Vaginal Symptoms: Causes & Management (Carol Totterdell Professional Development Nurse)

Vaginal Symptoms: Causes &
(Carol Totterdell Professional Development Nurse)
Aims and objectives:
To have a basic understanding of
signs and symptoms of STIs
Have an awareness of vaginal
symptoms and genital conditions
in women
Have an understanding of own
scope of practice and when to
Genital tract symptoms
Unusual vaginal discharge
Bleeding between periods &/or after sex
Pain when passing urine
Lower abdominal pain
Discharge from the penis (in men)
Burning and itching in the genital area
Pain when passing urine
Genital lumps, spots, sores
Rashes and swellings
Age groups of women
• Reproductive age – some degree of vaginal
discharge is normal and healthy
– Important to differentiate between
normal/abnormal (changes, odour, onset,
duration, colour, consistency)
(NB Pregnant women may be at special risk
& should be referred)
• Pre pubertal
Discharge usually
not normal - refer
• Post menopausal
Common causes of vaginal
• Infective (non sexually transmitted)
Bacterial vaginosis
• Infective (sexually transmitted)
• Non infective
Foreign bodies (retained tampons)
Cervical polyps and ectopy
Genital tract malignancy
Dermatological conditions
Infective (non sexually transmitted)
Bacterial Vaginosis
• Commonest cause of vaginal discharge
in women of reproductive age
• Overgrowth of mixed anaerobic
organisms which replace normal
• Can occur and remit spontaneously
• Sexually associated rather than sexually
Infective (non sexually transmitted)
Vulvo-vaginal Candidiasis
Caused by an overgrowth of yeasts
Does not require treatment unless
Most common when vagina exposed to
oestrogen during reproductive years &
Can be precipitated by use of antibiotics
Immuno-compromised women and
those with diabetes more predisposed
What Are the Main Sexually
Transmitted Infections?
The commonest infection Chlamydia
Number 2 Genital Warts
Number 3 Gonorrhoea
Genital Herpes
Women with cervicitis due to Herpes may
occasionally present with vaginal discharge
• Primary stage - sores may
appear on the penis, vagina,
anus or mouth.
• 2ndary stage - All over skin
rash, flu like symptoms,
lethargy, anorexia
• Tertiary Stage - Large Ulcers
Heart Failure
Encephalitis, loss of mental
faculties. Deterioration of
central nervous system
leading to paralysis and
Trichomonas Vaginalis
Can cause vaginal discharge and urethral
irritation. Much rarer than BV or VVC
Pubic lice
BV may be more prevalent and persistent in
HIV positive women.
TV may increase transmission of the HIV virus
Possible Complications from
STI Infection
Pelvic Inflammatory Disease (PID) in women
Ectopic pregnancy
Prostatitis & Epididymo-orchitis in men
Infertility & chronic pain in both sexes
Reactive arthritis
Conditions involving other systems of the body – disseminated
gonococcal infection, secondary & tertiary syphilis
Some infections are easily treated but others are not curable, e.g.
Hepatitis, Herpes and HIV.
Even when treated some infections may have lifelong implications for
the individuals affected.
Things to consider • Vaginal discharge alone is a poor
predictor of an STI
• STIs often come in pairs/groups
• Many women with an STI are
asymptomatic – aprox 70% with
Chlamydia, 50% with Gonorrhoea
• Most common causes of altered vaginal
discharge are physiological, BV and
Candida but STIs and other causes
must be considered
The first symptoms of gynaecological
cancer may be alterations in the
menstrual cycle, intermenstrual
bleeding, post coital bleeding, post
menopausal bleeding or vaginal
discharge (NICE 2005)
Management of vaginal discharge
Full clinical assessment and history
Address underlying concerns/expectations
Assessment of sexual activity and risk factors
Assessment of symptoms & associated
Medication history/contraception
Clinical examination and investigation
Assessment of upper genital tract infection
Treatment of client and partners where
Advice – re-infection and self help measures
What can you offer in the
• Advise clients with genital symptoms to
seek medical advice – especially if
symptoms persist or do not improve
after OTC treatment
• Advise STI screening if they are
sexually active
• Keep up the good work with the
CASPHER screens!
• Advice and support
Tips For Your Bits!
• Regular changing of sanitary protection
– don’t wear panty liners all the time
• Avoid douching
• Avoid strongly perfumed toiletry
products and “feminine hygiene
products”. Use of emollients/soap
substitutes for washing
• Use non bio washing powders
• Wash pants at 60%C
• Don’t wash hair in the bath
• Shower in preference to bathing
• Faculty of Sexual & Reproductive
Healthcare Clinical Guidance:
Management of Vaginal Discharge in
Non-Genitourinary Medicine Settings
(2012) available at
• Mitchell H (2004) Vaginal discharge –
causes, diagnosis & treatment BMJ
2004; 328:1306