Some amount of vaginal discharge will always occur from about 2 years before puberty to the time of menopause. The discharge is composed of secretions of the cervical glands, the vaginal lining cells and secretions of Bartholin Glands. The amount of vaginal discharge will change from time to time depending on the body’s level of estrogen.

How much discharge is normal?

The definition of normal will change from woman to woman. But if it involves using panty shields and change of underwear many times a day it probably is more than normal. The week before periods, use of oral contraceptive and being pregnant are all typically associated with increased vaginal discharge.

What are the characteristics of a normal discharge?

The normal discharge is not itchy nor is it foul smelling. A normal discharge is usually clear, creamy or slightly yellow.

When should the doctor be called?

The doctors should be visited when the characteristics of the discharge changes.

•             When there is a sudden increase in the volume of the discharge.

•             When the discharge changes color from the normal yellow-whitish to brownish or greenish.

•             When it becomes foul smelling.

The above symptoms of an abnormal discharge may be associated with signs of itching and burning.

What will the doctor do?

The doctor will take a swab from the vagina and see it under the microscope. The result would guide him to do further investigation or give treatment.

If a person suspects that she is suffering from a sexually transmitted disease she should contact her doctor immediately.

Absent periods

Most girls start their periods and show bodily changes of sexual development by the age of 10 to 16 years. But some do not. This defect is given the name of primary amenorrhea. It causes a serious concern in the minds of the young teenager and her parents.

The Causes

Many conditions can lead to primary amenorrhea. Some girls are born with an imperforate hymen. This means that the thin membrane that partially covers the vaginal opening has no opening in it. When menstruation occurs, the blood becomes dammed up in the vagina behind the hymen, and is not allowed to escape, due to the mechanical barrier.

On other less common occasions, some girls are born with a congenital absence of the vagina or their cervix has a deficient outlet. These defects lead to almost similar situation as an imperforate hymen.

But other than these birth defects, which lead to hidden menstruation, many situations can lead to a true absence of menses. Such situations include absent or grossly deficient uterus, intersexualism (ambiguous genitalia), poorly functioning pituitary or thyroid, and chromosomal abnormalities. In place of the usual two XX female chromosomes, a woman may have only one! This causes poor or deficient secondary sexual development. All of these situations require the attention of the doctor.

What To Do?

Primary amenorrhea is not amenable to self-treatment. If a woman doesn’t start her periods by the age of 17, she should visit a doctor. A gynecologist is best trained to handle such matters. She or he would take a complete clinical history, make full examination and as per the need investigate further.

Investigations and Diagnosis

A thorough general examination can sometimes lead to the diagnosis itself. Absence of secondary sexual characteristics suggests a major defect. Pelvic examination would blow the lid on conditions that lead to cryptic menses. If hormonal disorders are suspected, then the appropriate hormonal tests are carried out. Ultrasound tells all about the internal state of the reproductive organs. And whenever a genetic abnormality is suspected, that too can be tested out with the help of chromosomal analyses. The more specialized tests such as chromosomal tests are only available at more advanced medical diagnostic centers.

Treatment

The line of treatment depends on the cause. In an imperforate hymen, the simple expedient of making an incision will be followed by the escape of the dammed-up blood, and menstruation may proceed normally after this.

Plastic surgery can assist those women whose vagina is absent. Many novel ways have been found to carry out the vaginal reconstruction.

If ovaries are deficient or a chromosomal abnormality exists, hormonal therapy can be most useful. It can assist in the development of bodily changes that occur with sexual maturation in a woman. The correction, however, does not restore fertility, nor does it correct the basic defect.