Introduction
It is a thick whitish discharge from the vagina and almost all women would get this during reproductive cycle. It may be normal or that may be a sign of infection. It is normal when the quantity is very little and does not cause any discomfort. Although the vaginal discharge will be normally white in colour, for some women it may be yellow or greenish yellow in colour. A detailed evaluation is needed in such cases and if the vaginal discharge is accompanied by other symptoms like itching and redness in the vaginal area. There are number of factors like hormonal changes, diabetes and anaemia which cause leukorrhoea. In rare cases this white discharge begun before the first menstrual cycle of a girl.
Signs & symptoms
- Increased whitish vaginal discharge
- weakness and lethargy
- Itching and redness in vulva
- Pain during sexual intercourse
- It can also be accompanied by headache for some women.
- Low backache
- pain in the calf muscles
Causes
Any change in the vagina’s balance of normal bacteria can affect the smell, colour, or discharge texture. These are a few of the things that can upset that balance:
- Antibiotic or steroid use
- Bacterial vaginosis, a bacterial infection of the vagina
- Birth control pills
- Cervical cancer
- Chlamydia or Gonorrhoa ; sexually transmitted infections
- Diabetes
- Douches, scented soaps or lotions, bubble bath
- Pelvic infection after surgery
- Pelvic inflammatory disease (PID)
- Trichomoniasis, a parasitic infection.
- Vaginal atrophy, the thinning and drying out of the vaginal walls during menopause
- Vaginitis, irritation in or around the vagina
- Yeast infections
- hormonal disturbance.
- Increased secretion of estrogen
- Improper hygiene habits
- Iron deficiency anaemia
- Pregnancy and after child birth
- Indigestion and constipation
Two types of leucorrhea are there namely –
A. Physiological leucorrhea
B. Inflammatory leucorrhea
- Physiological leucorrhea
It is common in almost all women and is caused by defence mechanism of the body for restoring chemical balance. It also preserves to maintain the flexibility of the vagina and the surrounding tissues. It has got its name “physiological” due to the reason that vaginal discharge occurs when estrogen levels are increased.
- Inflammatory leucorrhea
It occurs when there is vaginal swelling or congestion of mucosa in that area. Very often the yellowish white discharge gives out a foul smell indicating infection. This type of leucorrhea also includes vaginal discharge caused by STD (sexually transmitted diseases) and due to lochia.
The aetiology of leucorrhoea is complex and not well understood. It is considered that changes in the vaginal epithelium; changes in the normal bacterial flora and pH of the vaginal secretion predispose to leucorrhoea. The creamy white discharge from vagina is a result of secretions from glands in the vulva, namely Bartholin’s glands, sebaceous glands, sweat gland, etc. It serves an important housekeeping function in the female reproductive system. Fluid made by glands inside the vagina and cervix carries away dead cells and bacteria. This keeps the vagina clean and helps prevent infection. Most of the time, vaginal discharge is perfectly normal. The amount can vary, as can odour and colour (which can range from clear to a milky whitish), depending on the time in the menstrual cycle. For example, there will be more discharge during ovulation, breast feeding or sexual arousal. It may smell different in pregnancy.
None of those changes is a cause for alarm. However, if the colour, smell, or consistency seems quite different than usual, especially associated with vaginal itching, redness or burning, there is a chance of an infection or any other disease. Any infection in the vagina can irritate the mucous glands of the cervix, resulting in excess secretion of mucous mixed with pus.
Diagnosis
History taking
Physical examination
A swab collected for microscopic evaluation
Pap smear test
USG
Cervical punch biopsy
Serological investigations like: VDRL, HIV etc
Blood tests to evaluate general health, immunity and chance of anaemia
The treatment depends upon the cause of the vaginal discharge.
Bacterial infections are managed by oral ant topical antibiotics. They are used in the form of pills & ointments.
Yeast/fungal infections are treated by antifungal creams or gels applied into the area.
Metronidazole or tinidazole are the common drugs of choice.
Other than medications, following some regimes are found beneficial and advised in lecorrhoea:
- Keep vaginal area clean and dry. Use only a mild soap and warm water on outside. Nothing should be inserted inside the vagina for cleaning.
