Some women can be uncomfortable with normal amount of vaginal discharge, while others may feel heavier discharge to be normal. It may also be presenting symptom of a woman who has an underlying psychosexual problem. There may be variation in amount of vaginal discharge during the course of a normal menstrual cycle. At the time of ovulation and sexual arousal there is increased amount of vaginal fluid. Physiological discharge may be sufficiently heavy to produce irritation. A blood stained discharge warrants investigation.
The use of oral contraceptives, hormone replacement therapy and pregnancy may cause increase in vaginal discharge.

Infection is the most common cause of unusual vaginal discharge.

Sexually transmitted disease is one of the main causes of persistent vaginal discharge. Changes in sexual attitudes, availability of contraceptives other than condoms and increased mobility of population have contributed to increase in the incidence of sexually transmitted diseases. When one is aware of the serious consequences of sexually transmitted disease especially the impact on human reproduction and fertility, the concern over this epidemic will be better appreciated.

Normal vaginal flora are dominated by lactobacilli of which a proportion will produce hydrogen peroxide and bacteriocins that inhibit the over growth of other organisms, thereby protecting the body from infection.
However, the balance of vaginal flora and hence local immunity may be disturbed by the administration of antibiotics, trauma to skin following sexual intercourse, and by allergens causing sensitization of the mucous membrane.

Local immunity may also be influenced by the presence of other infection producing inflammation or change in microbial environment. In late pregnancy there is reduced immunity which makes the woman susceptible to infections like candidiasis.

Common Infections:

- Candidiasis is more likely in patients with immune suppression, endocrine abnormalities such as diabetes mellitus, diseases of thyroid and parathyroid and adrenal glands.Vaginal vulval irritation and itching is worse at night and causes pain during sexual intercourse. The discharge is thick and white having cottage cheese appearance.

- Gonorrhea causes vaginal /urethral discharge, dysuria, and pelvic pain. Gonococcus infects the cervix, urethra, rectum and pharynx depending on site of exposure. It is transmitted by direct sexual contact or by mutual masturbation. It can cause ascending or disseminated infection.

- Trichomanas vaginalis is another cause of malodorous vaginal discharge, itching and irritation.

- Chlamydia trachomatis infection exceeds that of gonorrhea and is most frequently reported communicable disease in the world.

- Herpes simplex virus in genital area is usually attributed to HSV Type 2 virus.HSV1 virus can also occur due to oro-genital contact with a partner having active HSV1lesions around the mouth. HSV infection causes a profuse mucopurulent discharge, can affect vulval and perianal areas.

- Bacterial vaginosis is another common cause of persistent increased vaginal discharge. Bacterial vaginosis presents with white or grey fishy smelling discharge. The etiology is unknown. It is advisable to avoid douching and the use of soap, bubble baths and shower gels in genital area which may alter the PH (acidity) and eradicate lactobacillus and thus make one susceptible to vaginosis.

- Urea plasma urealiticum and Chlamydia are associated with mucopurulent cervicitis producing mucopurulent yellowish discharge.
Benign/malignant lesions of cervix, endometrium ovary may cause watery foul smelling and bloody discharge per vagina.

It is, I hope, now evident that all women especially post-menopausal must take unusual vaginal discharge seriously and seek medical advice promptly from the gynaecologist. This may also involve complete screening for sexually transmitted disease, and microbiological examination of swabs of high vagina, cervical canal, and the urethra.Ultrasonography of abdomen and pelvis may also be called for. Sexually transmitted disease infections require that the partner of a patient screened for STD be treated for infection that has been identified.
Appropriate management of unusual vaginal discharge is essential for maintaining the health of the family. Early diagnosis and good follow up are vital for successful treatment.