Q 22. 1 Why is it natural to have some vaginal discharge?

Vaginal secretion is the body’s natural way to clean and defend the vagina against infection and to provide lubrication. It is normal for there to be a little white fluid, which may leave a yellowish patch on underclothes. A woman in her reproductive years discharges about 2 grams of epithelial (surface) cells and about half a gram of mucus each day.

The volume of normal discharge will vary between women. Some may seem to have more than average and there may be no abnormality to account for it – this is called leukorrhoea. The epithelial cells are rich in glycogen, which is a carbohydrate. Lactobacilli are bacteria normally found in the vagina that are able to break down glycogen to lactic acid. The lactic acid keeps the fluid in the vagina slightly acidic and this protects against infections. Oestrogen tends to increase the amount of glycogen. Ultimately, the hormone environment alters the amount of normal vaginal discharge.

A number of factors will contribute to the volume of the normal discharge. These include the stage of the menstrual cycle, hormone medication (e.g. oral contraception or hormone replacement therapy increase vaginal discharge), sexual arousal and activity, and clothing. There is an increased fluid discharge around the time of ovulation (egg release); this occurs fourteen days before the next period is due. Pregnancy is associated with an increase in vaginal discharge.

References:

The ecologically wrong vaginal Lactobacilli. (1991 – 2653a)

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Vaginal discharge is one of the more common reasons for a woman to consult her doctor. A troublesome increase in vaginal discharge may need assessment. An offensive odour, vaginal and vulval (external) irritation or soreness are common accompanying symptoms when there is infection.

Blood stained discharge is always an indication for medical assessment. Bacteriological (swab) and blood tests are required particularly if there is any possibility of a sexually transmitted disease.

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 3 Should I regularly undertake vaginal douching?

It is natural for women to be fastidious about their hygiene and many regard vaginal douching as part of female cleanliness. Historically douching was regarded as therapeutic, reducing the likelihood of infections in the pelvis, and some, inappropriately, assumed it had a role in contraception. Many chemists have sold perfumed solutions designed for the purpose.

Frequent douching probably does more harm than good. The vagina is capable of keeping itself clean. The vaginal fluid is rich in protective bacteria (Q22.1) and excessive douching may reduce their numbers significantly. Chemicals in the douching fluid and the nozzle or tube may cause trauma and irritation. Douching may increase rather than decrease vaginal discharge. It may be reasonable to undertake douching once each month after a period. Daily washing the vulva, perineum (Figure 2.2) and anal area, perhaps with the benefit of a bidet, can be recommended.

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 4 What causes abnormal vaginal discharge?

There are several reasons why an abnormal discharge may occur including:

• vaginal infections (Q22.6):

Candida (thrush).

Trichomonas vaginalis.

• bacterial vaginosis.

• cervicitis (Q21.3).

• cervical ectopy (Q21.3).

• cervical polyps (Q21.2)

• foreign body such as a retained tampon. Occasionally a tampon may be inadvertently forgotten. If a tampon should be forgotten for a few days, a serious condition called “Toxic Shock Syndrome” can develop (Q22.5). Children may explore themselves with various objects. In addition to vaginal discharge, a “foreign body” left in the vagina is associated with some blood stained discharge.

• perfumed soaps.

• douching too frequently: this may result in excessive discharge.

• atrophic vaginitis. After the menopause the natural vaginal secretions diminish. The vaginal lining may become inflamed leading to discharge, which can be blood stained. Other reasons for such blood stained discharge must be excluded by your doctor before local oestrogen treatment (Q28.2) or HRT (Q28.3).

• blood stained discharge may be the presenting symptom of cervical cancer. (Q32.07).

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 5 What is toxic shock syndrome?

This condition was first described in 1978. The majority of cases happen in women during their periods and there is a link with the use of tampons particularly if they are accidentally retained for too long. The illness is characterised by fever and shock (drop in blood pressure). The early cases were associated with almost 10% mortality but with modern therapy this rate has fallen to less than 3%.

