Patient's question:
My girlfriend started noticing fluid discharge from her vagina a few days ago. The fluid is transparent and doesn't stick to her hands. Could you please tell me what the problem might be?!Doctor's answer:
Hello! First of all, I wish your girlfriend 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, composed of secretions from the Bartholin's glands, cervical glands, endometrial glands, and exudate from vaginal mucosa, as well as shed vaginal epithelial cells. Leukorrhea contains lactobacilli, 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. 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, at which point leukorrhea starts to appear. During each menstrual cycle, the quality and quantity of leukorrhea vary due to fluctuations in estrogen levels. Generally, around the middle of the cycle (equivalent to the ovulation period), estrogen secretion peaks, stimulating the cervical glands to secrete more mucus. At this time, leukorrhea is abundant, clear, and egg-white-like, viscous and stretchable, with a moist sensation in the external genitalia. After ovulation, progesterone increases and inhibits cervical mucus secretion, resulting in less leukorrhea that is thicker. In the days leading up to and following menstruation, due to pelvic congestion, vaginal exudate increases, and leukorrhea also becomes slightly more abundant, appearing cloudy due to the presence of more shed cells. Additionally, leukorrhea increases during pregnancy, after sexual arousal, and after 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 does leukorrhea occur?
Leukorrhea is a secretion of the female vagina, primarily composed of cervical mucus and vaginal exudate, containing shed epithelial cells from the reproductive tract and bacteria.
1. Cervical mucus is a transparent, viscous fluid secreted by cervical glandular cells. Estrogen promotes its secretion and makes it thinner, while progesterone makes it thicker.
2. Vaginal exudate 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 increases exudate before menstruation.
Both types of leukorrhea depend on the influence of ovarian hormones. After puberty and during the reproductive stage, the ovaries begin to function and enter a period of peak activity, resulting in leukorrhea. During pregnancy, the placenta secretes estrogen and progesterone, leading to 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 caused by foreign bodies. Leukorrhea is composed of exudate from vaginal mucosa, secretions from cervical and endometrial glands, Bartholin's gland secretions, 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 lactobacilli. 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 Bartholin's glands secrete colorless, clear acidic fluid; the vaginal epithelium lacks glands, and its white, thin, viscous fluid is exudate from the vaginal mucosa, 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 estrogen and progesterone are secreted, the characteristics and quantity of leukorrhea change with the ovarian cycle. At mid-cycle (before ovulation), due to active secretion of cervical glands, the cervical mucus component in leukorrhea increases, resulting in abundant, clear, thin, egg-white-like leukorrhea that stretches several centimeters and is highly elastic. 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 in cases of luteal insufficiency.
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 maintaining good hygiene, may experience excessive leukorrhea, a strong odor that makes them cover their noses, or significant changes in the color and nature of leukorrhea, indicating abnormal conditions. Married women with 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 risk of infection, largely due to frequent sexual activity. Factors such as a partner not washing their hands before intimate contact, long nails with dirt, lack of hygiene before intercourse (especially if the male 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) Initial judgment of the type of pathogen through the color, odor, and nature of leukorrhea
1. During purulent bacterial infections, leukorrhea is purulent, yellow or yellow-green, viscous, foul-smelling, such as in cases of senile vaginitis, endometritis, pyometra, and relatively common gonococcal vaginitis, non-gonococcal vaginitis (chlamydia infection).
2. During fungal infections, leukorrhea is curd-like with significant external genital itching, such as in cases of candidiasis.
3. During trichomoniasis, leukorrhea is creamy and foamy with severe vaginal itching.
However, abnormal leukorrhea may not be 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 either partner has a history of unprotected sex, it is essential to seek medical attention promptly, preferably at a dermatology and venereology clinic, to avoid misdiagnosis or missed diagnosis. Currently, the medical community has effective medications for bacterial (including gonococcal), fungal, and trichomoniasis vaginal infections, so targeted treatment can be administered once the cause is identified. Women with bloody leukorrhea, especially older women or those who have gone through menopause, should be particularly vigilant and seek medical attention as soon as possible to avoid delaying the diagnosis and treatment of tumors.
Additionally, it must be emphasized that couples with gonorrhea or trichomoniasis must be treated together. Otherwise, if only the female is treated while the male remains a carrier of bacteria or pathogens, the female may become reinfected after treatment through sexual activity.
If you find this answer helpful, please do not disappoint me by failing to click "Accept as Answer" in a timely manner.