Abnormal vaginal discharge

Introduction Leucorrhea is a white liquid that women shed from the vagina. The vaginal discharge is divided into physiological leucorrhea and pathological leucorrhea. Pathological leucorrhea is mostly caused by inflammation. Clinically common pathological white belt: colorless transparent sticky leucorrhea, white or grayish yellow foamy leucorrhea, curd leucorrhea, watery leucorrhea and so on. The formation of vaginal discharge has a close relationship with estrogen. When the secretion of estrogen reaches a peak, there will be a large amount of vaginal discharge and a transparent leucorrhea. The leucorrhea is sticky like an egg white and can be drawn into a filament.

Cause

Physiological

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 application of estrogen drugs can appear leucorrhea.

2. Pathological

Vaginal inflammation, chronic cervicitis, senile vaginitis, endometritis, uterine fluid or intravaginal foreign body, uterine fibroids, genital herpes, gonorrhea, condyloma acuminata, uterine prolapse, chronic pelvic inflammatory disease.

an examination

Related inspection

Vaginal speculum check gynecological routine examination of gynecological diseases, virus check vaginal discharge pH

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.

(A) vulva inspection: see the identification of vaginitis. The erythema and small collars around the vulva and anus may be candidiasis, and the vulva of patients with vaginal edema, trichomoniasis, cervicitis or cervicitis is often contaminated by a large amount of purulent vaginal discharge. In the case of bacterial vaginosis, only accumulated vaginal discharge is seen at the vaginal opening.

(B) the appearance of vaginal discharge: a variety of pathological vaginal discharge with different specificity can provide diagnostic clues.

1. Physiological vaginal discharge: color white homogeneity, flocculent, highly effective and accumulated in the vagina.

2. Bacterial vaginal clear: The leucorrhea is gray, homogeneous, and low in tying. 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, may also have little or similar leucorrhea However, 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, and the purulent secretion of the endocervix can be observed. 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.

Laboratory inspection

(1) Determination of pH value: The application of a paper strip to measure the state value of vaginal discharge has 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 leucorrhea should be tested for the presence or absence of glue. 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 have negative KOH smear smear, so those with high risk of genital itching and candida infection (diabetes, long-term application of broad-spectrum antibiotics, immunosuppressants, etc.) or Patients with erythema in the vagina and KOH specimens cannot be diagnosed should be clearly diagnosed.

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.

Device 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.

(1) 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.

(B) from the cells: in the hanging drops, normal vaginal discharge high-power field can only see one or two white blood cells, such as the presence of a large number of white blood cells should consider trichomoniasis or cervicitis, candidiasis and bacterial vaginal vaginal suspension There are few white blood cells in the drip smear.

(3) Trichomonas: It is a protozoan with flagella, slightly larger than white blood cells. If the activity is good, it is easy to identify, but when surrounded by white blood cells, the 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 a specimen mixed with vaginal vaginal vaginal discharge and 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

Non-inflammatory vaginal discharge

(1) White is sticky and has a large amount, which is found after the application of estrogen drugs.

(2) Women in childbearing age have too few leucorrhea, which can not meet their own physiological needs, so that women often feel that the vulva is dry and discomfort, often caused by ovarian dysfunction and excessive secretion of sex hormones. It is also a pathological condition.

(3) The stimulation of mental factors increases the secretion of vulva, vagina and cervix, and is colorless and transparent.

(4) vaginal discharge is milky white water, which can occur in patients with pelvic tumors, uterine flexion, chronic systemic diseases (heart failure, diabetes, anemia, tuberculosis, etc.), due to pelvic and uterine congestion, increased vaginal secretions.

Inflammatory leucorrhea

(1) leucorrhea is milky white or light yellow, purulent, more amount, odor, more with abdominal pain, usually caused by chronic cervicitis or endocervitis.

(2) The leucorrhea is yellow or yellowish green, thin and foamy, or like rice bran water, grayish white, white with odor, mostly caused by vaginal trichomoniasis.

(3) The vaginal discharge with gonorrhea is yellow pus.

(4) Most of the leucorrhea secreted by the amoeba infection is: serous or yellow viscous secretions with blood, sometimes mixed with fine rotten meat (like yellow sauce).

(5) The leucorrhea is yellowish white, most of the texture is viscous, and sometimes the texture is thin, typically milky white, like bean dregs, or like a curd-like white flake or block, mostly due to mold infection.

(6) If blood is present in the vaginal discharge, it is common in cervical polyps, side effects caused by intrauterine devices, submucosal uterine fibroids, severe chronic cervicitis.

(7) In the case of fallopian tube cancer, the leucorrhea is intermittent, clear, yellow-red liquid due to tumor stimulation of the oviductal epithelial exudate and pathological tissue necrosis, and flows out from the vagina for a while.

(8) After women suffer from cervical cancer, vaginal cancer, uterine body cancer and other diseases, the "leucorrhea" when they are secreted, most of them are: leucorrhea, gold, me, rice, water, turbid and stench, sometimes Mixed with blood is pale pink, the amount is large.

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