Discharge in women: causes, meaning and ways to eliminate pathology

Every woman experiences vaginal discharge throughout her life. Unfortunately, in schools there is no subject that teaches how to distinguish a normal physiological process from a pathological one. And the gynecologist at the first scheduled appointment does not always devote time to such a detailed conversation with the teenager. As a result, a woman acquires this knowledge gradually, relying on her own experience, often negative.

Let's learn more about the clinical characteristics, etiology of normal and pathological discharge.

How much mucus is normal? Where is the border between normal and pathological?

Mucus production is not always quantitatively the same; the process varies physiologically depending on different stages of life. Mucus production is enhanced:

• In the days leading up to ovulation
  , when the mucus becomes not only more abundant, but also more viscous and elastic, similar to the white of a raw egg;
• During pregnancy
  (leukorrhea of ​​pregnancy), when watery and clear vaginal discharge is normal;
• During menopause
  (less frequently), which is associated with a decrease in hormone production and thinning of the vaginal mucosa.

Other factors may also affect mucus production, such as:

• climate change;
• taking birth control pills;
• personal hygiene;
• sexual arousal;
• states of emotional stress.

Taking birth control pills
The mucus produced by the glands of the cervix, which in turn forms a whitish/clear secretion with a sour odor due to the presence of lactic acid-producing lactobacilli, is added to the exfoliated vaginal epithelium.

In some cases, the normal white discharge may change in appearance, take on a different color, consistency or smell, or become heavier, causing discomfort or real problems for the woman. Typically, these symptoms indicate pathological leukorrhea, the cause of which can presumably be attributed to the presence of a lesion in the cervix or vagina.

Cloudy urine due to glomerulonephritis

Damage to the glomeruli is called glomerulonephritis.

This disease is characterized by the following symptoms:

• the appearance of morning swelling;
• decreased amount and cloudiness of urine;
• presence of blood in the urine;
• decrease in general tone;
• pain in the head and lumbar region.

The acute course of glomerulonephritis disrupts the functioning of the renal glomeruli.

An advanced process can also affect the renal tubules.

Acute glomerulonephritis develops against the background of:

• hypothermia;
• transferred bacterial diseases;
• poisoning with toxic substances;
• allergic reactions.

It takes about two weeks for glomerulonephritis to develop after the inciting event.

The disease is characterized by two forms of progression.

The cyclic form has clear, pronounced symptoms.

The patient's blood pressure rises sharply, and test results are significantly changed.

This form can be successfully treated in an average of two weeks.

After treatment, the presence of protein and blood impurities in the urine is acceptable for some time.

The symptoms of the latent form are blurred, the patient does not notice critical changes.

He may be bothered by minor swelling and shortness of breath.

This makes the disease difficult to diagnose.

Therefore, the latent form often develops into a chronic inflammatory process.

An important diagnostic method in making a diagnosis is the Rehberg test.

The patient needs to collect all the daily urine in one large container.

Additionally assigned:

• urine analysis for general examination with microscopic examination of sediment;
• hematological and biochemical blood tests;
• bacteriological urine culture;
• Ultrasound of the kidneys.

A similar method is the Zimnitsky test .

The patient needs to collect all the daily urine in eight containers.

They need to indicate the time of collection of the portion.

In each of them, the laboratory assistant will determine and analyze the main indicators.

Leukorrhea and other vaginal discharge - normal and pathological options

Vaginal discharge is assessed according to the following parameters:

• color;
• subsequence;
• smell;
• quantity.

In particular, women may experience the following vaginal discharge:

• Transparent:
  they do not indicate any pathology. This is an odorless discharge, not accompanied by symptoms, physiologically produced in varying quantities depending on fluctuations in sex hormones or under the influence of other factors. They shouldn't cause concern.
• White
  : indicates the presence of mucus and is normal for a woman of childbearing age. If they are particularly abundant or dense, they may be accompanied by a feeling of intimate discomfort and be a sign of intimate inflammation or indicate the presence of pathologies that need to be identified during a thorough gynecological examination.
• Yellow or green
  : indicate intimate infection. Other symptoms: unpleasant odor, intimate burning or pain, itching.
• Brown
  : indicates the presence of blood. You need to be able to distinguish it from normal menstrual losses, which occur in women every 28-30 days. Such spotting occurs between one menstrual cycle and the next and can be caused by various reasons, such as: stress, initial use of birth control pills or pathologies, including: endometriosis, ovarian cysts, uterine polyps or fibroids, gynecological infections.

