Leukorrhea: all about white losses or vaginal losses

Definition: what is white discharge?

Leucorrhoea (also called white discharge) refers to non-bloody vaginal discharge (unlike menstruation or metrorrhagia which corresponds to bleeding occurring between periods).

White discharge is most often a normal physiological phenomenon in women. They are due to secretions of cervical mucus and accessory glands (Skene's and Bartholin's glands) and vaginal desquamation. They appear from puberty and gradually disappear from menopause.

These whitish secretions are more or less abundant depending on the patient and depending on the period of their menstrual cycle. Indeed, leucorrhea increases during ovulation (the mucus is then more abundant and similar to egg white). These discharges are not associated with burning, itching or any other general symptoms. They don't give off any smell.

The sign of an infection in case of colored, odorous, painful leucorrhoea

However, if the leucorrhoea is colored, fragrant, painful (burns), accompanied by pruritus or general symptoms (fatigue, fever...), we are talking about pathological white discharge. In this case, the white losses are the sign of an infection to be identified in order to treat it.

"In the majority of cases, these are lower genital infections. They can be caused by a mycosis linked to the proliferation of candida albicans yeast. The losses are then abundant, lumpy and associated with itching.Sometimes, white discharge is linked to vaginosis.The latter corresponds to an imbalance of the vaginal flora between a loss of lactobacilli (flora of Döderlein) and a proliferation of other bacteria in the vagina (such as Gardnerella vaginalis or Peptostreptococcus)" according to Doctor Olivier Marpeau, gynecological surgeon at the Private Hospital of Provence.

Leucorrhea can also be a symptom of a sexually transmitted infection (STI). In this case, they result from an infectious agent transmitted by the sexual partner: a bacterium (chlamydia, gonococcus or gonorrhea, mycoplasma) or the parsasite trichomoniasis vaginalis.

More rarely, leucorrhoea can be a sign of ectropion (immaturity of the cervix), uterine cancer or a benign tumor.

When white discharge does not indicate an infection, there is no need to treat it. “Some patients complain of having excessive losses. There is then not much to do. Sometimes, the prescription of a contraceptive pill or probiotics to rebalance the vaginal flora can see the leucorrhoea decrease. Conversely, for women who complain of vaginal dryness, there are many solutions: gel, creams, lubricating eggs, vaginal laser..." explains the specialist.

In case of infection, the doctor prescribes appropriate treatment quickly so that the pathogen does not reach the upper genital tract (uterus, fallopian tubes, etc.). Most often based on antifungals or antibiotics depending on the causative pathogen.

Normal or pathological white discharge: what's the difference?

A distinction is made between normal physiological leucorrhoea and pathological leucorrhea.

Physiological leucorrhoea

They correspond to normal vaginal secretions in women. They appear from puberty and become rare at menopause. The preovulatory period and pregnancy increase their quantity. These losses come from:

Physiological losses are not accompanied by irritation or odor and are not a sign of an infection (they do not contain white or polymorphonuclear blood cells). Their abundance or, on the contrary, their absence (vaginal dryness) can sometimes be a source of discomfort for the patient.

Pathological leucorrhoea

These are vaginal discharge symptomatic of an infection. They are colored (yellowish, greenish, etc.) or white, sometimes have a bad smell and may contain blood. They are sometimes associated with other local symptoms (burns, pruritus, etc.) or general symptoms (fever, fatigue, pain in the lower abdomen, etc.). They most often reflect a lower genital infection linked to an imbalance of the genital microbial flora (mycosis, vaginosis) or to a sexually transmitted infection (chlamydiosis, gonorrhea, mycoplasma, trichomoniasis vaginalis).

More rarely pathological leucorrhea is a sign of cancer of the cervix or a benign tumor.

Be careful, ectropion (that is to say when the mucous membrane normally present in the uterus is exteriorized in the vagina) can also cause a significant secretion of leucorrhoea. There is then no particular risk.

Causes: what causes white discharge?

Physiological leucorrhoea is normal in women between the onset of puberty and menopause. They are due to the action of estrogens allowing their production by vaginal desquamation and the activity of the cervical mucus. They are more or less abundant from one woman to another. They increase in the preovulatory period and during pregnancy.

Pathological leucorrhoea is most often caused by a lower genital infection induced by:

What are the risk factors for white discharge?

White losses are physiological in women (appearing from puberty and becoming rarer at menopause). Risk factors for increased white discharge are the preovulatory period and pregnancy.

The risk factors for pathological white discharge (which are fragrant, colored and associated with other symptoms such as itching or a change in general condition) are:

How do white discharge appear?

Physiological leucorrhoea is accompanied by only a few signs. They are:- variable in quantity;- clear;- non-odorous.

Symptoms of pathological leucorrhoea

Pathological leucorrhoea can present in different ways, depending on its cause:

They can be associated with other signs:

Any suspicious leucorrhoea (even leucorrhoea that looks physiologically worrying) must be taken seriously. It requires a medical or gynecological consultation.

What advice for prevention?

"Some patients complain of excessive white discharge. But if they are not symptomatic of an infection, there is no reason to treat them. In addition, there is no effective treatment against white losses. Sometimes, when the patient is very embarrassed, it is possible to prescribe a contraceptive pill or probiotics which can reduce vaginal secretions", according to Olivier Marpeau, gynecological surgeon.

To prevent infections, the cause of pathological leucorrhoea, it is recommended to:

How to know if vaginal discharge is pathological?

In case of bad smelling or itchy white discharge, it is recommended to consult a gynecologist. He will practice:

What are the treatments for pathological white discharge?

What to do against excessive white discharge?

There is no treatment for physiological leucorrhoea even if it is abundant. Sometimes the doctor may prescribe a contraceptive pill or probiotics to reduce their quantity. In addition, the simple use of panty liners can improve a woman's comfort.

What to do if there is no white discharge (vaginal dryness)?

In case of vaginal dryness (insufficient or even absence of white discharge), especially in the context of menopause, the doctor offers several solutions to patients:

If vaginal dryness is linked to taking a hormonal contraceptive, your gynecologist may suggest that you change this method of contraception. Finally, if vaginal dryness interferes with sexual intercourse, you can consult a sexologist, extend the time of foreplay, communicate this problem with your sexual partner in order to adapt your sexual practices with him.

What to do in case of vaginal infection (pathological leucorrhoea)?

In case of abundant white discharge, bad smelling and colored (yellowish to greenish), it is recommended to consult a gynecologist because it could be a sign of an infection. In case of infection, treatment depends on the causative pathogen:

Oral treatments for recurrent mycosis also exist.

In general, in order to prevent infections and take care of your vaginal flora, it is recommended to adopt an intimate (but not intrusive!) wash once a day with an alkaline soap .

Laser or cryotherapy (cold) can limit annoying leucorrhea during ectropion.

When cancer occurs, special treatment is initiated.

Interview with Doctor Olivier Marpeau, gynecological surgeon at the Private Hospital of Provence.

https://www.docteurmarpeau.com/

"Chapter 21 Female genital infections. Leucorrhea", CNGOF (National College of French Gynecologists and Obstetricians).

"Overview of Vaginal Infections", Oluwatosin Goje, 2021.