Ques. 1 What is Leucorrhoea?
Ans. The term Leucorrhoea (Fluor alba of the white) is used to designate any discharge from the genital canal other than blood (urine of stool).
Ques. 2 Which are the varieties of Leucorrhoea?
Ans. Leucorrhoea may be distinguished both anatomically and clinically as –
- Cervical Leucorrhoea – is most frequent during the child-bearing period. It is thick tenacious and ropy, having the appearance of uncoiled white of an egg.
- Vulvar Leucorrhoea – occurs chiefly in children, but is also present in aged women, esp. associated with pruritus. In young children in whom sebaceous glands are not yet developed and in old women after glands have atrophied, discharge is serous or sero-purulent in character. At puberty and during child – bearing period the sero-purulent discharge becomes mixed with secretions of vulvo-vaginal and sebaceous glands, rendering it viscid and unctuous, having characteristic cheesy of fleshy odor.
- Uterine Leucorrhoea – occurs mostly during the child-bearing period and resembles cervical leucorrhoea, but is more watery and also less dense and gelatinous in character, and is more often thinned with blood, or yellowish in colour from the admixture of pus. Sometimes after menopause a uterine leucorrhoea occurs which consists purposes, yet no infrequently do we find more than one variety present in same patient, and it becomes necessary to examine discharges microscopically to ascertain their respective nature and proportions.
Note : A gradual increase in amount of vaginal discharge must be expected throughout pregnancy. Augmented estrogen production increases the secretion of cervical mucous. The milky colour is due to epithelial desquamation which accompanies hypertrophy and hyperplasia of vaginal and cervical surfaces.
- Vaginal Leucorrhoea – occurs most often in young women and consists of a white, creamy, purulent-looking fluid.
Ques. 3 What can be the causes of Leucorrhoea?
Ans. (A) Physiological –
- During ovulation.
- During pregnancy.
- During sexual excitement.
- Premenstrual period.
- New born (female bady) for a week.
- During puberty.
(B) Pathological :
(a) General –
- Dysfunction, e.g. endocrinal, disharmony, psychosomatic etc.
- Diabetes mellitus.
- Poor nutrition and ill health.
- Unhygienic condition.
(b) Pelvic factors (age-wise) :
- Middle aged – infection, erosion, fibroid, polyp, chronic pelvic inflammation, use of contraceptives may be the cause.
- Elderly–carcinoma of the genital tract, genital prolapsed, retained ring pessary, senile vaginitis, endometritis, myometra etc.
- Children- foreign body.
- Young- infection, i.e. vaginitis (trichomonas, monilial non-specific; cervicitis, Bartholinitis. Endometritis, Excessive sexual act, etc.
Ques. 4 What are the clinical features of Leucorrhoea?
Ans. CLINICAL FEATURES – Symptoms- The subjective symptoms are mostly those which result directly from existing causes rather than from the discharge itself, though instances undoubtedly arise where irritating and long-continued leucorrheal discharges give rise to symptoms which are same nature as those which result from any long-lasting discharge or debilitating influence. The most constant symptoms of leucorrhoea are a pain in back and loins, which is always worse from active exercise, such as walking. These symptoms are always more intense in uterine leucorrhoea, and are more apt to be associated with symptoms of an inflammatory character, than when resulting from the vaginal leucorrhoea. Uterine leucorrhoea is more related to menstrual functions, being usually aggravated immediately before and after flow. The excoriations liable to arise from an excessively acrid discharged are also symptomatic.
Ques. 5 How can we investigate a case of Leucorrhoea?
Ans. Investigation –
- Symptoms about the discharge –
- Dyspareunia etc.
- On examination –
- Abdominal – any tumour, fibroid.
- Vaginal – vulva, vagina, cervix for any tumour, inflammation, foreign body, colour, smell, amount of discharge etc.
- General – for any other systemic disease, nutrition, anaemia etc.
- History of –
- Any relation of discharge with the menstrual cycle.
- Age, marriage, marital life, parity and child-birth, trauma, local hygiene, coitus, masturbation, tuberculosis, diabetes mellitus, dysentery, anaemia etc.
Laboratory Investigations –
- Chest X-Ray for T.B.
- Blood – Hb, RBC count for anaemia, sugar for diabetes mellitus.
- Urine – Pus cells for urethritis, sugar for diabetes mellitus.
- Stool – Ova, parasites or cyst for any worm infection.
- D & C.
- Test of vaginal smear for any yeast of Trichomonal vaginalis.
- Swab test for bacterial culture.