- Never use sprays or perfumes or douche in vulval area.
- Avoid bubble bath and pool bath.
- After peeing etc, always wipe/wash from front to back to prevent bacterial invasion from anus into the vagina, causing infection.
- Use only natural/cotton clothing as underwear. Wash and iron them regularly.
- Wash and change underwear regularly. Avoid tight clothing.
Prognosis
Leucorrhoea usually has a good prognosis. It can be cured by weeks to months with proper medications and hygiene measures taken.
Complications
Worsening of symptoms
Chronic abdominal pain
Recurrent infections
Pelvic inflammatory disease
Disease & Ayurveda
Swetapradara
Nidana
Diet & habits vitiating kapha dosha
Excess sexual activity
Abortion
Improper diet and lifestyle during menstruation
Lack of hygiene in the vulval area
Purvaaroopa
Not mentioned
Samprapti
Due to the causative facors, doshas mainly kapha dosha which is the causative dosha for any type of Sraava(discharhge), vitiate themselves and rasa-rakta dhatus, then get lodged in the female reproductive system and cause the abnormal white discharge from vagina.
Lakshana
White, thick discharge from vagina sometimes associated with itching, burning sensation or pain (depending upon the associated dosha vitiation)
Divisions
Raktapradara
Swetapradara
Prognosis
Sadhya if the disease is new and devoid of any other comorbidities.
Yaapya if chronic presentation.
Chikithsa
Samana
Aamapaachana
Agnideepana
Yonikshalana – Lodhratwk kwatha/Vatatwak kwatha
Yonipurana – Plakshatwakchoorna+honey
Yonidhoopana – Saraladi yoga
Yonivarti – Lodhradi yoga
Sodhana
Snehana with tiktakaghtruta
Mriduswedana
Virechana
Uttaravasti
Commonly used medicines
        Musalikhadiradi kashayam
Khadiraseetadi kashayam
Pravaal bhasma
Asokaghruta
Brands available
AVS Kottakal
AVP Coimbatore
SNA Oushadhasala
Home remedies
- Apply yoghurt on vagina to control itching and white discharge.
- Make a paste of mango pulp and apply on the genitals to get relief.
- Include yoghurt in your routine diet.
- Drink the water residue which is used for preparation of white rice; which is best remedy to treat white discharge because of heat.
- Drink the decoction of fenugreek seeds boiled and cooled in one litter of water.
- Take care of proper personal hygiene.
Diet
- To be avoided
Heavy meals and difficult to digest foods – cause indigestion.
Junk foods- cause disturbance in digestion and reduces the bioavailability of the medicine
Carbonated drinks – makes the stomach more acidic and disturbed digestion
Refrigerated and frozen foods – causes weak and sluggish digestion by weakening Agni (digestive fire)
Curd – causes vidaaha and thereby many other diseases
Red chilli and other pungent, hot and spicy food items. Eg.pickles.
- To be added
Light meals and easily digestible foods
Green gram, sesame oil, soups, milk and ghee.
Freshly cooked and warm food processed with cumin seeds, ginger, ajwain etc
Behaviour:
Avoid stress.
Better to avoid exposure to excessive sunlight wind rain or dust.
Avoid sedentary lifestyle. Be active.
Maintain a regular food and sleep schedule.
Avoid holding or forcing the urges like urine, faeces, cough, sneeze etc.
Yoga
Exercises should be decided considering the disease. While the target is female reproductive system, vigorous exercises which exert abdominal pressure are not allowed in painful conditions. In such persons, only stretching, moderate walking, and mild cardio exercises are advised.
Also, specific yogacharya for correcting Apaanavayu and strengthening reproductive system including bhujangaasana, pavanamuktasana, vajrasana etc is recommended.
Sookshma sandhi vyayama (warming up small joints) is advised.
Regular exercise helps improve bioavailability of the medicine and food ingested and leads to positive health.
Yoga can maintain harmony within the body and with the surrounding system.
Pavanamukthasana
vajrasana
Bhujangasana
All the exercises and physical exertions must be decided and done under the supervision of a medical expert only.
Research articles
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