Vaginal discharge characteristics and causes
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Vaginal Discharge Characteristics: Normal vs. Abnormal
Vaginal discharge is a common experience for women and can be either physiological (normal) or pathological (abnormal). Normal discharge is usually clear or white, varies in amount and consistency throughout the menstrual cycle, and is not associated with itching, odor, or irritation. It is influenced by hormonal changes, sexual activity, and the presence of healthy vaginal flora, mainly lactobacilli, which help maintain an acidic pH between 3.8 and 4.4 .
Abnormal vaginal discharge, on the other hand, often presents with changes in color (yellow, green, gray), consistency (thick, curd-like, frothy), odor (fishy or foul-smelling), and may be accompanied by symptoms such as itching, burning, or irritation. These changes usually indicate an underlying infection or other pathology 12569.
Common Causes of Vaginal Discharge: Infectious and Non-Infectious
Infectious Causes
The majority of abnormal vaginal discharge cases are due to infections. The most common infectious causes include:
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Bacterial Vaginosis (BV): BV is the leading cause of abnormal vaginal discharge in women of reproductive age, accounting for 26–47% of cases in various studies. It is characterized by a thin, grayish-white discharge with a fishy odor. BV is associated with an imbalance in vaginal flora and is more common in women with new or multiple sexual partners, but can also occur in women without sexual activity 123456910.
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Vulvovaginal Candidiasis (VVC): Candidiasis, caused by Candida species (most commonly Candida albicans), presents with thick, white, "cottage cheese-like" discharge, often accompanied by itching and irritation. It affects up to 75% of women at least once in their lifetime, with 15–40% experiencing recurrent episodes 12345689.
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Trichomoniasis: This sexually transmitted infection is caused by Trichomonas vaginalis and results in a frothy, yellow-green discharge with a strong odor. It is less common than BV and candidiasis, accounting for 3–13% of cases 23456910.
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Other Infections: Less common causes include aerobic vaginitis, mucopurulent cervicitis (often due to chlamydia or gonorrhea), herpes genitalis, and Group B streptococcus 25810.
Non-Infectious Causes
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Physiological Discharge: Up to 18% of women with vaginal discharge have no underlying infection; their discharge is considered normal and related to hormonal fluctuations 125.
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Other Pathological Causes: These include atrophic vaginitis (especially in postmenopausal women), desquamative inflammatory vaginitis, allergic or irritant reactions, foreign bodies, and, rarely, cervical or vaginal malignancies 125.
Diagnostic Considerations and Importance
Diagnosis of the cause of vaginal discharge relies on a combination of clinical history, physical examination, and laboratory tests such as microscopy, pH testing, amine (whiff) test, and cultures. Pap smears can help identify cervical pathology, including precancerous changes 2458. Accurate diagnosis is important for targeted treatment and to prevent complications such as pelvic inflammatory disease, infertility, and adverse pregnancy outcomes .
Conclusion
Vaginal discharge is a frequent concern among women and can be due to a range of physiological and pathological causes. The most common infectious causes are bacterial vaginosis, vulvovaginal candidiasis, and trichomoniasis, but non-infectious and less common causes should also be considered. Proper evaluation and diagnosis are essential for effective management and to safeguard reproductive health 12345689+1 MORE.
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