Выделения из влагалища: причины, диагностика и лечение.

the periodic bloody discharge originating from the uterus
Vaginal discharge is a mixture of liquid, cells, and bacteria that lubricate and protect the vagina. This mixture is constantly produced by the cells of the vagina and cervix, and it exits the body through the vaginal opening. The composition, amount, and quality of discharge varies between individuals and can vary throughout the menstrual cycle and throughout the stages of sexual and reproductive development. Normal vaginal discharge may have a thin, watery consistency or a thick, sticky consistency, and it may be clear or white in color. Infections that may cause changes in vaginal discharge include vaginal yeast infections, bacterial vaginosis, and sexually transmitted infections. The normal composition of bacteria in the vagina (vaginal flora) can vary, but is most commonly dominated by lactobacilli.

The vagina of girls before puberty is thinner and has a different bacterial flora. The composition of the bacterial population in pre pubertal girls is dominated by staphylococcus species, in addition to a range of anaerobes, enterococci, E. coli, and lactobacillus. In the days right after menstruation, vaginal discharge is minimal, and its consistency is thick and sticky. When approaching ovulation, the rising estrogen levels cause a concomitant increase in vaginal discharge.

With the drop in estrogen levels that comes with menopause, the vagina returns to a state similar to pre puberty. These symptoms can often be treated with vaginal moisturizers/lubricants or vaginal hormone creams.

Abnormal discharge can occur in a number of conditions, including infections and imbalances in vaginal flora or pH. Sometimes, abnormal vaginal discharge may not have a known cause. In one study looking at women presenting to clinic with concerns about vaginal discharge or a foul smell in their vagina, it was found that 34% had bacterial vaginosis and 23% had vaginal candidiasis (yeast infection). 32% of patients were found to have sexually transmitted infections including Chlamydia, Gonorrhea, Trichomonas, or Genital Herpes. Self treatment is not recommended and can worsen symptoms. Upon the diagnosis of vaginitis, a speculum exam is performed to evaluate the vagina, vaginal discharge, and the cervix. The physician will insert the speculum into the vagina while the patient lies on their back to exam for foreign bodies, vaginal warts, inflammation, as well as rashes/bruises. A sample of the vaginal discharge is then collected using a cotton swab and tested for pH and under microscopy. The most common causes of pathological vaginal discharge in adolescents and adults are described below.

Bacterial vaginosis (BV) is an infection caused by a change in the vaginal flora, which refers to the community of organisms that live in the vagina. It is the most common cause of pathological vaginal discharge in women of childbearing age and accounts for 40–50% of cases. In BV, the vagina experiences a decrease in a bacterium called lactobacilli, and a relative increase in a multitude of anaerobic bacteria with the most predominant being Gardnerella vaginalis. This imbalance results in the characteristic vaginal discharge experienced by patients with BV. The exact reasons for the disruption of vaginal flora leading to BV are not fully known. However, factors associated with BV include antibiotic use, unprotected sex, douching, and using an intrauterine device (IUD). The role of sex in BV is unknown, and BV is not considered an STI. or lactobacillus.

vaginal yeast infection or vaginal candidiasis results from overgrowth of candida albicans, or yeast, in the vagina. Risk factors for yeast infections include recent antibiotic use, diabetes mellitus, immunosuppression, increased estrogen levels, and use of certain contraceptive devices including intrauterine devices, diaphragms, or sponges. Vaginal discharge is not always present in yeast infections, but when occurring it is typically odorless, thick, white, and clumpy. The symptoms described above may be present in other vaginal infections, so microscopic diagnosis or culture is needed to confirm the diagnosis. It can be transmitted by way of the penis to the vagina, the vagina to the penis, or from vagina to vagina. The discharge in Trichomonas is typically yellowish green in color. Other symptoms may include vaginal burning or itching, pain with urination, or pain with sexual intercourse. The causes of abnormal vaginal discharge in pre pubertal girls are different than in adults and are usually related to lifestyle factors such as irritation from harsh soaps or tight clothing. Another cause of vaginal discharge in pre pubertal girls is the presence of a foreign object such as a toy or a piece of toilet paper. In the case of a foreign body, the discharge is often bloody or brown.