When vaginal discharge becomes problematic, one must not focus solely on surface symptoms. Understand that the underlying causes of abnormal discharge are complex and intertwined. It is highly likely that gynecological inflammation is silently causing trouble, revealing itself through abnormal discharge. Therefore, to accurately identify the true cause of abnormal discharge or even gynecological inflammation, a gynecological examination is essential. Below, we will explain the methods for examining abnormal vaginal discharge.
I. Physical Examination
The physical examination proceeds from external to internal structures. First, visual inspection assesses the vulva, urethra, paraurethral glands, and Bartholin's glands. Subsequently, a speculum is used to observe the vaginal walls and cervix. This aids in detecting vaginitis and cervicitis.
II. Laboratory Tests
1. Vaginal pH Measurement: Normal pH is approximately 4.5.The vagina maintains a weakly acidic environment, which supports its self-cleansing function and prevents pathogenic bacteria from proliferating. In cases of trichomoniasis or bacterial vaginosis, the pH rises and may exceed 5–6.
2. Vaginal Cleanliness Grading: Grades I–II indicate a normal vaginal environment. Grades III–IV denote abnormal discharge, indicating vaginal inflammation.
3. Microbial Culture: After processing, vaginal discharge is examined under a microscope for trichomonads or fungi. Positive results are denoted as "+", while negative results show "-". This symbol indicates infection but does not indicate severity.
4. Amine Test: Place a drop of 100% KOH solution on a slide and mix with the discharge. Bacterial vaginosis discharge emits a fishy odor, while normal discharge and candidal discharge lack this amine smell.
5. Clue cells: Numerous bacteria cluster around vaginal epithelial cells, blurring their edges. These are clue cells, the most sensitive and specific sign of bacterial vaginosis.
III. Ultrasound Examination
Ultrasound examines vital reproductive organs—uterus, cervix, adnexa, ovaries—for abnormalities, aiding diagnosis of cervicitis, adnexitis, endometritis, and uterine fibroids.