Patient's question:
Hello doctor, I am 20 years old and have not had sexual activity. My period comes every 12th day, and from the 24th to the 26th of each month, there are blood streaks in my leukorrhea, which disappears by the 26th. At other times, my leukorrhea is normal and odorless. Could you please tell me what factors or causes this? Thank you.Doctor's answer:
Hello! First of all, I wish you a speedy recovery! Based on your statement, I will 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 then appears. 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 increased 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 more viscous. In the days leading up to and following menstruation, due to pelvic congestion, vaginal exudate increases, and leukorrhea also becomes slightly more abundant. Because it contains more 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 a lack of estrogen in the body, the vagina becomes dry and leukorrhea disappears.
### 1) Why Do Women Have Leukorrhea?
Leukorrhea is a secretion of the female vagina, primarily composed of cervical mucus and vaginal exudate, containing shed cells from the reproductive tract and bacteria.
1. Cervical Mucus: This is a transparent, viscous fluid secreted by the cervical glandular system. Estrogen promotes its secretion and makes it thin, while progesterone makes it thick.
2. Vaginal Exudate: This is plasma and lymph fluid that seeps 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 types of leukorrhea depend on the influence of ovarian hormones. After puberty and during sexual maturity, the ovaries begin to function and enter a period of peak activity, leading to the presence of leukorrhea. During pregnancy, the placenta secretes estrogen and progesterone, causing even greater pelvic congestion and increased leukorrhea. Girls and elderly women, due to underdeveloped or declining ovarian function and low estrogen levels, lack both cervical mucus and 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 due to foreign bodies. Leukorrhea is composed of exudate from vaginal mucosa, secretions from cervical and endometrial glands, secretions from the greater vestibular glands, and sebum from 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: This is a white, thin, viscous liquid with no odor. 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 mature and secrete estrogen and progesterone, the characteristics and quantity of leukorrhea change with the ovarian cycle. Around the mid-cycle (before ovulation), due to active cervical gland secretion, leukorrhea increases, becoming clear, thin, and egg-white-like, with the ability to stretch into threads several centimeters long. This elasticity 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 tinged with blood or a brownish hue. Insufficient corpus luteum function may result in a brownish discharge.
After marriage, during sexual activity (including premarital sexual fantasies, self-stimulation, or sexual arousal), pelvic congestion increases, leading to significant leukorrhea. The longer and more intense the stimulation, the more abundant the discharge. These are normal physiological phenomena and responses.
However, some women, despite maintaining good hygiene, may have excessive leukorrhea with a strong odor, or the color and consistency of their leukorrhea may change significantly, 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 gland secretion during ovulation, but significantly more abundant. This may suggest chronic cervical endometritis, ovarian dysfunction, vaginal adenosis, or high-grade cervical adenocarcinoma.
2. White or Yellowish-Green Foamy Leukorrhea: A hallmark of trichomoniasis, often accompanied by vulvar itching.
3. Cheese-like Leukorrhea: Characteristic 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 yellowish-green, viscous, with an odor, caused by acute vaginal infections (e.g., trichomoniasis, gonorrhea), cervicitis, or cervical canalitis. It may also result from pyometra, cervical cancer, vaginal cancer, or retained foreign bodies in the vagina.
6. Hemorrhagic Leukorrhea: Containing blood, suggesting cervical cancer, endometrial cancer, cervical polyps, or submucosal fibroids. IUD insertion may also cause hemorrhagic leukorrhea.
7. Other Possibilities: Such as cervical cancer.
### 4) Relationship Between Abnormal Leukorrhea and Sexual Activity
After puberty, women often experience wetness in their lower body, with underwear becoming dirty. The discharge may be clear and colorless or creamy white, sometimes slightly yellow, bloody, or brownish. Although it may have no odor during the day, it can become foul if the external genitalia are not cleaned or underwear is not changed for a day or two. This is due to the influence of estrogen after ovarian development, 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 more, leading to increased leukorrhea that is thin, clear, and egg-white-like. The cervical mucus can be stretched into several centimeters without breaking, showing 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 tinged with blood or a brownish hue. Insufficient corpus luteum function may result in a brownish discharge.
After marriage, during sexual activity (including premarital sexual fantasies, self-stimulation, or sexual arousal), pelvic congestion increases, leading to significant leukorrhea. The longer and more intense the stimulation, the more abundant the discharge. These are normal physiological phenomena and responses.
However, some women, despite maintaining good hygiene, may have excessive leukorrhea with a strong odor, or the color and consistency of their leukorrhea may change significantly, indicating abnormal conditions. Married women experiencing these symptoms should first consider issues related to sexual activity.
### 6) Abnormal Leukorrhea
It is often a sign of reproductive tract inflammation. Married women have a higher risk of infection, largely due to frequent sexual activity. Factors such as a partner not washing their hands before sexual contact, long nails with dirt, lack of hygiene before intercourse (especially if the partner has poor hygiene habits), phimosis or excessive foreskin in the male, and failure to urinate or clean after intercourse are significant contributing factors or causes of abnormal leukorrhea in women.
### 7) Preliminary Diagnosis Based on Leukorrhea Color, Odor, and Consistency
1. Purulent Bacterial Infection: Leukorrhea is purulent, yellow or yellowish-green, viscous, with an odor. Examples include senile vaginitis, endometritis, pyometra, and relatively common gonococcal vaginitis, non-gonococcal vaginitis (chlamydia infection).
2. Fungal Infection: Leukorrhea is curd-like, with significant vulvar itching, such as candidiasis.
3. Trichomoniasis: Leukorrhea is creamy white and foamy, with severe vulvar itching.
However, abnormal leukorrhea is not always as typical as described, and mixed infections often occur. Therefore, 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 if either partner has 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. Once the cause is identified, targeted treatment can be administered. Women with bloody leukorrhea, especially older women or those who have gone through menopause, should be particularly vigilant and seek medical attention early to avoid delaying tumor diagnosis and treatment.
Additionally, it should be emphasized that couples with gonorrhea or trichomoniasis must be treated together. Otherwise, if only the female is treated, the male remains a carrier of bacteria or pathogens, and the female may re-infect after treatment through sexual activity.
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