VAGINAL DISCHARGE

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					VAGINAL DISCHARGE
    + PRURITIS
                By:
 Prof. Moustafa A. Abdel-lah, M.D.
                   Abdel-
    Department of Obstetrics &
             y      g
           Gynecologic
    PHYSIOLOGY OF THE
    VAGINA
                       non-
The vagina is lined by non-keratinized stratified
             ith li    h        ld
squamous epithelium, hormonal dependantd t
(influenced by estrogen and progesterone)

In children the pH of the vagina is 6-8.
predominant flora is gram positive cocci and
bacilli

At puberty, the vagina estrogenized and glycogen
content increase.
Lactobacilli (Duoderline Bacilli)

      Convert glycogen to lactic acid

        p           g
        pH of the vagina is 3.5-4.5
Vaginal E   t
V i l Ecosystem
   Dynamic equilibrium between microflora
                  by-
   and metabollic by-products of the
   microflora, host estrogen and vaginal pH

   The predominant organism is aerobic
                g       g         y
Factors affecting the vaginal Ecosystem
 1.   Antibiotics
 2.   Hormonal milieu
 3.   Contraceptive preparations
 4.   Douching
 5.   V i l Medication
      Vaginal M di ti
 6.   Sexual trauma
 7.   Stress
 8.
 8    Diabetes Mellitus
 9.   Decrease host immunity: e.g. HIV, steroids
Vaginal Desquamated epithelium
1.      p            g      p             (est)
     Reproductive age – superfacial cells ( )
2.          phase-
     Luteal phase- Intermediate cells (prog)
3.   Postmenopausal women- parabasal cells
     P t             l women-     b l ll
     ( absence of hormone))
    g          g
Vaginal Discharge
Normal Vaginal Discharges:
Never:
- wet
- smell
- stain
- irritate
         g            g
       Vaginal Discharge
 Leukorrhea: Excessive amount of normal
 secretion

-Abnormal Vaginal discharge may be:
- white creamy,
  yellow,
- yellow
- blood stained
- greenish
CAUSES OF VAGINAL
   DISCHARGES
Differential Diagnosis
1.   Pediatrics + Peripubertal

       Physiological leukorrhea – high
       estrogen
         c e
       Eczema
       Psoriasis
       Pinworm-
       Pinworm- rectum itchy
       Foreign body
       Sexual Abuse
       g
Investigation:
  Swab for culture
            i i
  PR Examination
  EUA
  X-RAY pelvic
  Exclude sexual abuse
Management:
 Hygiene
 Antibiotics
 Steroids
Post M       l
P t Menopausal

    Exclude malignancy
3.         i A
3 Reproductive Age:

  1. Physiological :
      Increased in pregnancy and
          cycle.
      mid cycle
                                 ,
      Consists of cervical mucous,
      endometrial and oviduct fluid,
      exudates from Bartholin’s and
              g      ,
      Skene’s glands, transudate
      from vaginal epithelium.
     2
     2.   Infection:
a.   Trichomonas vaginalis
     T i h            i li
b.               g
     Candida vaginitis
c.   Bacterial vaginosis( non specific
        i iti )
     vaginitis)
d.   Sexual transmitted disease:
-    Neisseria gonorrhea,
-    chlamydia trachomatis,
-    AIDS
-    syphilis
3. Urinary and faeculent fistulae
4. Foreign body: IUCD, neglected
  pessay
  pessay, vaginal diaphragm

5. Pregnancy: PROM

6. Post cervical cauterization
DIAGNOSIS
1.   History:
       Age
       Type of discharge
       Amount
       Onset (relation to antibiotics
       medication relation to menstruation)
       Use of toilet preparation
       Colour of discharge     ASSOCIATED SYMPTOMS
       Smell
       Pruritus
2. Systemic Examination:
  for Anemia, Cachaxia
  f A      i C h i

3-Local Examination:
     p
  Inspection of vulva
  Speculum examination
- Amount, consistency, characteristic,
   d
  odor
  Bimanual examination
       Investigation
1.  3 Specimens
       Wet       t       ( d li )
    a. W t mount smear (ad saline)
                                      y
    b. Swab for culture and sensitivity
    c. Gram stain
2. Biopsy from suspicious area
  S l i lt t
3.Serological test
4. Test for gonorrhea
5. Cervical Smear
   X-
6. X-ray in children
Treatment: According to the Cause
 1.   Foreign body – remove
 2.   Leukorrhoea
      a. Reassurance
      b Proper Hygiene
      b.
                  p         g        y
      c. Minimize pelvic congestion by
      exercise
PRURITUS VULVAE
 Definition:
   Sensation of itching. It is a term used
   to describe a sensation of irritation
   from which the patient attempts to
                  scratching.
   gain relief by scratching
   Vulvar irritation: Pain, burn, tender
     CAUSES:
1.                                g
     Pruritus associated with vaginal discharge g
     e.g. candida and trichomonas vaginalis.
     Other discharge which is purulent and
                l t di h
     mucopurulent discharge cause pain. i
2.   Generalized pruritis: Jaundice, ureamia,
     d     induced
     drug i d d
3.   Skin disease specific to vulva: Psoriasis,
     seborrhoed dermatitis, scabies, Paget’s
     disease, squamous cell carcinoma
4.   Disease of the anus and rectum: Faecal
     incontinence, tread worms
5.   Urinary condition: Incontinence:
     glycosuria
6.   Allergy and drug sensitivity : soaps,
                ,        p
     deodorant, antiseptic contains p      ,
                                     phenol,
     nylon underwear
7
7.                state,       A B B12
     Deficiency state Vitamin A, B, B12 ,
     hypochromic macrocytic anaemia
8.   Psychological f t
     P h l i l factor
9.   Chronic vulvar dystrophies : Leukoplakia,
     lichen sclerosus, Kyourosis vulvae and
     p       y      p y
     primary atrophy senile atrohy y
1. Investigation
1. History
       The onset, site, duration
       Presence or absence of vaginal
       discharge
       History of allergic disorders
               disease,family            D
       Medical disease family history of D.
2. Examination
 General – anemia, jaundice
 Local examination
 Urine for sugar and bile
 Blood sugar and liver function test
 Bacteriological examination of vaginal
 discharge
 Biopsy from any abnormal vulvar lesion
     Treatment
1.   General measure:
          Wearing loose fitting Cotton under
          clothes
          Keep vulva dry and clean regularly
2.   Systemic antihistamine
3.   Local fungicides
4.   Hydrocortisone and local corticosteroid
5.               g (p
     Oral antifungal (perianal p        )
                                pruritis)
6.   Estrogen cream
7.
7    Surgical measure: Local anesthetics, injection,
     denervation of the vulva , simple vulvectomy

				
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posted:7/24/2013
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