An Insight into Leucorrhea

HEALTH: ASK THE DOCTOR

Dr. Dharmakanta Kumbhakar

Leucorrhea or excessive vaginal discharge is one of the most common gynecological problems faced by women of reproductive age, which has far-reaching psychological effects. Unless properly treated, Leucorrhea affects the health and efficiency of women in all spheres.

In normal women of reproductive age, some secretions from Bartholin, sebaceous, sweat and apocrine glands along with skene’s ducts and mucous crypts of vulva-vagina, uterine, cervical secretions are always present. Normal vaginal secretion is granular and contains desquamated epithelial cells carrying glycogen, cervical mucus, and lactobacilli. It is scanty and appears white or gray. The pH of the normal secretion is acidic (4.5 to 5.7).

Normal leucorrhea is colorless or ivory without any abnormal odor. Leucorrhea is characterized by painless white discharge per vaginum and may be a symptom of many underlying diseases. The usual cause is estrogen imbalance. It can be due to vaginitis, cervicitis or endometritis. Leucorrhea is a natural phenomenon during pregnancy. Non-pregnant women experience leucorrhea during ovulation (generally transparent discharge), vaginal infections or sexually transmitted disease.

During pregnancy, a high concentration of hormones especially, estrogen, and secretions from cervix and vagina and normal bacteria present in the vagina can cause leucorrhea. As a result of hormonal effects on the genital tract, there is increased blood flow to the vaginal area, which results in increased vaginal secretions. Moreover hormonal changes in pregnancy favor hyperemia and ectopy of the squamocolumnar junction at the external cervical orifice. This favors excessive secretion of mucoid discharge. This discharge generally increases as the pregnancy progresses. The discharge is often thick and white. It may have a yellowish tint or if it is accompanied by a bad odor, it is an indication of a possible infection.

Pathological conditions like general debility, anemia, diabetes, tuberculosis, chronic nephritis, endocrine disorders, trauma to genital organs, neoplasm (benign, especially when infected and malignant), pelvic congestion, uterine prolapse, vaginal medication, genital fistula, infection or inflammatory conditions of the reproductive systems and even psychological factors are some non specific causes which increase the amount of vaginal discharge to a degree that makes the condition a pathological problem. Excessive coitus, abortions, poor hygiene, moisture in the genital area, contaminated pad, accessories use, improper diet, stress and constipation also constitute the etiological factors.

Although birth control factors play a dominant role in family planning, they can have adverse gynecological problems, one among which is leucorrhoea. Sometimes leucorrhea occurs after tubectomy and post intrauterine contraceptive device use. The insertion of intrauterine contraceptive devices (IUCD) irritates the vagina, which in turn reacts by releasing abnormal vaginal discharge.

Leucorrhea due to infection can be interpreted by its color and odor. Yellowish discharge with foul odor is mostly due to infectious pathologies. Colpitis mycotica causes white curd- like leucorrhea and excessive vaginal itching. Monilial (Candidial) vulvo-vaginitis is caused by Candida albicans, an organism that thrives in the acidic pH of vagina. Predisposing factors include poor hygiene, sexually transmitted infections, and recent drug therapy with broad spectrum antibiotics or steroid administration. White curd-like or crusted flaky discharge is commonly seen at the introitus on separation of the labia.

Confirmation can be done by tests like urine analysis, pelvic examination, standard pregnancy test, Chlamydia test, bacterial smear, Pap smear, and ultrasonography.

Appropriate therapy in the form of antifungal and antibacterial needs to be given to treat coexistent infections. Ensuring proper hygiene of the genital region is the best method of reducing leucorrhea. Vaginal deodorants or scented soaps should not be used. Cotton underwear and loose-fitting pants should be worn. It is advisable for women to consume a good diet with light and easily digestible food and plenty of water. Taking proper rest, sleeping adequately, and abstaining from smoking also help in keeping a check on leucorrhea. Regular exercise also helps to prevent excessive discharge.

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