Patient's question:
Currently, in general situations: Leukorrhea is abundant about one week before and after menstruation, and sanitary pads get completely soaked through. Sometimes, sanitary napkins are also needed! The color of the leukorrhea is light yellow and very viscous! Is there any problem?Doctor's answer:
Hello! First of all, I wish you a speedy recovery! Based on your statement, let me discuss the issue of "leukorrhea" with you.Leukorrhea is a viscous white liquid secreted from the vagina of women. It is composed of secretions from the greater vestibular glands, cervical gland secretions, endometrial secretions, exudate from vaginal mucosa, and shed vaginal epithelial cells. Leukorrhea contains lactic acid bacteria, lysozyme, and antibodies, which help inhibit bacterial growth. After marriage, leukorrhea can also lubricate the vagina, making sexual intercourse more comfortable.
The formation of leukorrhea is closely related to estrogen. Therefore, girls before puberty generally do not have leukorrhea. After puberty, the ovaries begin to develop and secrete estrogen to promote the growth of reproductive organs, and leukorrhea starts to appear. During each menstrual cycle, the quality and quantity of leukorrhea change due to the fluctuation of estrogen secretion. Generally, around the middle of the menstrual cycle (equivalent to the ovulation period), estrogen secretion reaches its peak. Excessive estrogen stimulates the cervical glands to secrete more mucus, resulting in a large amount of leukorrhea that is clear, thin, and egg-white-like, with a sticky texture that can be stretched into threads. The external genital area may feel moist. After ovulation, progesterone increases and inhibits cervical mucus secretion, causing leukorrhea to become less abundant and thicker. In the days before and after menstruation, due to pelvic congestion, vaginal exudate increases, and leukorrhea also becomes slightly more abundant. Because it contains a large number of shed cells, the leukorrhea appears cloudy. Additionally, leukorrhea may increase during pregnancy, after sexual arousal, and after sexual intercourse.
After menopause, due to the decline in ovarian function and the lack of estrogen in the body, the vagina becomes dry and leukorrhea disappears.
### 1) Why is there leukorrhea?
Leukorrhea is a secretion of the female vagina, primarily composed of cervical mucus and vaginal exudate, containing shed cells of the reproductive tract and bacteria.
1. Cervical mucus is a transparent, viscous fluid secreted by the cervical glandular tubes. Estrogen promotes its secretion and makes it thin, while progesterone makes it thick.
2. Vaginal exudate is plasma and lymph fluid exuded from the capillaries and lymphatic vessels of the vaginal wall, mixed with shed vaginal epithelial cells. The vaginal epithelium lacks glands, and congestion in the pelvic organs before menstruation increases exudate.
Both are influenced by ovarian hormones. After puberty and during the reproductive period, the ovaries begin to function and enter a period of peak activity, resulting in leukorrhea. During pregnancy, the placenta secretes estrogen and progesterone, causing even greater pelvic congestion and an increase in leukorrhea. In young girls and elderly women, the ovaries have not yet developed or have declined, leading to low estrogen levels, no cervical mucus secretion, and no vaginal exudate, resulting in dry external genitalia and vagina.
### 2) Abnormal leukorrhea
1. Pathological leukorrhea: Such as inflammatory leukorrhea, leukorrhea caused by tumors, and leukorrhea caused by foreign bodies. Leukorrhea is composed of exudate from vaginal mucosa, secretions from cervical glands and endometrial glands, secretions from the greater vestibular glands, and secretions from the sebaceous glands of the labia majora and minora. The former two are the main components. Leukorrhea contains shed vaginal epithelial cells, white blood cells, and lactic acid bacteria. Leukorrhea is divided into physiological and pathological types, with different production factors, causes, and characteristics.
2. Physiological leukorrhea is a white, thin, viscous liquid, generally odorless. Under normal conditions, leukorrhea moisturizes the labia and vagina. The labia secrete viscous, milk-like fluid; the greater vestibular glands secrete colorless, clear, acidic fluid; the vaginal epithelium lacks glands, and its white, thin, viscous fluid is exudate from the vaginal mucosa, which is acidic; cervical mucus is alkaline, like egg white; endometrial secretions are thinner and less abundant than cervical mucus. The amount of leukorrhea varies depending on age, estrogen levels, and congestion of the reproductive organs.
After puberty, as the ovaries develop and mature, estrogen and progesterone are secreted, causing leukorrhea to change in quality and quantity with the ovarian cycle. At mid-cycle (before ovulation), due to the abundant secretion of cervical glands, the cervical mucus component in leukorrhea increases, resulting in a large amount of clear, thin, egg-white-like leukorrhea that can be stretched into several centimeters without breaking, with good elasticity. This phenomenon is not observed in the second half of the menstrual period. Two to three days before and after menstruation, due to pelvic congestion, vaginal exudate increases, and leukorrhea also becomes more abundant, sometimes slightly tinged with blood or brownish due to insufficient corpus luteum function.
After marriage, during sexual activity (including premarital sexual fantasies, self-stimulation, or sexual arousal), pelvic congestion occurs due to sexual excitement, leading to a significant increase in vaginal secretion and leukorrhea. The longer and more intense the stimulation, the more abundant the secretion. These are normal physiological phenomena and responses.
