By Dr. Deyo Famuboni
From puberty to menopause, having some vaginal discharge is normal. The quantity can vary from person to person, and it also varies throughout the menstrual cycle. Following menstruation, discharge can be white, creamy or yellow, thick and sticky. After ovulation (when an egg is released), the discharge changes to slippery, more clear, stretchy and wet. Following this, if the egg isn’t fertilised, discharge becomes thick and sticky, and therefore hostile to sperm.
Discharge is considered abnormal if it occurs alongside other symptoms or if the colour and amount changes. For example, discharge may become chalky white if you have thrush, or frothy and a yellow or green colour if you have trichomoniasis, a sexually transmitted infection (STI). Hormonal contraceptives, or having a condition where the inner lining of the cervix protrudes outward (ectropion) can also change your discharge, and mean it becomes more copious.
Other causes of an increase in the amount of discharge include cervical polyps (a growth on the cervix which can be easily removed), a forgotten tampon, douching, an allergic reaction to a spermicide, and, rarely, a connection between the bladder or bowel and the vagina (a fistula).
A condition we worry about is cancer, and if this affects the vagina, the cervix, or the lining of the womb, it can also cause an increase and change in the type of discharge, such that it becomes thinner and blood stained. Should this happen, a review by a healthcare professional is warranted, and they would offer a vaginal examination to ensure it looks healthy, or refer you to a specialist if necessary.
What is the link between anxiety and discharge?
The feeling that discharge is excessive or abnormal is a common complaint, and the World Health Organisation (WHO) has recommended that this is seen as part of a syndrome, treated as reproductive tract infections. However, research has shown that the association between laboratory confirmed reproductive tract infections and vaginal discharge is weak.1
The combination of the factors that occur during stress can affect the immune system by increasing inflammation and dampening the response of cells that fight infection. This can lead to an increase in opportunistic infections within the vagina, such as thrush and bacterial vaginosis.
Exploring feelings of anxiety and/or depression as well as social stresses during the time of changes in vaginal discharge may show an association between both, as observed in a study which showed a strong association between psychosocial factors and vaginal discharge seen as a compliant.2 It is vital this is discussed when seeking medical opinion on treatment. There is a condition called Dhat syndrome, which is classified by the WHO as a culture bound syndrome affecting men complaining of semen loss within the urine, associated with psychological distress. One study has suggested that abnormal vaginal discharge with no other cause found could be a manifestation of Dhat in females.3
The effects of stress and anxiety on the immune system
One thing of note when considering abnormal vaginal discharge and anxiety is how the immune system is affected when put under stress. Everyone experiences stress and anxiety at one time or another, and while stress is a response to a threat in a situation, anxiety is a reaction to the stress.4
Anxiety is a feeling of unease, such as worry or fear, than can be mild or severe.5 It is a feature of other conditions including panic attacks, phobias, and generalised anxiety disorder which affects up to 5% of the UK population.6 Generalised anxiety disorder appears to be more common in women and in the age group of 35 to 59.7
Acute stress can prepare the body to fight off infections as it increases substances needed in acute inflammation so the body can eliminate pathogens, heal, and then resolve.8 Chronic stress, on the other hand, makes inflammation persist. The immune system becomes dysregulated, therefore, with an increase in stress hormones such as cortisol and inflammatory substances called cytokines.
Other factors that affect the immune response during stress include poor sleep, less exercise, and potential dietary changes. Even one night of total sleep deprivation was recently found to significantly increase neutrophil (a type of immune cell that is one of the first to travel to the site of infection) counts and decrease neutrophil function in healthy men.9
Anxiety is a feeling of unease, such as worry or fear, than can be mild or severe. It is a feature of other conditions including panic attacks, phobias, and generalised anxiety disorder which affects up to 5% of the UK population. Generalised anxiety disorder appears to be more common in women and in the age group of 35 to 59.
As cortisol, the ‘stress hormone’ is raised when you are stressed or anxious, this influences the amount of sugar in the blood which also has an effect on our immune system. On top of this, both laboratory and epidemiological studies suggest that depression and stressful events motivate less healthy food choices. Furthermore, there may be greater risk of eating more during stress if female, overweight, or scoring high on dietary restraint.10,11 This can lead to consuming foods high in sugar.
The combination of the factors that occur during stress can affect the immune system by increasing inflammation and dampening the response of cells that fight infection. This can lead to an increase in opportunistic infections within the vagina, such as thrush and bacterial vaginosis. Thrush can cause a chalky white vaginal discharge and is often associated with other features such as itching and sometimes redness or soreness in the area. Bacterial vaginosis, which is due to an overgrowth in the normal bacteria of the vagina, can have no symptoms, or sometimes causes a fishy smell with or without a thin, watery, white or grey discharge.
These can be treated with over the counter medications from a pharmacist, although addressing any underlying stress or anxiety may also help anecdotally.
The tests for vaginal infections performed when swabs are taken and sent to the laboratories tend to be accurate in picking up infections, to the extent that sometimes thrush shows up in tests where women have had no symptoms at all. Therefore, a change in one’s discharge should be discussed with a healthcare professional to ascertain if there are any other associated features to assist in finding out what has caused it.
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