Characteristics of pathological discharge (leukorrhea)
During a gynecological examination and patient interview, the physician is required to describe the properties of the discharge in detail. Accurate characterization of leukorrhea helps narrow down the diagnostic search and suggest the nature of the disease.
The following parameters must be evaluated:
- Quantity: the discharge can be scant, moderate, or heavy.
- Color: varies from milky and yellowish to green, yellow-green, gray, or "dirty" (if mixed with blood).
- Consistency: leukorrhea can be thick, viscous, creamy, foamy, or curdled.
- Odor: from completely absent to pronounced, pungent, and extremely unpleasant.
Specific questioning for complaints of leukorrhea
To determine the etiology of pathological discharge, it is necessary to take a detailed history of the present illness (anamnesis morbi). The physician asks the patient a series of clarifying questions:
- Does the amount of discharge increase during certain periods of the cycle (specifically, in connection with menstruation)?
- Is there a clear connection between the onset of leukorrhea and sexual intercourse or a recent change of sexual partner?
- When exactly and against the background of what events did these complaints first appear?
Uterine bleeding and menstrual irregularities
Genital tract bleeding is often associated with menstrual dysfunction. It is divided into two large groups depending on its relationship to the cycle:
- Menorrhagia — cyclic bleeding associated with menstruation. Includes hypermenorrhea (an increase in the volume of blood loss), polymenorrhea (prolongation of bleeding duration), and proyomenorrhea (rhythm disturbance). The cause is often reduced uterine contractility (due to myoma, endometritis, myometritis) or ovarian dysfunction (lack of ovulation, follicular maturation defects).
- Metrorrhagia — acyclic uterine bleeding not tied to the cycle. It occurs against the background of dysfunctional disorders, submucosal myoma, hormonally active ovarian tumors, as well as cancer of the uterine body and cervix.
- Menometrorrhagia — a condition in which heavy menstruation does not stop and continues into the intermenstrual period.
Discharge in oncological processes
The nature of vaginal discharge changes radically in malignant neoplasms, particularly in cervical cancer. Symptoms directly depend on the stage of the process:
- Initial forms (microinvasive carcinoma and carcinoma in situ): clinical manifestations and pathological discharge are absent.
- Invasive cancer: the main pathognomonic symptom appears — contact bleeding (occurs when tissues are touched). Acyclic bleeding is less commonly observed.
- Advanced and inoperable forms: against the background of tumor breakdown, the discharge becomes purulent-like and acquires a putrid odor. This is accompanied by fever, weight loss, and lower back pain.
During a gynecological examination of an exophytic tumor, the physician visualizes cauliflower-like growths that easily break down and bleed, with gray fibrin deposits visible on their surface.
Discharge in pregnancy pathologies
Pathological discharge also accompanies a complicated course of pregnancy or the consequences of its termination:
- Missed miscarriage (missed abortion): fetal death and subsequent detachment of the gestational sac from the uterine wall lead to spotting. This occurs against the background of pathological uterine inertness (e.g., due to chronic endometritis).
- Septic abortion: infection of the uterine contents (often a consequence of illegal intervention) manifests as purulent discharge, chills, fever, and uterine tenderness upon palpation.
Deontology in history-taking
Discussing the nature of discharge requires the physician to adhere to the principles of deontology. Modern medicine implies a transition from a paternalistic model to a partnership model. The physician must conduct a dialogue, listen attentively to the patient, answer questions truthfully, and strictly maintain medical confidentiality. The patient takes an active part in choosing treatment, and any manipulations are performed only after obtaining written consent.
To systematize the examination for complaints of leukorrhea, use the "CCCD" rule: Color, Count (amount), Consistency, Door (odor) — four basic parameters that the physician must record in the medical history.
Class and exam questions
Does leukorrhea always indicate a disease of the genital organs?
No, pathological discharge can be a symptom not only of reproductive system damage, but also of pathological processes located outside of it (extragenital diseases).
What discharge is considered a specific sign of invasive cervical cancer?
This stage is characterized by contact bleeding, which appears upon mechanical impact on tissues (e.g., during an examination).
Why does spotting occur during a missed miscarriage?
They occur due to the initiated detachment of the deceased gestational sac from the uterine walls against the background of the absence of an adequate rejection reaction.
How do menorrhagia and metrorrhagia differ?
Menorrhagia is bleeding clearly associated with the menstrual cycle (occurs cyclically), whereas metrorrhagia is acyclic uterine bleeding independent of the cycle phase.
What else to study on this topic
- Classification of amenorrhea and hypomenstrual syndrome
- Colposcopic picture in suspected squamous cell carcinoma
- Ultrasound diagnostics of missed miscarriage (anembryony)
- Criminal abortion: methods, risks, and septic complications
- Algodismenorrhea: etiology of painful menstruation
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