Vaginal discharge is a prevalent concern among women presenting to healthcare providers. While often a normal physiological process, it can also indicate an underlying pathology. Understanding the nuances of vaginal discharge is crucial for accurate diagnosis and appropriate management.
Physiologic Vaginal Discharge: Recognizing Normality
Normal, or physiologic, vaginal discharge is a natural occurrence in women of reproductive age. Typically, the volume ranges from 1 to 5 mL every 24 hours. This discharge is characterized as transparent to white-yellowish in color, mucousy in consistency, and either odorless or with a slight, non-offensive odor.
The characteristics of physiologic vaginal discharge are dynamic and influenced by hormonal fluctuations throughout the menstrual cycle and across different reproductive stages. Elevated estrogen levels, such as those experienced during pregnancy, with the use of estrogen-progestin contraceptives, or at the time of ovulation, are associated with a noticeable increase in vaginal discharge.
The vaginal flora, predominantly composed of Lactobacilli, plays a vital role in maintaining a healthy vaginal environment. These bacteria produce hydrogen peroxide and lactic acid, which contribute to vaginal acidity. This acidic pH (between 4.0 and 4.5 in reproductive-aged women) acts as a natural defense mechanism, inhibiting the growth of pathogenic microorganisms. In contrast, women in premenarchal and postmenopausal stages, who have lower estrogen levels, may have a vaginal pH of 4.7 or higher, potentially altering the vaginal microbiome.
Epidemiology of Vaginal Discharge: Prevalence and Significance
Vulvovaginal symptoms, including vaginal discharge, are commonly reported by women both before and after menopause.1 However, determining the precise prevalence of pathologic vaginal discharge is challenging. This is partly due to the fact that vaginitis, the condition characterized by vaginal discharge, can often be asymptomatic, leading to self-diagnosis and self-treatment without medical consultation.2
A community-based survey conducted in Goa, India, involving 3000 women aged 18 to 50 years, revealed that 14.5% reported experiencing abnormal vaginal discharge.3 In a US community-practice setting, a significantly higher proportion, 68% of women presenting with vaginitis symptoms, reported abnormal vaginal discharge.4 These figures highlight the variability in reported prevalence, possibly due to geographical location, population characteristics, and definitions of “abnormal” discharge.
Pregnancy is a physiological state associated with increased vaginal discharge for most women.5 Studies indicate that the prevalence of pathologic vaginal discharge during pregnancy ranges from 40% to 50%.6, 7, 8 This elevated prevalence underscores the importance of recognizing and managing abnormal vaginal discharge in pregnant women, considering potential implications for both maternal and fetal health.
References
1 Watson LJ, James KE, Hatoum Moeller IJ, et al. Vulvovaginal discomfort is common in both premenopausal and postmenopausal women. J Low Genit Tract Dis. 2019 Apr;23(2):164-9. http://www.ncbi.nlm.nih.gov/pubmed/30741753?tool=bestpractice.com
2 Foxman B, Marsh JV, Gillespie B, et al. Frequency and response to vaginal symptoms among white and African American women: Results of a random digit dialing survey. J Womens Health. 1998 Nov;7(9):1167-74. http://www.ncbi.nlm.nih.gov/pubmed/9861594?tool=bestpractice.com
3 Patel V, Pednekar S, Weiss H, et al. Why do women complain of vaginal discharge? A population survey of infectious and pyschosocial risk factors in a South Asian community. Int J Epidemiol. 2005 Aug;34(4):853-62. https://academic.oup.com/ije/article/34/4/853/692864?login=false http://www.ncbi.nlm.nih.gov/pubmed/15833795?tool=bestpractice.com
4 Hillier SL, Austin M, Macio I, et al. Diagnosis and treatment of vaginal discharge syndromes in community practice settings. Clin Infect Dis. 2021 May 4;72(9):1538-43. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8248297 http://www.ncbi.nlm.nih.gov/pubmed/32350529?tool=bestpractice.com
5 National Institute for Health and Care Excellence (UK). Antenatal care. Aug 2021 [internet publication]. https://www.nice.org.uk/guidance/ng201
6 da Fonseca TM, Cesar JA, Mendoza-Sassi RA, et al. Pathological vaginal discharge among pregnant women: pattern of occurrence and association in a population-based survey. Obstet Gynecol Int. 2013;2013:590416. https://www.hindawi.com/journals/ogi/2013/590416 http://www.ncbi.nlm.nih.gov/pubmed/23843798?tool=bestpractice.com
7 Prasad D, Parween S, Kumari K, et al. Prevalence, etiology, and associated symptoms of vaginal discharge during pregnancy in women seen in a tertiary care hospital in Bihar. Cureus. 2021 Jan 14;13(1):e12700. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7883588 http://www.ncbi.nlm.nih.gov/pubmed/33614308?tool=bestpractice.com
8 Cesar JA, Mendoza-Sassi RA, González-Chica DA, et al. Prevalence of self-reported vaginal discharge and associated factors in pregnant women [in Portuguese]. Cad Saude Publica. 2009 Dec;25(12):2705-14. https://www.scielo.br/j/csp/a/WZhWNVpTHL9fMv9QdjGnp7R/?lang=pt http://www.ncbi.nlm.nih.gov/pubmed/20191161?tool=bestpractice.com
