary slightly with the menstrual cycle.

(2) Pathological self-contained

Any situation that can make the pelvic cavity and uterus congestion can cause the uterus gland and endometrium to function and then secrete too much of the sputum. Found in chronic diseases and debilitating people and mental stimulation, inflammatory irritation, foreign body stimulation, as well as cancer and urine thin, fecal thin. The vaginal discharge can be white watery, purulent, curd or bloody leucorrhea.

an examination

Related inspection

Vaginal gynecological routine examination of gynecological inflammation examination

First, medical history

Should consult the amount of vaginal discharge in detail, whether it is contaminated with underwear or need to use menstrual belt; the color of vaginal discharge; whether there is special smell; the time of occurrence; whether it stimulates the vulva and causes itching; whether there has been a diagnosis of pathological leucorrhea in the past; Treatment; whether the spouse has genitourinary disorders and so on.

Second, physical examination

The examination was performed from the outside to the inside. The vulva, urethra, paraurethral gland and vestibular gland were first examined by visual inspection, and the vaginal wall and cervix were observed by a vaginal speculum.

(1) Vulva inspection

See the identification of vaginitis. The erythema and small collars around the vulva and anus may be candidiasis, and the genital area of patients with trichomoniasis may be trichomoniasis vaginitis or cervicitis often contaminated by a large amount of purulent vaginal discharge. In bacterial vaginosis, only accumulated vaginal discharge is seen at the vaginal opening.

(two) the appearance of vaginal discharge

Various pathological vaginal discharges with different specificities provide diagnostic clues.

1. Physiological leucorrhea: homogenization, flocculation, high potency and accumulation in the vagina.

2. Bacterial vaginal clear: The leucorrhea is gray, homogeneous, and has a low tympanic pressure. It is often attached to the surface of the anterior wall of the vagina or the side wall. It is easy to wipe off and the vaginal membrane has no obvious change.

3. Trichomonas vaginitis: leucorrhea is yellow or even yellow-green, obviously purulent, often foamy.

4. Candidiasis: leucorrhea is white, highly porcine thick, in the form of case or bean curd, attached to the vaginal wall, sometimes similar to white goose-like plaque, or leucorrhea rarely or similar to normal leucorrhea, but The vaginal wall is leukoplakia.

(C) cervical secretions

The cervix has a clear liquid-like secretion before ovulation, which is thicker in the luteal phase.

1. Cervicitis: At any stage of the menstrual cycle, the presence of purulent cervical secretions should consider the possibility of cervicitis. When examining, the vaginal discharge outside the cervix should be swabbed. Observing the purulent secretion of the endocervix can be diagnosed as Cervicitis. At this time, the columnar upper degree of the cervical canal is erythematous, and the fragility is increased. The swab can often cause bleeding.

2. Chlamydia cervicitis: Chlamydial cervicitis often hypertrophic columnar epithelium, prominent squamous epithelial plane.

3. Malaria toxic cervicitis: ulcerative or necrotic lesions often appear in the columnar epithelium.

4. Gonorrhea cervicitis: yellow thickening in the neck tube or liquid plug, overflowing the vagina and causing vaginitis, squeeze the urethra, paraurethral glands or vestibular glands often have purulent overflow.

Third, laboratory inspection

(1) pH measurement

The use of a paper strip to measure the state of the vaginal discharge has a certain value for diagnosis. The pH of normal vaginal discharge is 4.5, and the pH value of trichomoniasis and bacterial vaginal discharge increases.

(b) the smell of amine

Patients with excessive vaginal discharge should be tested for odor. First, put a drop of 100% KOH solution on the slide to mix the leucorrhea. The vaginal discharge of bacterial vaginosis can give off the smell of fish sputum. It is caused by the alkalinization and volatilization of the hydrazine present in the discharge. Occasionally, this is also the case with vaginal vaginal discharge. The normal vaginal discharge and the leucorrhea of Candida have no such amine odor.

(3) Microbial culture

1. Candidiasis: About 20% of people with candidiasis are negative for KOH smear, so those with high risk of genital itching and candida infection (diabetes, long-term application of broad-spectrum antibiotics, immunosuppressants, etc.) or vagina Patients with erythema and KOH specimens that cannot be diagnosed should be cultured for definite diagnosis.

