Patient's question:
Leukorrhea, abnormal discharge, sometimes even a bit painful during intimacy in the past two yearsDoctor's answer:
Under normal conditions, the vagina and vulva often have small amounts of secretions to maintain moisture, known as leukorrhea. It is composed of vaginal mucosal exudates, cervical gland secretions, and endometrial secretions, and contains desquamated vaginal epithelial cells and white blood cells. Normal leukorrhea is white and odorless, and its quantity and quality are related to changes in the body's physiological status. If the secretion volume increases or the characteristics become abnormal, it is referred to as pathological leukorrhea or abnormal leukorrhea.The composition of normal leukorrhea is a mixture of vaginal mucosal exudates, cervical secretions, and some endometrial secretions. It is odorless, and the amount expelled varies among individuals, which is related to estrogen levels in the body and the degree of genital congestion. In addition to physiological factors, underlying causes, or a decline in constitution that can lead to increased leukorrhea, infections caused by infectious diseases require identifying the cause before symptomatic treatment.
Pathological factors or underlying causes can lead to abnormal leukorrhea, characterized by changes in color, consistency, and quantity:
- Viscous leukorrhea: Although it appears colorless and transparent, it is abundant and sticky, commonly seen in women with a weak constitution or those using estrogen drugs.
- Purulent leukorrhea: It has an odor, is yellow or yellow-green in color, and is caused by purulent infections or trichomoniasis.
- Hemorrhagic leukorrhea: It contains varying amounts of blood and may be caused by cervical polyps, uterine fibroids, severe cervical inflammation, or intrauterine devices. If it persists or the bleeding volume gradually increases, there should be a of the possibility of cancer.
- Cheese-like leukorrhea: It resembles curd or small curd-like fragments and is caused by fungal infections, often accompanied by vulvar itching.
- Sewage-like leukorrhea: It is caused by necrosis or degeneration of pathological tissues in the uterine cavity, cervix, or fallopian tubes. A thorough gynecological examination should be conducted to rule out the possibility of cancer.
Treatment for infectious leukorrhea: For non-infectious leukorrhea, the underlying cause must be addressed promptly. For the majority of infectious conditions that cause abnormal leukorrhea, appropriate medications should be selected based on the type of infection.
- Trichomoniasis vaginitis: This is the most common type of infectious leukorrhea, characterized by vulvar itching and pain, or a sensation of crawling insects. The leukorrhea significantly increases in volume, appearing foamy and sour-smelling. Metronidazole tablets (200 mg each) can be taken three times daily.
- Candidiasis vaginitis: Intense vulvar itching, vaginal pain, abundant leukorrhea (cheese-like or curd-like). Nystatin suppositories (10,000 units each) can be inserted into the vagina nightly for a 10-day course.
- Bacterial vaginosis: Leukorrhea is yellow, abundant, and has an odor, accompanied by vulvar redness, swelling, burning pain, and urinary symptoms (frequency, urgency, dysuria). Erythromycin tablets (two tablets each) can be taken three times daily; or Cefixime (1 g each) can be taken 2–3 times daily for a 7-day course.
Traditional Chinese Medicine (TCM) treatment for leukorrhea: In TCM, leukorrhea is referred to as "dai-xia syndrome," and treatment is primarily based on identifying the underlying cause.
- Spleen deficiency type: Leukorrhea is pale and odorless, with symptoms such as chest tightness, fatigue, poor appetite, loose stools, and white tongue. Treatment involves strengthening the spleen and resolving dampness, such as Yu Dai Wan (15 g each, twice daily) or Ren Shen Gui Pi Wan (1 pill each, three times daily).
- Damp-heat type: Leukorrhea is yellow, viscous, and has an odor, with dark yellow urine and a yellow tongue. Treatment involves clearing heat and resolving dampness, such as Zhi Dai Pian (5 tablets each, three times daily) or Er Miao San (10 g each, twice daily).
- Liver-fire type: Leukorrhea is yellow and abundant, with vulvar itching, burning pain, dry mouth and throat, and a red tongue with a yellow coating. Treatment involves clearing heat and draining the liver, such as Ku Dan Cao Pian (5 tablets each, three times daily) or Long Dan Xie Gan Wan (15 g each, three times daily).
- Kidney deficiency type: Leukorrhea is thin and pale, with symptoms such as lower back pain, weak limbs, aversion to cold, and loose stools, with a pale and white tongue. Treatment involves warming the kidneys and replenishing yang, such as Jin Gui Shen Qi Wan (1 pill each, three times daily).