1. Test Slide
Douglas Ong

2. NON-medicinal factors that affect cervical mucus douglas ong

3. Common causes of vaginal discharge
“Discharge” from other sources
“Normal” discharge
“Abnormal” discharge

4. “Discharge” from other sources
Urine
( incontinence )
If this is affecting charting refer for treatment

5. Cervical Mucus And Its Functions
Fertility
Cleansing & vaginal health
Ageing
Vaginal infection (vaginitis)
Foreign body
Abnormal growth
Benign (non-cancerous)
Cancerous
Medical illness eg anemia

6. Ageing effect on cervical mucus
In young women around puberty S crypts are very numerous As the woman ages, they are replaced by L crypts, At premenopause the number of S crypts is considerably reduced This transformation of L - S crypts is a normal process
S (-sperm-transmission) mucus and L (- locking-in) mucus

7. Cervical Mucus And Its Functions
Fertility
Cleansing & vaginal health
Ageing
Vaginal infection (vaginitis)
Foreign body
Abnormal growth
Benign (non-cancerous)
Cancerous
Medical illness eg anemia

8. Features of Vaginitis Vaginal infection = Vaginitis Characterised by:
Excessive
“abnormal”
discharge
Odour
Irritation
Itching
pH changes

9. “Abnormal” discharge – Simple vaginitis or STD?`
Is it associated with symptoms of:
urine infection – painful urination, urgency
abdominal pain
fever?
More likely to be STD

10. “Abnormal” discharge – Simple vaginitis or STD?
Is it associated only with:
itch and/or
vaginal odour?
More likely to be a simple vaginal infection

11. Discharge due to STD Important to make the diagnosis
Complications of STDs –
Severe pelvic infection
Infection of other distant organs – liver, brain, blood poisoning
Tubal damage and infertility
Chronic pelvic pain

12. Pelvic Inflammatory Disease

13. Long term complications of Pelvic Inflammatory Disease

14. Discharge due to simple vaginal infection
Vaginitis
Candida (Yeast, Thrush, Fungus)
Trichomonas (Trich)
Bacterial vaginosis (BV)

15. Simple vaginal infections - Yeast
Causative in up to 95% of cases of simple vaginal infection 75% of women will experience at least 1 yeast infection in their lifetime % recurrence May be found in % of women without any symptoms

16. Simple vaginal infections - Yeast
Predisposing causes:
Broad spectrum antibiotics
Steroid medication
Poor immunity
Diabetes mellitus
Pregnancy

17. Simple vaginal infections - Yeast
“Milk curd” or “cottage cheese”discharge
Vaginal / vulvar itch
pH <= 4.5

18. Simple vaginal infections - Trichomonas
Protozoan (parasite)
Diagnosis:
Frothy vaginal discharge, “strawberry cervix”
Vulval irritation
Vaginal odour
pH > 4.5
Microscopy

19. Simple vaginal infections – BV (Bacterial vaginosis)
Most common cause of vaginitis among women of childbearing age
Reflects a change in balance in vaginal ecosystem

20. Simple vaginal infections - BV
Vulvar irritation
Watery/clear vaginal discharge
Absence of normal vaginal lactobacilli
Clue cells
Multi-bacterial infection by:
Gardnerella, Mycoplasma & Mobiluncus

21. Simple vaginal infections - BV
Diagnosis:
Fishy odour
pH > 4.5

22. Cervical Mucus And Its Functions
Fertility
Cleansing & vaginal health
Ageing
Vaginal infection (vaginitis)
Foreign body
Abnormal growth
Benign (non-cancerous)
Cancerous
Medical illness eg anemia

23. Foreign Body Causing Change in Vaginal Mucus
IUCD
Retains bacteria
Local irritant
Frequent non-specific
vaginal discharge

24. Abnormal Growths Causing Change in Vaginal Mucus
Benign
Polyp
Malignant
Cancer

25. Abnormal Growths Causing Change in Vaginal Mucus
Symptoms
Increased vaginal mucus
Bleeding between periods
Bleeding after intercourse
Prolonged menstrual staining

26. Chronic Illness Causing Change in Vaginal Mucus
Anemia
“Anaemias are usually accompanied by an increased amount of L and S mucus. After treatment, these symptoms cease”

27. Cervical Mucus And Its Functions
Fertility
Cleansing & vaginal health
Ageing
Vaginal infection (vaginitis)
Foreign body
Abnormal growth
Benign (non-cancerous)
Cancerous
Medical illness eg anemia

28. Thank You Everyone 31