However, some women, despite being very careful about hygiene, may have a large amount of leukorrhea, a strong odor that makes one want to cover their nose, or a significant change in the color and nature of the leukorrhea, indicating abnormal conditions. Married women experiencing these symptoms should first consider issues related to sexual activity.
### 3) Common pathological leukorrhea
1. Clear, viscous leukorrhea: Egg-white-like in texture, similar to cervical mucus during ovulation, but significantly increased in amount. Chronic cervical endometritis, ovarian dysfunction, vaginal adenosis, or high-grade cervical adenocarcinoma should be considered.
2. White or yellowish-gray frothy leukorrhea: A characteristic of trichomoniasis, often accompanied by vulvar itching.
3. Cheese-like leukorrhea: A feature of candidiasis, often accompanied by severe vulvar itching or burning pain.
4. Gray, homogeneous, fishy-smelling leukorrhea: Common in bacterial vaginosis.
5. Purulent leukorrhea: Yellow or yellow-green, viscous, with an odor, caused by acute vaginal infections (e.g., trichomoniasis, gonorrhea), cervicitis, or cervical canalitis. It can also be caused by purulent discharge in the uterine cavity, cervical cancer, vaginal cancer, or retained foreign bodies in the vagina.
6. Blood-stained leukorrhea: Leukorrhea mixed with blood should be considered for cervical cancer, endometrial cancer, cervical polyps, or submucosal fibroids. The use of an intrauterine device (IUD) can also cause blood-stained leukorrhea.
7. Leukorrhea with blood: Possible cervical cancer.
### 4) The relationship between abnormal leukorrhea and sexual activity
After puberty, women's lower bodies are always moist, and their underwear is never clean. It may be transparent and colorless secretion or creamy white discharge, sometimes slightly yellow, bloody, or brownish. Although it has no odor at first, it becomes foul if the external genitalia are not washed or underwear is not changed for a day or two. This is due to the influence of estrogen secreted in large amounts after ovarian development, which is medically known as leukorrhea.
### 5) Leukorrhea secretion
Generally, leukorrhea is odorless and not excessive, but it varies depending on the individual and the stage of the menstrual cycle. For example, during ovulation, cervical glandular cells secrete abundantly, leading to increased leukorrhea that is thin, clear, and egg-white-like. The cervical mucus can be stretched to several centimeters without breaking, with good elasticity. This phenomenon is not observed in the second half of the menstrual period. Two to three days before and after menstruation, due to pelvic congestion, vaginal exudate increases, and leukorrhea also becomes more abundant, sometimes slightly tinged with blood or brownish due to insufficient corpus luteum function.
Women who have sexual activity after marriage (including premarital sexual fantasies, self-stimulation, or sexual arousal) experience pelvic congestion due to sexual excitement, leading to a significant increase in vaginal secretion and leukorrhea. The longer and more intense the stimulation, the more abundant the secretion. These are normal physiological phenomena and responses.
However, some women, despite being very careful about hygiene, may have a large amount of leukorrhea, a strong odor that makes one want to cover their nose, or a significant change in the color and nature of the leukorrhea, indicating abnormal conditions. Married women experiencing these symptoms should first consider issues related to sexual activity.
### 6) Abnormal leukorrhea
It is usually a sign of reproductive tract inflammation. Married women have a higher chance of infection, which is closely related to frequent sexual activity. Factors such as a lack of handwashing by the male partner during sexual activity, long nails with dirt, poor hygiene habits before sexual intercourse, phimosis or excessive foreskin in the male partner, and failure to urinate or clean after intercourse are important causes or contributing factors to abnormal leukorrhea in women.
### 7) Preliminary judgment of the type of pathogen through the color, odor, and nature of leukorrhea
1. Purulent bacterial infection: Leukorrhea is purulent, yellow or yellow-green, viscous, with an odor. Examples include senile vaginitis, endometritis, purulent discharge in the uterine cavity, relatively common gonococcal vaginitis, and nongonococcal vaginitis (chlamydia infection).
2. Fungal infection: Leukorrhea is curd-like, with significant vulvar itching, such as candidiasis.
3. Trichomoniasis: Leukorrhea is creamy white and frothy, with severe vulvar itching.
However, the manifestations of abnormal leukorrhea are not as typical as described above, and mixed infections often occur. Therefore, a simple visual judgment cannot provide a definitive diagnosis. It is best to undergo a routine gynecological examination for a clear diagnosis and timely treatment. Especially when one or both partners have a history of unprotected sex, it is important to seek medical attention promptly, preferably at a dermatology and venereology department, to avoid misdiagnosis or missed diagnosis. Currently, the medical community has effective medications for bacterial (including gonococcal), fungal, and trichomoniasis vaginal infections. Therefore, after identifying the cause, targeted and effective treatment can be provided. Women with blood-stained leukorrhea, especially older women or those who have been menopausal, should be more vigilant and seek medical attention promptly to avoid delaying the diagnosis and treatment of tumors.
Additionally, it should be emphasized that couples with gonorrhea or trichomoniasis must be treated together. Otherwise, if only the female partner is treated, the male partner remains a carrier of bacteria or pathogens, and the female partner may re-infect after treatment through sexual activity.
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