The Flow, Discharge or Vaginal Leucorrhoea are synonymous with the same event: production, loss or secretion of fluid by external female genitalia. The correct medical term is Vaginal Leucorrhoea. In pregnancy the term “loss of fluid by external genitalia” is reserved for the rupture of the amniotic membrane (Water Bag) but is a frequent reason for consultation; Fortunately, in the vast majority of cases, this loss is caused by vaginal secretions and not by loss of amniotic fluid.

During pregnancy the flow can be modified by hormonal effect and usually the amount is greater when compared to the non-pregnant woman. This is considered a protective effect that prevents the bacterial ascent towards the growing fetus; in fact, that mucus that continually moistens the genitals is the replacement of the cervical mucus that constitutes the mucous plug of the cervix.

The abundant vaginal discharge does not necessarily represent a pathological situation (most women speak of “flow” when their secretion is abnormal) and most of the time is a normal condition of the vagina since it is an organ that due to its physiological characteristics It must remain moist constantly and in spite of its humidity it must maintain certain conditions that prevent the appearance of abnormal infections. Humidity and normal pregnant genital (increased) flow is called Hydrohrrea Gravidarum.

Pregnancy is a risk factor for vaginal fungal infections, genital moniliasis (Candida). Likewise, the other common causes of pathological vaginal discharge that are present in non-pregnant women can be present: Bacterial Vaginosis and Trichomoniasis .

Physiology of vaginal secretions

The vaginal secretions come mainly from the cervix (approximately 80-90%) and to a lesser extent from the paraurethral glands of Skene and the vulvovestibular Glands of Bartholin , the vagina does not have glands but is moistened by filtering fluid from its deeper layers, this explains why the vagina remains moist after surgically removing the cervix and the Bartholin glands. The vagina gets wet when you wake up in the morning, with sexual stimulation and during intercourse.

The vaginal discharge contains water, mucus, fat (from the sebaceous glands of the vulvovaginal vestibule), cervicovaginal cells, white blood cells, antibodies and bacteria (Lactobacillus acidophilus) in harmonious balance to preserve the integrity of the organ. This explains why using Vaginal Shower is harmful to the vagina. During douching, douching is absolutely forbidden!

Color: it is variable depending on the phase of the menstrual cycle, use of oral contraceptives or other hormones, medication, sexual activity, type of intimate garment, etc. but in general lines it should be between transparent and homogeneous pearly white (like skimmed milk). The intense yellow or green color is not normal and logically, neither is the color red. The latter may suggest serious conditions (threatened abortion, placenta previa, premature birth, etc.) that should be immediately evaluated.

Consistency: variable, very fluid and delicate (as occurs during ovulation) to thick and sticky (postovulatory phase, use of mini pill and pregnancy). During pregnancy the cervical mucus is thick and adherent with a pearly appearance, is difficult to manipulate and has the tendency to return to its initial position when pulled: this is the famous Mucous Stopper of pregnancy, the most important structure in prevention of fetal infections from the vagina.

Odor: it is “sui generis“, that is, what is supposed to smell something specific. Urine, for example, smells like urine and smells like that. The vaginal discharge has its own smell that is described as “raw meat” or a slight axillary (urder arm) scent. The smell is exacerbated during sexual stimulation by the secretion of their glands. There do not seem to be racial differences in the female genital odor, although there must surely be differences due to diet, body weight, physical activity and the type and material of intimate clothing.

Quantity: there are women more humid than others, judging by the subjective report of some of them, but this is not scientifically demonstrable. The truth is that each woman knows herself and when they report an increased amount of vaginal discharge, it is possible that this symptom needs to be taken into account, especially if it has characteristics that suggest a vaginal infection. In the pregnant woman the amount of flow is noticeably greater and very often there is loss of a considerable amount when getting out of bed in the morning due to the nocturnal accumulation of the secretions, this is frequent reason for consultation since it can be confused with rupture of the Water Exchange.

Premature Membrane Break (RPM)

It is the rupture of the amniotic membranes before the onset of labor or worse, the rupture of the membranes when the baby is premature (Preterm Premature Rupture of Membranes, PPRM). It can be a severe complication if it occurs during prematurity (before 37 weeks) as it will invariably lead to premature birth with or without intra amniotic infection (infection of the fetus and its attachments). The fetal prognosis will depend on the gestational age of the fetus.

I include in this article the RPM since it is a frequent cause of call due to the confusion that a large amount of vaginal discharge can cause.

RPM almost always manifests with abrupt outflow of clear fluid from the external genitalia, at any time of the day, but is more frequent between 10 pm and 2 am; has a characteristic odor of semen or chlorine, increases in number with changes in maternal position and decreases with rest, abdominal volume may decrease and uterine contractions and decreased fetal movements may be associated

Whenever there are doubts about your vaginal discharge, you should notify your obstetrician immediately.