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 6 What are the more common vaginal infections?

There are a number of microorganisms that may cause vaginal infection and several may co-exist.

Typically, acute candida vaginitis (inflammation of the vagina) is accompanied by intense irritation. Vaginal candidiasis is colloquially known as ‘Thrush”. The discharge is thick and white (described as milk curds). The skin of the vulva surrounding the vaginal entrance may be acutely red.

• Candida.

These are yeast organisms that are found in the vagina in 25% of women usually without any symptoms. The most common species of candida to be found in the vagina is Candida albicans which is an organism that lives in the bowel and can easily be transferred from back to front passage. Symptoms occur when there is an excess of the yeast. High blood sugar levels (diabetes mellitus), pregnancy, antibiotics and steroid administration tend to increase the incidence of candidiasis. An acidic environment encourages the growth of the candida.

• Trichomonas vaginalis.

This is a protozoan (each organism is much bigger than a bacterium and is capable of propelling itself by means of a flagella which is hair-like structure). Infection is generally acquired by sexual contact. There is an offensive, greenish frothy vaginal discharge and often vaginal and vulval soreness and irritation.

References:

Gynaecological and microbiological findings in women attending for a general health check-up (1998-2547)

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 7 What is bacterial vaginosis?

    Bacterial vaginosis (BV) is the most common cause of vaginal discharge in women during their reproductive years; it is more common than “thrush”. The discharge has a fishy odour, which is intensified after intercourse and during menstruation. Itching and soreness are not features of BV. In 1983 the condition was called bacterial vaginitis but inflammation of the vagina is not a feature and it was renamed vaginosis. There have been other names including non specific vaginitis, haemophilus vaginitis and non specific vaginosis.

A variety of microorganisms have been implicated but we still do not know which are the main culprits. Attention has focused on a bacterium named Gardnerella vaginalis. This organism can be found in more than 50% of healthy women. A thousand-fold increase in concentration of Gardnerella and other anaerobes (bacteria that can thrive at low oxygen levels) is typical of BV. Some suggest that BV is a sexually transmitted condition. Bacterial vaginosis, however, can occur in virgins. Diagnosis is made essentially from the history and the nature of the discharge, which has a typical pattern on direct microscopic examination. Swabs sent for culture are not helpful.

    Bacterial vaginosis is likely to occur when the balance between protective organisms (lactobacilli) and potential pathogens (organisms associated with disease) is adversely altered. Excessive vaginal douching, for example, may lead to bacterial vaginosis by removing the lactobacilli. Semen reduces the natural acidity of the vagina and predisposes to BV.

    There have been suggestions that BV may be a factor in miscarriage and premature delivery and studies are under way to investigate the potential benefit of antibiotic treatment. The author has introduced the hypothesis that sub-clinical bacteria ascending into the uterus (bacteria endometrialis) may provide a plausible explanation for a variety of gynaecological and obstetric enigmas including unexplained infertility, recurrent miscarriage, excessive vaginal bleeding, and blood pressure problems in pregnancy (pre-eclampsia). A great deal of research will be required to investigate this concept as these conditions probably result from a variety of causes, which will confound analysis. At this time we do not know whether antibiotics will prove to be of value but research has begun.

References:

Bacterial vaginosis, ethnicity, and the use of genital cleaning agents: A case control study (2975)

Bacterial vaginosis: An update. (1998 – 2444)

Recurrent bacterial vaginosis. (1998 – 2630)

Sex, thrush and bacterial vaginosis. (1997 – 2628)

Defining bacterial vaginosis: To BV or not to BV, that is the question. (1996 – 2627)

Plasma cell endometritis in women with symptomatic bacterial vaginosis. (1995 – 2623)

Reduced incidence of preterm delivery with metronidazole and erythromycin in women with bacterial vaginosis. (1995 – 2461)

A longitudinal study of bacterial vaginosis during pregnancy. ( 1994 – 2629)

Abnormal bacterial colonisation of the genital tract and subsequent preterm delivery and late miscarriage. (1994 – 2626)

