ABNORMAL VAGINAL DISCHARGE

• A common symptom in the Gynaecologic clinic
• Commonly associated with itching, foul smell, burning sensation, etc.
• It may be non-infective (Leucorrhoea), infective, neoplastic, or due to a foreign body
• Pelvic examination - to find whether there is an infection, foreign body, or any premalignant or malignant lesions
• Leucorrhoea is excessive normal vaginal discharge (non-purulent, non-offensive, and non-irritant)
• Common infections occurring in vulva and vagina are Bacterial vaginosis, Candidiasis, Trichomonas vaginitis, STI such as Gonorrhea, Chlamydia, etc.

• Disturbance of the normal vaginal pH and oestrogen levels can alter the vaginal flora, leading to overgrowth of pathogens
• Factors that alter the vaginal environment include feminine hygiene products, contraceptives, vaginal medications, antibiotics, STD’s, sexual intercourse, and stress
• Infections like Bacterial vaginosis, cervicitis, chlamydia, gonorrhea, PID, Yeast infection, etc.
• Cervical or vaginal carcinomas, vaginal fistula, etc causes discharges

Trichomoniasis

• Pruritus +++
• Strawberry spots in vagina
• Thin, greenish-yellow frothy discharge
• Vaginal pH- >4.5

 Candidiasis

• Pruritus++
• Burning sensation
• Discharge- Thick, curdy white discharge (in flakes) – cottage cheese type
• Vaginal pH- <4.5

 Bacterial vaginosis

• Malodour
• Thin, grey white, and adherent discharge
• Vaginal pH- >4.5

Proper history

• Associated symptoms 
• Nature and duration of discharge
• Presence of itching
• Any other symptoms like dysuria, dyspareunia, pelvic pain, etc
• History of contraceptive measures used
• Sexual behaviour

 Physical Examination

• General health and nutrition
• Abdominal examination for any tenderness and mass
• Vulval Inspection for assessing the characteristics of discharge, any lesions or ulcers
• Speculum examination for discharge, cervical ectopy /erosion, vaginitis, cervicitis, any growths, etc.
• Pelvic examination to assess tenderness, pelvic mass, etc.

 Other

• Wet mount microscopy of vaginal discharge
• KOH Whiff test – Positive (Fishy odour) in bacterial vaginosis
• Culture and gram staining of discharge
• Pap smear
• Urine routine
• Serological tests: HIV, VDRL, PCR tests, etc

• Improvement of general health
• Cervical factors require surgical treatment like electro-cautery, cryosurgery, or trachelorrhaphy
• Stopping ‘pills’ temporarily
• Local hygiene 

Ayurvedic Treatment

Internal Medicines

• Musali khadiradi Kashaya 
• Satavaryadi Kashaya
• Guduchyadi Kashaya –in discharge with burning sensation and itching
• Maha tiktaka kashaya
• Aragwadadi Kashaya – with itching
• Pancha Tiktaka Kashaya
• Pushyanuga Choornam
• Guggulu Panchapala Choorna
• Triphala Guggulu
• Chandraprabha vati
• Lodhraasava
• Saribadyasava
• Chandanaasava
• Ashokaarishta
• Madhusnuhi Rasayana
• Khadali Madhusnuhi Rasayana
• Shatavari Gudam
• Gandhaka Rasayana

Procedure 

• Yoni Kshalana – Triphala kashaya, Nalpamaradi kashaya