Yellow discharge

Urine with turbidity in pyelonephritis

Pyelonephritis is an inflammatory disease of the pyelocaliceal apparatus of the kidney.

The disease has the following symptoms:

• cloudy urine;
• hematuria;
• pulling and aching pain in the lumbar region;
• body temperature up to 40 degrees;
• general malaise;
• feeling of nausea and productive vomiting.

The disease is provoked by benign prostatic hyperplasia, nephrolithiasis, and recurrent renal colic.

The causative agents are:

• staphylococcus;
• enterococcus;
• coli;
• Proteus.

Women are more susceptible to pyelonephritis due to the anatomical structure of the genitourinary system.

They have a short and wide urethra.

This makes it easier for infection to reach higher organs.

In men, the disease occurs more often as a complication of existing conditions.

These include benign hyperplasia or chronic inflammation of the prostate gland, nephrolithiasis.

There are three ways pathogens enter the kidneys:

• with blood;
• along the urethra;
• along the walls of the urinary tract.

Getting into the blood is possible in the presence of any inflammatory process in the body.

Examples include caries, sinusitis or otitis media.

In this case, infection will be successful only if there is a urinary diversion disorder.

Penetration through the urethra occurs when there is a disorder in the dynamics of urinary diversion. Reverse absorption is present in diseases such as nephroptosis, nephrolithiasis.

In the third case, the pathogen infects the walls of the ureter.

Then it climbs along them to the kidneys.

For diagnosis, the patient undergoes general, biochemical and hematological blood tests.

Specialists do bacteriological culture of urine on a nutrient medium. Additionally, it is necessary to undergo an ultrasound of the kidneys.

It reflects both pathological changes in the organ and the causes of these changes.

Causes of leucorrhoea - normal and pathological conditions

Physiological leucorrhoea, that is, not associated with diseases, is usually associated with estrogen stimulation. It is not necessarily an abnormal condition or a condition that requires active treatment.

For example, Leucorrhoea gravidarum - an increase in mucus production, typical of pregnancy and stimulated by an increase in estrogen synthesis, is not a manifestation of the disease. It is a useful mechanism for protecting and cleaning the vaginal canal and protecting the uterus. Or leukorrhea in newborn girls, occurring within a short time after birth.

However, leucorrhoea can also occur in the presence of various pathological conditions, such as:

• uterine polyps or fibroids;
• cervicitis;
• inflammatory diseases of the pelvic organs;
• ectropion;
• vulvovaginitis;
• gynecological tumors;
• medications taken, ingestion of foreign bodies or various chemicals.

A common cause of leukorrhea is the presence of a polyp in the cervix that secretes mucus. This is a benign hormonal tumor that a gynecologist can easily diagnose during an examination. Uterine polyps most often form in mature women (40 years of age and older).

Cervicitis – inflammation of the cervix, acute or chronic, occurs due to various reasons, such as:

• bacterial, fungal or viral infections;
• the presence of intrauterine devices for contraceptive purposes;
• allergy to condoms;
• exposure to irritating chemicals such as spermicides or frequent douching.

In these cases, during a pelvic examination, the cervix appears red with small and numerous localized red dots called petechiae (hence the name strawberry).

Inflammatory diseases of the pelvic organs caused by bacterial infection: uterus, fallopian tubes, ovaries. Patients may complain of various accompanying symptoms, such as:

• vaginal discharge;
• abdominal pain;
• burning when urinating;
• painful sexual intercourse;
• irregular menstrual cycle;
• fever.

Irregular menstrual cycle
Ectropion is a change in the part of the cervix near the vaginal canal. The tissue of the cervical canal expands towards the vaginal canal. The pathology may be congenital or develop as a result of lacerations during childbirth or infection.

Trichomonas vaginalis is a protozoan that causes frequent infections of the vagina, cervix, urethra and sometimes the urinary tract. Transmission occurs through sexual contact or (less commonly) through the use of contaminated clothing or objects.

Other pathogens that can cause vulvovaginitis include infections:

• Candida Albicans;
• Gardnerella vaginalis;
• Herpes simplex;
• Gonorrhea;
• Chlamydia trachomatis.

Gynecological tumors develop quite often in women after breast cancer and colon and rectal cancer. The most common symptom is postcoital, intermenstrual or postmenopausal blood loss.

Other symptoms: pain in the lower abdomen, increased vaginal secretion.