Bacterial vaginosis is associated with prematurity and vaginal fluid mucinase and sialidase: Results of a controlled trial of topical clindamycin cream. (1994 – 2625)

Observations concerning the microbial etiology of acute salpingitis. (1994 – 2445)

Bacterial vaginosis. (1992 – 2448)

Treatment of bacterial vaginosis with lactobacilli. (1992 – 2725)

Is bacterial vaginosis a sexually transmitted disease? (1991 – 2726)

Reliability of diagnosing bacterial vaginosis is improved by a standardized method of gram stain interpretation. (1991 – 2728)

Reservoir of four organisms associated with bacterial vaginosis suggests lack of sexual transmission. (1990-2632)

Treatment of bacterial vaginosis in women with vaginal bleeding complications of discharge and harboring Mobiluncus. (1990 – 2624)

Diagnosis of bacterial vaginosis by direct gram stain of vaginal fluid. (1983- 2729)

Nonspecific vaginitis. Diagnostic criteria and microbial and epidemiologic associations. (1983 – 2727)

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 8 How is the cause of vaginal discharge determined?

The diagnosis is determined from the story, examination findings and investigations that usually include sampling the discharge (swab tests) and obtaining a laboratory report.

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

We call bleeding after sexual intercourse ‘post-coital bleeding’ or P.C.B. Several conditions could be responsible:

• most women have bleeding with first intercourse as the hymen is opened.

• vaginal infections (Q22.6) such as ‘thrush’ may increase the blood supply and render the vaginal surface more prone to bleeding.

• cervical ectopy and cervicitis (Q21.3) may be result in bleeding from the cervix after intercourse.

• cervical polyps (Q21.2) are another cause.

• after themenopause, the vaginal skin becomes thin and inflamed so that post-coital bleeding may occur (Q26.18).

• cervical cancer (Q32.07) usually presents with irregular bleeding, which can follow intercourse.

• a possibility of trauma from a finger-nail should be considered if, during examination by your doctor, there is no obvious cause for the bleeding,

• Pre-malignant changes of the cervix do not cause symptoms. They cause neither discharge nor bleeding.

References:

The frequency of significant pathology in women attending a general gynaecological service for postcoital bleeding (2001-3285)

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 10 How are vaginal infections treated?

From a theoretical point of view, one should usually await the results of investigations before commencing treatment. In clinical practice one is keen to make an early start in assisting patients and it is common practice to commence treatment on the basis of clinical observations and adjust treatment subsequently according to investigation results.

Candida may respond to Nystatin (Nystan – BMS) vaginal pessaries and cream. The full course of 14 days should be followed. Candida is sensitive to imidazole derivatives (Table 22.1), which are usually applied locally as creams or pessaries.

Table 22.1 Imidazoles used for the treatment of genital candida infections.

Imidazole Derivative

Preparation

Manufacturer

Clotrimazole

Canesten

Bayer

Clotrimazole

Masnoderm

Dominion

Econazole

Ecostatin

BMS

Econazole

Gyno-Pevaryl

Janssen-Cilag

Fenticonazole

Lomexin

Dominion

Isoconazole

Travogyn

Schering

Miconazole

Gynodaktarin

Janssen-Cilag

The vaginal creams may be applied internally for vaginal infections and externally for vulval infections. The creams may also be applied to the penis of the partner particularly when there are recurrent infections. There are four pessaries designed for single application. These are Canesten-1, Ecostatin-1, Gynokatarin-1 and Gyno-Pevaryl 1. Three preparations are taken orally – fluconazole (Diflucan 150 – Pfizer), ketoconazole (Nizoral- Janssen-Cilag) and itraconazole (Sporanox- Janssen-Cilag).

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 11 I keep getting bouts of ‘thrush’. How can this be prevented?

Swab tests should be taken to confirm that you really are having bouts of thrush. Whilst most people have heard of thrush, relatively few know about bacterial vaginosis and this is more common than thrush (Q12.13).

