Bloody leukorrhea, refers to leukorrhea mixed with blood, the amount of blood varies. It is commonly found in cervical cancer, cervical polyps, submucosal fibroids, senile vaginitis, benign or malignant tumors, cervical tuberculosis, cervicitis, endometritis, senile vaginitis, and bleeding with a ring.
Once bloody leukorrhea is found, especially after sexual intercourse mixed with blood, one should be alert to the possibility of malignant tumors in the genitalia.
The examination is performed sequentially from the outside to the inside. Firstly, the vulva, urethra, paraurethral glands and vestibular glands are examined visually, and secondly, the vaginal wall and cervix are observed through the vaginal speculum.
I. Visual examination of the vulva
See helps in the identification of vaginitis. Erythema and small collar fissures around the vulva and anus may be Candidiasis, and vulvar edema may be Trichomoniasis. In patients with trichomoniasis or cervicitis, the vulva is often contaminated with large amounts of purulent vaginal drainage, whereas in bacterial vaginosis, only accumulated vaginal drainage is seen at the vaginal opening.
Appearance of vaginal discharge
Various pathologic vaginal discharges have different specific traits that may provide diagnostic clues.
1.Physiological leucorrhea
It is homogeneous, flocculent, highly potent and accumulates in the low hanging part of the vagina.
2.Bacterial vaginal clear
The leucorrhoea is gray, homogeneous, low in bulge, and often evenly adheres to the surface of the membrane of the anterior or lateral walls of the vagina, which can be easily swabbed away.
3.Trichomonas vaginalis
The leucorrhoea is yellow or even yellow-green, obviously purulent and often foamy. The leucorrhoea is white, highly thick, cheese-like or bean curd-like, attached to the vaginal wall, sometimes resembling white goose sore-like patches, or it may be very little or similar to normal leucorrhoea, but the vaginal wall is white-spotted.
Cervical discharge
The cervical discharge is clear and liquid-like before ovulation and becomes thicker during the luteal phase.
1. Cervicitis
At any stage of the menstrual cycle, the presence of purulent cervical discharge should be considered as a possibility of cervicitis, which can be diagnosed by swabbing the vaginal discharge outside the cervical opening and observing the purulent discharge in the lining of the cervical canal. In this case, the columnar epithelium of the endocervical canal is erythematous and the brittleness increases, and swabbing with cotton often causes bleeding.
2. Chlamydia cervicitis
In chlamydial cervicitis, the columnar epithelium is often hypertrophic and protrudes into the squamous epithelial plane.
3. Malarial viral cervicitis
Ulcerative or necrotic lesions are often present in the columnar epithelium.
4. Gonorrhea cervicitis
The cervical canal appears as a yellow, thick, or fluid plug that overflows into the vagina and causes vaginitis, and there is often purulent overflow from the squeezed urethra, paraurethral glands, or vestibular glands.