Vaginal discharge is one of the most common vaginal symptoms and can be examined using clinical microscopes. Gynecological conditions that range from vaginal Candidiasis to Chlamydia cervicitis to Bacterial vaginosis to cervical carcinoma may cause vaginal discharge. Vaginal lesions may occasionally be palpable to a woman. More commonly vaginal lesions are discovered on examination using clinical microscopes. They may contribute to symptoms (bleeding or discharge) or they may be entirely asymptomatic. Vaginitis, cervicitis, and vaginal or cervical lesions (including malignancies) can be causes of vaginal discharge. Other noninfectious causes of discharge are as follows:

1.    Retained foreign body - tampon, pessary
2.    Ulcerations-tampon-induced, lichen planus
3.    Malignancy-cervical, vaginal
4.    Postmenopausal atrophic vaginitis, postradiation vulvovaginitis

Sexual abuse should always be considered in prepubertal children with vaginal discharge. A vaginal culture for gonorrhea and chlamydia should be performed using clinical microscopes. Multiple organisms that are present in the perineal area though a single organism such as streptococcus or Shigella, that are distinct when examined under clinical microscopes, may be causative and usually causes Vulvaginitis. Treatment should be initiated with a focus on hygienic and cleansing measures. A short-term (weeks) course of topical estrogens and broad-spectrum antibiotics may be necessary. Culture should also be performed using clinical microscopes if simple hygienic measures are ineffective in resolving vaginal symptoms. This type of problem can be recurrent.

Vaginal irrigation is a technique for obtaining vaginal cultures for examination under clinical microscopes and for performing vaginal irrigation.  A “catheter within a catheter” can made by using the• tubing from an intravenous “butterfly” setup within a sterile urethral catheter. Nonbacteriostatic saline (1 cc) can be injected; aspirated, and sent for culture and pathology using a medical microscope. Cultures taken in this manner almost always better tolerated than cultures obtained using a cotton-tipped applicator. A larger quantity of saline can then be used to irrigate vagina while the catheter is still within the vagina. Small foreign bodies can often flushed from the vagina in this manner.

Adolescence and Older

Vaginal tampons have been associated with both microscopic and macroscopic ulcerations. Healing of the macroscopic ulcerations occurs within several weeks without specific therapy if tampon use is suspended. A follow-up examination to demonstrate healing is appropriate, with biopsy, using clinical microscopes, of any persistent ulcerations to rule out other lesions.

Toxic shock syndrome has been associated with tampon use and vaginal Staphylococcus aureus-produced exotoxins. Toxic shock syndrome consists of fever, hypotension, and diffuse erythroderma with desquamation of the palms and soles, plus involvement of at Ieast three major organ systems. Vaginal involvement includes mucous membrane inflammation.

Some vaginal lesions are asymptomatic and are noted incidentally on examination. Fibroepithelial polyps consist of polypoid folds of connective tissue, capillaries, and stroma covered by vaginal epithelium. Although they can be excised easily in the office, their vascularity can be troublesome, and excision is not necessary unless the diagnosis is in question. Cysts of embryonic origin can arise from mesonephric, paramesonephric, and urogenital sinus epithelium. Gartner’s duct cysts are of mesonephric origin and are usually present on the lateral vaginal wall. They rarely cause symptoms and, therefore, do not re¬quire treatment. Other embryonic cysts can arise anterior to the vagina and beneath the bladder. Cysts that arise from the urogenital sinus epithelium are located in the area of the vulvar vestibule. Vaginal adenosis, the presence of epithelial-lined glands within the vagina, has been associated with in utero exposure to diethylstilbestrol. No therapy is nec¬essary, other than close observation and periodic palpation to detect nodules that may need to be biopsied using clinical microscopes to rule out vaginal clear cell adenocarcinoma.

Women will sometimes describe a bulging lesion of the vagina and vulvar area, variably associated with symptoms of pressure or discomfort. The most common cause of such a le¬sion is one of the disorders of vaginal support: cystocele, rectocele, or urethrocele. Other genital lesions, such as ure¬thral diverticulitis or occasionally embryonic cysts, may present with similar symptoms.