About one per cent of women will have more than six episodes of vaginal candidiasis a year. It is prudent to exclude underlying illness and to correct other causes of vaginal discharge such as cervical ectropion (erosion Q21.3).

Preventative measures include avoiding clothes that keep the genital area moist. Natural fibres such as cotton are preferable to nylon. Underclothes should be thoroughly rinsed. Daily bathing/showering may be helpful but frequent vaginal douching should be avoided as this may remove protective organisms. Irritant soaps and bubble baths should be avoided. Shampoos should not be used in the bath. Use a soft clean towel and dab rather than rub. Rough flannels should not be used.

One of the orally active agents may eliminate the reservoir of candida in the bowel although this may subsequently recur. Wiping the anal area from front to back may help to prevent transfer of candida to the vagina; soft toilet paper should be used. The objective is to prevent recurrence. As antibiotics may be associated with acute episodes, those particularly at risk should request treatment for candida at the same time. The male partner should be offered local or oral treatment. Some women will require regular preventative treatment usually administered after each period.

References:

The value of prophylactic (monthly) clotrimazole versus empiric self-treatment in recurrent vaginal candidiasis (1994-2040a)

Lack of in vitro resistance of Candida albicans to ketoconazole, itraconazole and clotrimazole in women treated for recurrent vaginal candidiasis (1993-2040b)

Epidemiologic characteristics of women with idiopathic recurrent vulvovaginal candidiasis (1993-2040c)

Intermittent prophylactic treatment of recurrent vaginal candidiasis by postmenstrual application of a 500 mg clotrimazole vaginal tablet (1990-2040d)

Zinc status in women with recurrent vulvovaginal candidiasis (1986-2040e)

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 12 How is vaginal trichomonas infection treated?

Trichomonas vaginalis is sensitive to metronidazole (Flagyl – Hawgreen). The male partner may be symptom free but will act as a source for re-infection if he does not receive treatment.

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 13 How is bacterial vaginosis treated?

Bacterial vaginosis (Q22.7) responds to antibiotics active against anaerobic bacteria. Oral metronidazole (Flagyl – Hawgreen) tablets two or three times daily have been the traditional first line of treatment. Clindamycin (Dalacin – Pharmacia & Upjohn) vaginal cream introduced each night for a week and metronidazole gel (Zidoval – 3M Health Care) one application for five nights have provided further options. Some women are prone to recurrence; there is no evidence that treating the partner provides benefit.

References:

A population based case-control teratologic study of oral metronidazole treatment during pregnancy (1998-3134)

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

A study reported in 1985 of 1300 women attending genitourinary medicine departments found no evidence that the pill is associated with an increased incidence of thrush.

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 15 Where can I obtain more information?

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

Q 22. 16 Could I have some useful Web sites?

Evaluation of the quality of Web sites is discussed in Q4.27. You may find that several general women’s health sites may help you (Q4.28). The following are more specialised Web sites on topics found in this chapter.

Q 22. 1 Is it natural to have some vaginal discharge?

Q 22. 2 How can I tell if my vaginal discharge is abnormal?

Q 22. 3 Should I regularly undertake vaginal douching?

Q 22. 4 What causes abnormal vaginal discharge?

Q 22. 5 What is toxic shock syndrome?

Q 22. 6 What are the more common vaginal infections?

Q 22. 7 What is bacterial vaginosis?

Q 22. 8 How is the cause of vaginal discharge determined?

Q 22. 9 I tend to bleed after love-making. What causes this post-coital bleeding?

Q 22. 10 How are vaginal infections treated?

Q 22. 11 I keep on getting bouts of ‘thrush’. How can this be prevented?

Q 22. 12 How is vaginal trichomonas infection treated?

Q 22. 13 How is bacterial vaginosis treated?

Q 22. 14 Does the combined oral contraceptive pill cause thrush (vaginal candidiasis)?

Q 22. 15 Where can I obtain more information?

Q 22. 16 Could I have some useful Web sites?

Women’s Health – Home Page

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