That bad-smelling vaginal discharge

Vaginal discharge is common concern among women. It’s a situation where fluid or mucus flows from the vagina and the discharge usually varies between individuals in volume and consistency.

In reproductive-aged women, the common causes can be grouped into normal discharge (physiological), infective cause (sexually transmitted and non-sexually transmitted) and non-infective.

Normal (physiological) discharge is one that occurs in women of reproductive age and consists of about one-half to one teaspoon (2 to 5 mL) of white or clear, thick, mucus-like, and mostly odourless vaginal discharge every day.

This discharge varies with time, it becomes more noticeable during pregnancy or ovulation due to high oestrogen level in these states.

The abnormal vaginal discharge symptoms depends on cause but common symptoms include change in colour of discharge, itching, burning pain during urination, offensive smell and sometimes pain during sexual intercourse.

Therefore it is difficult to self-diagnose the exact cause without proper evaluation by the healthcare provider. Depending on the cause, the discharge can be a result of what we call bacterial vaginosis, candidiasis and trichomonas virginals. Of these, bacterial vaginosis is the most common cause of vaginal discharge.

It results from the reduction of normal vaginal bacteria that allows in return overgrowth of other harmful bacteria. Symptoms include thin white or grey discharge with offensive or fishy smell, worse after intercourse and discharge coating the vagina. Though 50 per cent of those having bacterial vaginosis may be asymptomatic, risk factors include early age at first intercourse, risky sexual behaviour, smoking, douching and using feminine hygiene products, strong soaps and shower gel and those using intrauterine contraceptive devices.

Candidiasis is the second most common cause of vaginal discharge. It results from overgrowth of vaginal yeast. Symptoms include non-offensive thick and white discharge (‘curdy’), vaginal itching and sometimes painful urination.

Risk factors include: antibiotic treatment, steroid use, synthetic underwear, diabetes mellitus and pregnancy.

Trichomonas vagianalis is another cause of infectious vaginal discharge which is sexually transmitted. It is the most common STI worldwide. Symptoms include vaginal discharge which is profuse, yellowish-green and frothy, strong-smelling fishy odour, itching and painful urination.

Treatment involves proper evaluation of the discharge by the healthcare provider, physical examination and some specific diagnostic tests.

Prevention is better

Excessive use of strong soaps, shower gel, feminine hygiene products and douching is not advised, since all these may lead to the killing of the normal bacteria that reside in the vagina, which in turn favours growth of the harmful ones.

If left untreated, vaginal discharge may interfere with a woman’s comfort, concentration and quality of life. Some are associated with poor pregnancy outcomes and pelvic inflammatory disease.

Despite a huge concern among women, many opt for self-diagnosis and treat themselves with over the counter prescription with no improvement. It is important to seek medical advice for proper management of such.

Dr Mkindi is a Medical Doctor based in Dar es Salaam.