Other factors that can irritate the vagina and cause abnormal discharge can affect the balance of a woman's vagina:

• changing products used for intimate hygiene;
• detergents and softeners for washing clothes;
• intimate sprays, creams;
• frequent douching;
• contraceptive gels or foams;
• medications such as antibiotics;
• tampons;
• full pubic shave.

The presence of fat in the urine is characterized by a white sediment in the urine.

Most often, cloudiness is caused by the presence of pus and microbes in the urine.

In this case, the urine sediment is characterized by a greenish color and the presence of purulent threads in the urine.
The cause of pus and microbes in the urine may be:

• Inflammation of the genitourinary canal due to any sexually transmitted infection (STD)

• Inflammation of the bladder (cystitis) occurs most often in women
• Inflammation of the prostate gland in men (prostatitis)
• Kidney inflammation (pyelonephritis)

When mixed with blood sediment, the color of cloudy urine can be red, pale pink, or dark burgundy.

The most common causes of blood in the urine may be:

• Injuries to the urinary tract due to passing stones and sand

• Vascular ruptures in the urinary tract
• Urinary tract injuries

Associated symptoms

Leukorrhea can be virtually asymptomatic, meaning a woman may experience only a white, thick vaginal discharge that can cause discomfort when performing normal daily activities.

In other cases, depending on the cause, other symptoms may appear, such as:

• burning when urinating;
• intimate burning;
• pain during intercourse;
• lower abdominal pain;
• abnormally colored vaginal discharge: yellow, greenish, brown or reddish,
• vaginal discharge of abnormal consistency: milky (in case of bacterial infections), lumpy (similar to cottage cheese, typical of Candida infection);
• vaginal discharge with an unpleasant odor (such as the typical fishy odor of Gardnerella infection);
• intimate itching;
• irritation and redness of the vaginal mucosa and external genitalia;
• irregular menstrual cycle;
• the appearance of bloating.

When to see a doctor? What does a gynecologist check? How is a gynecological examination performed?

You should see your gynecologist for a checkup if you notice yellow, green, or brown vaginal discharge or if there is particularly heavy or irritating whitish mucous discharge.

A gynecological examination primarily includes a detailed medical history, which takes into account factors such as:

• symptoms;
• any medications you are taking;
• allergy;
• surgical interventions;
• full-term pregnancies or miscarriages;
• contraceptive methods (if used);
• characteristics of the menstrual cycle (when it appeared, regularity, duration and amount of bleeding, whether it was associated with pain/other disorders);
• the presence of diseases - diabetes, tumors, premature menopause or changes in the menstrual cycle, thyroid disease, blood clotting disorders, metabolic diseases, hypertension, heart disease;
• any sleep disorders;
• any appetite disturbances;
• habits – smoking cigarettes, alcohol, drugs;
• body weight.

Then the woman is asked to lie down on a gynecological chair equipped with two leg supports. The gynecologist conducts:

• observation and palpation of the external genitalia;
• internal examination using a mirror and bimanual palpation (vaginal and abdominal);
• transvaginal ultrasound.

Using a speculum and transvaginal ultrasound, most causes of leukorrhea can be identified.

Other possible tests performed during a medical examination include:

Pap test

. This is a cytological study that allows you to study cervical material taken by a gynecologist during an examination. The examination is painless and involves the use of a small spatula inserted into the vagina to collect cells and mucus from the cervix.

This material is smeared onto glass slides and then analyzed in the laboratory using a microscope and staining the slides. This allows us to distinguish:

• normal cells;
• cells with benign changes (due to inflammation and/or infections);
• cells changed as a result of physiological aging of the reproductive system (menopause);
• abnormal cells found in precancerous lesions, called CIN (for cervical intraepithelial neoplasia), or cancerous.

If the Pap smear is positive (i.e., if malignancy is suspected), additional tests are indicated, such as human papillomavirus (HPV) viral DNA testing and colposcopy.

Colposcopy

. Allows you to examine the cervix using a special instrument - a colposcope. It allows you to observe the affected area under magnification. Injecting certain fluids into the vagina, such as acetic acid or iodinated solutions, allows for better visualization of any abnormal cells.

During the test, small tissue samples may be taken (biopsy) or abnormal parts may be removed using electrical excision.

Colposcopy

Curettage (or curettage)

. This is a biopsy sample of uterine tissue that is sent to a laboratory for diagnosis to rule out possible malignancies.

