VAGINAL BLEEDING, VAGINAL DISCHARGE

Non-menstrual bleeding should always be investigated. Women may present with:

• Post-coital bleeding (PCB)
• Intermenstrual bleeding (IMB)
• Postmenopausal bleeding (PMB).

Vaginal bleeding may be a sign of:

• Ectopic pregnancy
• Gynaecological malignancy
• Miscarriage.

VAGINAL DISCHARGE

Normal physiological vaginal discharge changes with the menstrual cycle. It is thick and sticky for most of the cycle, but becomes clearer and wetter around ovulation.

Abnormal vaginal discharge is characterised by a change of colour, consistency, volume or odour, and may be associated with symptoms such as itch, soreness, dysuria, pelvic pain or intermenstrual or post-coital bleeding. Most commonly caused by infection e.g.

• Vaginal candidiasis
• Bacterial vaginosis
• Trichomoniasis
• Cervicitis, usually caused by chlamydia
• Pelvic inflammatory disease (PID), usually caused by chlamydia

Non-infective causes include retained foreign body, inflammation due to allergy or irritation, tumours, atrophic vaginitis, cervical ectopy or polyps. Refer women with suspected PID (same day) or suspected trichomoniasis for genitourinary medicine clinic investigation. Arrange urgent admission for women with PID who are pregnant, pyrexial and unwell or unable to take oral fluids or medication.