1. Clinical Assessment of the Vagina
Dr Helen Wemyss
Obstetrician and Gynaecologist

2. Wikipedia "vagina" Latin word meaning "a sheath or scabbard“
a scabbard into which one might slide and sheath a sword
( "sword" was the penis)

3. Definitions of Vagina Medical Definition
Muscular canal from the hymen (or remnants) to the cervix
Legal Definition
Begins at the vulva – between the labia

4. Clitoral Hood and Clitoris
Labia minora
Urethral opening
Vaginal Opening

5. Vaginal Functions Pathway for menstruation
Sexual and reproductive function
Old fashioned way to have a baby
Microbiota/ commensals

6. Microbiota
Dynamic ecosystem of mutually symbiotic flora of microorganisms
Undergoes change over life time
-neonate-puberty-menarche-menopause
-pH
-influenced by glycogen, oestrogen and lactobacilli
-acidic environment helps keep pathogenic bacteria at bay
And cyclical change- fluctuating hormones

7. Vaginal Microbiome
Maybe important for gut colonisation of the baby and prevention of childhood disease
eg asthma
Seeding from vaginal swab for babies born by elective LUSCS

8. Normal Vaginal Secretions
White, non-irritant, mucoid
Affected by
-life cycle – prepubertal, reproductive, post menopausal
-monthly cycle -pre or post ovulatory
- exogenous hormones – contraception
- pregnancy
-disruption of normal microbiome

9. Physiological Reproductive Secretions

10. Abnormal Vaginal Discharge
“Normal” is highly variable in volume
Discharge is a poor predictor of STI

11. Abnormal Vaginal Discharge 1
Creamy discharge
Vulvitis/vaginitis

12. Candidiasis
Creamy discharge
Vulvitis/vaginitis

13. Abnormal Vaginal Discharge 2
Offensive frothy discharge
+/- vulvitis/vaginitis

14. Trichomonas Offensive frothy discharge +/- vulvitis/vaginitis
Skin irritation
May well be asymptomatic
STI – co-exists with chlamydia
Strawberry cervix

15. Trichomonas Protozoa Treat with Metronidazole (Flagyl)
Treat sexual partner (s)

16. Abnormal Vaginal Discharge 3
Malodorous, grey, frothy discharge
No vulvitis or vaginitis

17. Bacterial vaginosis Malodorous, grey, frothy discharge
No vulvitis or vaginitis
Increase in anaerobic bacteria, loss of lactobacilli (increase in pH)
Gardnerella vaginalis
Treat with metronidazole

18. Normal Cervix

19. Cervicitis (Inflammation of Cervix)
Infective/STIs, Chlamydia, Gonorrhoea, HSV
Douching/irritants
HPV, warts
Retained tampon

22. Nabothian Follicle

23. Blood Stained Discharge
Benign conditions
-vaginal atrophy, uterine polyp, cervical polyp
-infection or inflammation

24. Vaginal Intraepithelial Neoplasia (VAIN)
Can be picked up on a cervical smear
If colposcopy of cervix is normal need to look elsewhere!

25. Vulval Warts

26. Vaginal Cancer

27. Thank You