PROGNOSIS – Leucorrhoea in pregnant, debilitated, or diabetic women is always difficult to cure, esp. when due to Candida albicans. Repeated or even continuous treatment for 3-4 months may be required until patient is delivered or the diabetes is controlled. Ultimate prognosis is good; however, if a specific diagnosis is made promptly and proper, extended, intensive therapy given.
Ques. 6 How can we manage a case of Leucorrhoea patient?
Ans. The constitutional or symptomatic treatment of leucorrhoea is of greatest importance, though local treatment in many cases should not be disregarded. Leucorrhoea is itself but a symptoms either of some constitutional dyscrasia. However, the following is the line of treatment-
- General – Anaemia is corrected, general health is improved by suitable diet, improve of local hygiene, outdoors exercise, bathing, regular habits, etc.
- Pelvic – According to tumour inflammation and foreign body –
- Foreign body – any forgotten pessary, or any loop giving the complication or any small thing in vagina of children is removed.
- Tumour – if fibroid Myomectomy or hysterectomy. If carcinoma of cervix hysterotomy (according to stage).
- Inflammation symptomatic treatment.
- For physiological leucorrhoea- needs no treatment only assurance.
- Treatment for specific cause.
Ques. 7 Which Homoeopathic Remedies are useful for this case?
Ans. Homoeopathic Remedies –
- BORAX – White albuminous leucorrhoea, with a sensation as if warm water were flowing down.
- CARB – Leucorrhoea like milk or like mucus; it may be discharged more whilst urinating; and there may be heat and inching of the vulva.
- CIMICIFUGA- Leucorrhoea, said to be esp. useful in endocervicitis when occurring in nervous, neuralgic or hysterical patients, irregular or painful menstruation, uterus and ovaries enlarged and sensitive.
- COCCUS CACTI – Leucorrhoea consisting of mucus, preceded by drawing and thrusting pains in inguinal, vesical, and pubic regious.
- IGNATIA- Violent, labor-kike pains, followed by a purulent corrosive leucorrhoea, smarting, burning after scratching purulent leucorrhoea, vaginitis, prolapsus of vagina, cases of vulvitis, smarting and excoriated spots, gonorrheal or syphilitics origin.
- PLUMBUM – Leucorrhoea with a continued sense of drawing in from the abdomen to the back.
- TEUCRIUM – Leucorrhoea from the irritation of thread worms.
- SULPHUR – Leucorrhoea smarting like salt. Leucorrhoea preceded by colic. Burning and painful leucorrhoea making the vulva sore.
- ALUMINA - When the leucorrhoea occurs either before or after the menses; it is acrid and profuse, > by cold washes. Transparent and mucous, running down to heels in large quantities.
- ARSENIC ALB – Leucorrhoea whilst standing and emitting flatulence; leucorrhoea thick and yellow, corroding the parts which are touched by it.
Ques. 8 Which Biochemic medicines are useful?
Ans. Biochemic Remedies –
- Natrum Mur – Leucorrhoea early in the morning, after colic; it may be transparent, white thick mucous. Greenish leucorrhoea, particularly when walking.
- Natrum Phos – Leucorrhoea, discharge creamy of honey coloured, or acrid and watery, discharges from the uterus sour smelling, acrid.
- Silicea – Leucorrhoea instead of the menses, preceded by colicky pains. Milky leucorrhoea in paroxysms preceded by cutting around the umbilicus.
- Calcarea Phos – Leucorrhoea, with discharge of albuminous mucous, looks like white of egg before it is cooked. Leucorrhoea after menses, when albuminous, weakness in sexual organs.
- Kali Mur – Leucorrhoea, discharge or milky-white, non- irritating mucous, mild, and profuse. Excellent in long-standing cases.
Ques. 9 What do you mean by Infantile Leucorrhoea?
Ans. It mean catarrhal inflammation of vulva occurring usually in strumous children.
The Causes of Infantile Leucorrhoea are:-
- Acrid urine; 2. Use of infected sponges: 3. worms; 4. Manual irritation; 5 unclean habits, etc. 6. Sudden check of perspiration ; 7. Exposure to cold;
Ques. 10 What are the symptoms of infantile Leucorrhoea?
Ans The symptoms of infantile Leucorrhoea are :-
Irritation of valve, resulting frequent desire to rub the part, slight pain may be present during passing urine; a thick or thin colorless creamy discharge. In some cases, it may be copious and corrosive and giving rise to ulceration of mucous membrane.
Ques. 11 What is the treatment of infantile Leucorrhoea?
Ans. The hygienic measure should be strictly followed. Diet should be good and easily digestible. Symptomatic treatment. Homoeopathic remedies are as mentioned in leucorrhoea.