Hysteroscopy

. This is an endoscopic examination to look for and possibly remove small uterine growths or small malformations. Therefore, there are 2 possible goals: diagnosis and treatment.

After inserting an instrument called a hysteroscope, the gynecologist examines the vagina, body and cervix. In the case of a polyp (or fibroids) of the uterus, the following formations will be observed:

• usually small in size (from a few millimeters to 2-3 cm);
• pedunculated or sessile (with implant base);
• single or multiple.

CT and/or magnetic resonance imaging (MRI)

. May be required in case of suspicious or questionable neoplasms.

If the gynecologist suspects an infection, he may prescribe:

• Vaginal secretion culture or urine test with antibiogram to establish a stable cause and specific treatment.
• Blood tests. They can signal the presence of an ongoing inflammatory process, increasing the value of such indices as ESR, C-reactive protein, and leukocytes.

Cloudy urine due to nephrolithiasis

Urolithiasis is one of the most commonly diagnosed pathologies of the urinary tract.

According to statistics, the disease is most often registered in people aged 30 to 55 years.

Reasons for the development of nephrolithiasis:

• disturbance of phosphorus and calcium metabolism;
• increase in serum Ca concentration;
• disorders of metabolism and functions of the digestive system;
• vitamin deficiency A, B and D;
• malformations of the pelvic organs;
• pathological changes in the urodynamic process.

Concretions are found of organic and inorganic origin.

Large, inactive stones cause less damage to kidney health than small, mobile stones.

Kidney stones are very often complicated by pyelonephritis.

Stagnation of infected urine provokes exacerbation of pyelonephritis.

Complications such as carbuncle, kidney abscess and even sepsis may develop.

In the case of nephrolithiasis, cloudy urine indicates restoration of ureteral patency.

Typical manifestations of nephrolithiasis:

• presence of blood in the urine;
• pain in the lumbar region;
• discharge of stones and salts;
• urination disorder;
• renal colic.

The clinical picture is closely related to the size and location of the stones.

It depends on concomitant diseases, congenital anomalies and defects.

Diagnosis of urolithiasis:

• collecting and studying anamnesis;
• general urine analysis with sediment microscopy;
• Ultrasound of the urinary system;
• X-ray or CT scan of the urinary tract.

Treatment of vaginal discharge

Normal vaginal discharge does not require any treatment. In the presence of pathological leukorrhea, on the contrary, it is necessary to resort to therapy, which may vary depending on the trigger cause.

The gynecologist may prescribe:

• Local therapy with vaginal suppositories or creams/gels;
• Systemic therapy in tablets. Antibiotics or antiviral drugs are prescribed if there is a bacterial or viral infection of the cervix or vagina. If the cause is a sexually transmitted disease, the sexual partner should also undergo drug therapy. Antifungal medications are indicated when fungal parasites are present, such as in the case of vaginal candidiasis. The treatment of choice for Trichomonas vaginalis infection is metronidazole.
• Additional funds. For example, natural-based products that moisturize and relieve irritation of the external genitalia - creams based on calendula and hyaluronic acid.

Systemic tablet therapy
Vaginal douching should be avoided unless prescribed by a gynecologist because it is associated with depletion of the protective mucous layer of the vaginal mucosa and bacterial flora and may ultimately contribute to the maintenance and intensification of the leukorrhea condition.

If the pathology is caused by surgical problems, surgery is prescribed. Surgery is an option if:

• large ovarian cysts that have not decreased while taking birth control pills;
• large polyps or fibroids of the uterus;
• malignant tumors - a hysterectomy is always required, that is, complete removal of the entire uterus with appendages and lymph nodes in the pelvis.

Prevention of diseases of the genitourinary organs in women

Some rules of behavior to prevent new episodes of leukorrhea:

• Avoid douching, for example, during menstruation or after sex.
• Carefully observe personal hygiene, which should not be too frequent.
• Use special and delicate personal hygiene products.
• After using the toilet, wash in one direction from the vagina to the anus, and never vice versa, so as not to promote the passage of intestinal pathogens into the vulva.
• Use only cotton underwear.
• Avoid clothing that is too tight.
• Use condoms during sexual intercourse to prevent possible sexually transmitted diseases.
• Treat any metabolic disorders, such as diabetes, promptly.
• If you have intimate disorders, consult a gynecologist and avoid self-treatment.

Have regular gynecological examinations at least once a year, even if you have no complaints.

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