Where do the vaginal discharge come from?

The term discharge generally refers to any type of genital discharge except blood. It is one of the complaints most often reported by patients during a visit to the gynaecologist.

Joanna Szymkowiak: Discharge is a non-specific symptom, which may but does not have to be a signal of a pathological condition in the genital tract. Sometimes even a fairly abundant discharge can be a physiological phenomenon, as it happens in pregnancy, for example, when it is completely natural to have a whitish, quite abundant, odourless discharge in the vagina.

The causes of vaginal discharge and where they come from can vary widely.

There may be discharge from the vestibule, vagina, cervix, endometrium or fallopian tubes. The cause of discharge may be excessive gland secretion, increased drainage, inflammatory or cancerous exudate, trauma or foreign matter.

Vestibular discharge

Physiologically, they occur in a state of sexual arousal as a discharge produced mainly by the greater vestibular glands.

Pathological vestibular discharge may be the result of excessive secretion of glands or occur in the presence of vulvovaginitis, such as fungal, bacterial or trichomoniasis.

Pathological vestibular discharge may result from excessive glandular secretion or occur in the presence of inflammatory conditions of the vulva and vagina such as fungal, bacterial or trichomoniasis inflammation.

Vaginal discharge

Pathological vaginal discharge is caused by mechanical irritation – such as the presence of a foreign body, chemical irritation – reaction to condom coatings, spermicides or vaginitis.

Vaginitis of the most common etiology is bacterial, fungal, trichomoniasis and atrophic.

1. Bacterial vaginosis

Most often caused by G. vaginalis, anaerobes, E.coli, staphylococci, streptococci. Often there is a whitish-grey discharge with an unpleasant „fishy” smell, in very advanced cases, severe pain may be present, with painful intercourse, difficulty urinating, and purulent discharge with a very unpleasant smell.

2. Fungal vaginosis

Vaginal colonizing fungi are conditionally pathogenic, i.e. colonization is usually asymptomatic. In the case of predisposing factors, such as hormonal disorders, metabolic disorders (e.g. diabetes), thermal and chemical irritation, use of oral contraceptives, pregnancy, treatment with steroids, antibiotics, symptoms of inflammation may occur. The characteristic symptoms are itching of the vagina and vulva, burning, swelling, severe redness and whitish, lumpy deposits adhering to the vaginal and vulvar tissues.

3. Trichomonas vaginitis

It is a mainly sexually transmitted infection caused by the protozoa – vaginal trichomoniasis.  Primary infection causes acute trichomoniasis characterized by the presence of significant symptoms such as burning, hot feeling, reddening of the vaginal epithelium, itching and purulent discharge with an unpleasant odour. If an acute infection is left untreated, it may progress to a chronic stage characterized by no or few symptoms. Such a situation threatens to turn into an acute phase of infection at any time.

4. Atrophic vaginitis

It can be the result of both a physiological situation and pathological conditions. It results from a reduced amount of estrogens, whether spontaneous, as is the case in childhood and after the menopause, or artificial, caused e.g. by removal of the ovaries. Lack of estrogens leads to thinning of the vaginal mucosa and thus an increase in its susceptibility to injuries, on the other hand, to glycogen deficiency and the disappearance of lactic acid production. Both of these situations result in a lack of protection of the vagina against mechanical injuries and microbes.

Cervical discharge

Cervical discharge is regulated by hormones. In the ovulation phase, there is an increased excretion of mucous, colourless secretions. In the presence of changes on the cervix, such as large erosions, cervical ruptures, increased secretion of cervical secretion into the vagina is probable. In the presence of lesions such as a cervical polyp or neoplastic processes, the secretion may be blood-coloured. In bacterial infections (gonorrhoea, chlamydiosis), the vaginal discharge is purulent.

Discharge from the endometrium

It is always a pathological symptom indicating the presence in the uterine cavity of hyperplastic, neoplastic, inflammatory changes or remnants of a miscarriage.

Discharge from the fallopian tubes

They occur very rarely in the presence of inflammatory or neoplastic changes in the fallopian tube.

Summing up, the occurrence of a secretion from the genital tract other than the physiological secretion described above should prompt you to visit and consult a gynaecologist.