A Profile of Vaginal Discharge

       A study of vaginal discharge was carried out in 2000 cases with limited facility and simple method in the private clinic. The age group included 16 to 45 years of age, incidence of trichomonal infection was found to be 21.55% and Monilial infection to be only 0.8%, There is a scope for further study of the Trichomonal infection in relation to other veneral diseases and abnormal cervical smear in Nepalese women,       Vaginal discharge consists of cervical discharge, exfoliated epithelium of the vagina, erythrocytes, a small number of leucocytes, nonpathogenic normal bacteria and yeast cells, The normal Ph of vagina is 4.3 to 5.2 Doderlein bacilli convert the glycogen in the epithelial cells to lactic acid maintaining a nomal level of acidity in the reproductive age dut to the presence of oestrogen, In the case of altered Ph due to glycogen imbalance, some normal inhabitants of the vagina become pathogenic organisms. Pinworms vaginal cosmetics, tight nylon underwears or foreign bodies may alter the normal physiology of the vagina. Drugs including "Pill", and douching also alter it. Poor hygiene the use of detergents and soap and    operative procedures such as 'repair' conisation and cauterisation of the cervix also lead to a change of the Ph of the vagina.       Vaginal discharge can be physiological or pathological. It may be classified as purulent or nonpurulent. Nonpurulent may be copious due to hormones or candidiasis which is thin whitish and does not contain excexssive pus. Purulent discharge may be due to Trichomonal or pyogenic infections which are pathological.       Physiologically, the excessive vaginal discharge may occur during the premenstrual period, during ovulation due to excessive cervical mucus, postcoitally and during pregnancy due to the hyperplasis and hypertrophy of vaginal epithelium. Pathological changes leading to vaginitis (inflammation of the vagina) may be caused by anything that causes a disturbance of the normal flora of the vaginal epithelium or the normal protective mechanism of the vagina. Vaginitis can be bacterial or viral, parasitic, allergic or due to mechanical irritation or functional (paychosomatic or psychosexual).       In Nepal, the woman who has complains relating to the private part prefers to consult a lady doctor in the private clinic.      In this article, the study of vaginal discharge is presented. The aim of the study is to observe the presentation and pattern of the problem with the limited facilities available. There is no facility for culture by use of Nickerson's medium in Nepal. A total of 2000 cases included in this study.      The patients present in in the private clinic mostly middle class and dwelt in the urban area (75%). The study group age ranged from 16 to 45 years of age. Eightyfour percent were married and staying with the husband, 9% were unmarried and the rest stayed separate from the husband though they were married. 75% of the women had 0-3 children, 15% had 4-6 children and the rest 10% had more than 6 children. The patients' husbands' professions were mostly service holders in the Government or private sectors. Some of them worked as businessmen and some were agriculturists & politicians.       A vaginal swab was taken from those patients who presented with two or more of the following complaints or findings:1. Excessive vaginal discharge disturbing to the patient.2. Itching vulva or irritation in the vulva or vagina.3. Burning micturition or a burning sensation after voiding.4. Heaviness of the lower abdomen and backache.5. Difficulty during or burning after intercourse.6. Clinically suspected infection of foul smelling during speculum examination (patient not aware of it).