2. Trichomoniasis: Most patients with trichomoniasis can find trichomoniasis in their vaginal discharge, but a considerable number of false negative results are also obtained. Because trichomoniasis requires fresh medium to obtain stable results and is limited, culture is best limited to leucorrhea containing a large number of white blood cells, suspected trichomoniasis and microscopic examination of patients with high risk of sexual and sexually transmitted diseases.

3. Vaginitis: Because many asymptomatic women have more pathogenic bacteria in the vagina, such as p-streptococci, vaginal Gatnerella. Escherichia coli and other enterococci, it is difficult to determine which bacteria caused by vaginitis, so the general bacterial culture is of little value in determining the cause of vaginitis.

Fourth, equipment inspection

The leucorrhea was observed under a microscope. Under the guidance of the clue of drainage, it is easier to obtain a correct diagnosis by microscopic observation. Mix a small amount of saline on the slide to disperse the vaginal epithelial cells, and observe the lactobacilli, white blood cells and drops under high magnification (400x). Insects and clue cells; another slide was mixed with a larger amount of leucorrhea with 10% KOH solution to observe Candida at 100x.

(a) Lactobacillus

Normal leucorrhea or Candida leucorrhea contains crude bacilli, which is found to indicate the presence of lactobacilli. Trichomonas vaginal discharge is often not found, but completely disappears in the vaginal tract of bacterial vaginosis.

(two) from the cell

In the hanging drops, normal white leucorrhea can only see one or two white blood cells in high power field. If there are a lot of white blood cells, trichomoniasis or cervicitis should be considered. Candidiasis and bacterial vaginosis leucorrhea less.

(3) Trichomonas

It is a flagellated protozoa, slightly larger than white blood cells. If it is active, it is easily recognizable, but when surrounded by white blood cells, its activity is limited. About 15%-20% of vaginal discharge in patients with trichomoniasis, no trichomoniasis observed under the microscope, in this case, should be observed under high magnification, according to the activity of the flagella and cell identification.

(4) Mycelium

Mycelium can be found under the microscope (100×) in the specimen of fungal vaginitis leucorrhea mixed with 10% KOH solution, but Candida does not exist in the vagina. On the contrary, buds can be seen with or without infection, but must be done in methylene blue or gram-free, Pap smear.

(5) clue cells

The so-called clue cells refer to bacterial vaginosis, and many bacilli are condensed on the edge of vaginal epithelial cells as a basis for diagnosis. In the hanging drop smear, the edge of the vaginal epithelial cells is granulated or spotted, so that the unclear is the clue cell. It is the most sensitive and specific sign of bacterial vaginosis. As long as it has two positive tests for lead cells and amine tests, it can quickly and correctly diagnose bacterial vaginosis.

Differential diagnosis

The diagnosis should be differentiated from the following symptoms:

1. Increased vaginal discharge after menopause: increased vaginal discharge after menopause refers to increased secretion of leucorrhea in postmenopausal women, exceeding normal levels. Leucorrhea is a female vaginal discharge. The leucorrhea of normal women is an odorless, slightly acidic viscous substance. It has the functions of moistening the vagina, excreting waste, and inhibiting the growth of pathogenic bacteria. It is a normal physiological phenomenon. Increased vaginal discharge in healthy women is directly proportional to the increase in estrogen levels in the body. Such as ovulation or vaginal discharge during pregnancy, in the case of excessive growth of the endometrium, or the use of estrogen drugs can appear similar leucorrhea.

2. Pus vaginal discharge: Salpingitis is more common in infertile women, the cause of which is caused by pathogen infection. The most common time for salpingitis to occur is after childbirth, after abortion or after menstruation. Injury of the birth canal and placental stripping surface during labor or abortion or wounds of the endometrial exfoliation during menstruation are all ways in which the pathogen infects the internal genitalia. Sometimes infections are associated with less stringent aseptic surgical procedures. Salpingitis is mainly characterized by lower abdominal pain, bloating, fever, increased vaginal discharge or irregular vaginal bleeding.

3. Increased vaginal discharge: vaginal discharge is a female vaginal discharge. The vaginal discharge of normal women is an odorless, slightly acidic viscous substance, which has the functions of moistening the vagina, excreting waste, and inhibiting the growth of pathogenic bacteria, and is a normal physiological phenomenon. Increased vaginal discharge in healthy women is directly proportional to the increase in estrogen levels in the body. Such as ovulation or vaginal discharge during pregnancy, in the case of excessive growth of the endometrium, or the use of estrogen drugs can appear similar leucorrhea. The increase in leucorrhea that deserves special attention is the vaginal discharge of the lesion.

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