Vaginal discharge is a common complaint, but may be physiological, rather than the result of an infection. Physiological discharge is odourless, does not cause itch and varies in quantity throughout the cycle. Nevertheless, it may be profuse and a source of embarrassment or discomfort. Benign changes of the cervix called cervical erosions and fleshy cervical polyps may be physical causes of excessive physiological discharge. Both these problems can be treated fairly simply by an out-patient procedure which involves a colposcopy.
A serious cause of vaginal discharge is vaginal, cervical or uterine cancer. In these cases the discharge is more likely to be of recent onset, varying in a way which is not related to the menstrual cycle, and may be smelly or blood stained. A discharge fitting this description should always be taken seriously, but particularly so in postmenopausal women in whom these cancers are more common.
Candida (yeast) infection or thrush: Thrush is the most common infectious cause of vaginal discharge. As yeasts form about 5% of the "healthy" organisms in the vagina, a candida "infection" usually represents an overgrowth of these yeasts rather than a new infection. Candida infection in women is usually internally arising, but also can be sexually transmitted. In contrast, sexual transmission is a common cause of genital candida infection in men.
Thrush develops very readily in some people, who may suffer from recurrent bouts. In susceptible people, a bout may be triggered by sexual intercourse, tight clothing, over-washing, use of a different soap or a course of antibiotics. However, serious causes, including immuno-deficiency and diabetes mellitus, must be excluded in people who suffer from recurrent thrush.
An alternative view is that recurrent thrush is associated with the candida syndrome, in which overgrowth of candida is believed to cause a wide range of physical and emotional symptoms. The candida syndrome is not recognised by conventional practitioners. Genital thrush causes itchy plaques of white discharge which may overlie red inflamed areas of epithelium. The itch can be intensely irritating, particularly in women, and may cause difficult urination.
Conventional treatment of thrush is with antifungal medication. In a mild case, application of a cream containing clotrimazole (Canesten® or Canesten HC®), may be sufficient to alleviate the symptoms. In more severe cases, this drug can be treated by mean of a course of vaginal tablet (called pessaries). Recurrent thrush may be treated with oral anti-fungal medication. Fluconazole (Diflucan®) is the most commonly prescribed preparation. Some women rely on recurrent treatments with these anti-fungal medications to keep their symptoms at bay.
