Assessment of causes of Vaginal Discharge
🌸 Vaginal discharge is a very common presentation and may be entirely physiological or a marker of infection, inflammation, hormonal change, or malignancy.
A careful assessment of the colour, consistency, odour, volume, and associated symptoms (itching, pain, bleeding) usually allows rapid differentiation between common causes such as bacterial vaginosis, candidiasis, trichomoniasis, and sexually transmitted infections (STIs).
The key clinical question is always: Is this normal, infective, or needs urgent escalation?
📝 Clinical History (Structured & Practical)
- ⏱️ Onset & Duration
- When did the discharge start?
- Acute vs chronic? Single episode vs recurrent?
- 🎨 Characteristics of Discharge
- Colour: white, grey, yellow, green, blood-stained
- Consistency: thin, watery, thick, curdy, frothy
- Odour: fishy (BV), foul (trichomonas), none (often thrush)
- Amount: light vs heavy, change from baseline
- 🔥 Associated Symptoms
- Itching, burning, soreness
- Dyspareunia (pain during intercourse)
- Dysuria (external vs internal burning)
- Pelvic or lower abdominal pain
- Intermenstrual or postcoital bleeding
- ❤️ Sexual History (Sensitive & Non-judgemental)
- Recent new or multiple partners
- Use of condoms or contraception
- Past or recent STIs (self or partner)
- 🧬 Medical, Gynae & Obstetric History
- Pregnancy or postpartum state
- Menstrual cycle timing and changes
- Recent antibiotics (predispose to thrush)
- Use of hormonal contraception or HRT
- Previous recurrent vaginal infections
🩺 Physical Examination
- 👀 General Assessment
- Fever or systemic illness
- Signs of discomfort or distress
- 🤲 Abdominal Examination
- Suprapubic or pelvic tenderness
- Exclude masses or guarding (PID concern)
- 🌸 External Genital Examination
- Erythema, excoriation, vulval swelling
- Ulcers, vesicles, warts (STI clues)
- 🔍 Speculum Examination
- Assess vaginal walls and cervix
- Observe discharge: colour, amount, odour
- Look for cervical friability or bleeding
- ✋ Bimanual Examination
- Cervical motion tenderness (PID)
- Uterine or adnexal tenderness/masses
🧩 Common Causes of Vaginal Discharge
- 🦠 Infectious
- Bacterial vaginosis: Thin grey/white, fishy odour
- Candidiasis (thrush): Thick white “cottage cheese”, intense itching
- Trichomoniasis: Frothy yellow-green, offensive smell
- Chlamydia / Gonorrhoea: Often asymptomatic; discharge ± bleeding
- ⚖️ Non-infectious
- Physiological (ovulation, pregnancy)
- Hormonal (OCP, pregnancy, menopause)
- Allergic/irritant (soaps, douches)
- Foreign body (retained tampon)
- Atrophic vaginitis (post-menopause)
🔎 Investigations (Targeted)
- 🧪 Vaginal pH
- > 4.5 → BV or trichomoniasis
- Normal (4.0–4.5) → candidiasis
- 🔬 Microscopy
- Clue cells → BV
- Yeast / pseudohyphae → thrush
- Motile trichomonads → trichomoniasis
- 🧬 NAAT
