Leucorrhea and Vaginitis

Leucorrhea is a whitish-yellow creamy discharge that can be a symptom of non-specific vaginitis (inflammation of the vagina), trichomoniasis, yeast infections, gardnerella, gonorrhea, or chlamydia. Not all whitish or creamy discharges are indicative of a problem however, and the ‘egg-white’ secretions that occur during the ovulatory phase are an indication of fertility. Changes that occur to the normal secretions of the vagina, including the consistency, colour and odour, may indicate uterine irritation, inflammation, or infection.

Vaginitis refers to a non-specific irritation and inflammation of the vagina with burning and irritation, sometimes with discharge, in which no specific pathogenic agent can be identified. The underlying mechanism is often a deficiency of the bacteria that act upon the vaginal secretions to make the vagina slightly acidic. The intensity of the vaginal secretions typically reach their height during ovulation, but gradually decrease during the luteal phase and during menopause. Thus, the susceptibility to vaginitis increases late in the luteal phase just before menstruation, and also during menopause when vaginal secretions naturally diminish. Other factors however can negatively affect the pH of the vagina, including antibiotics, diabetes, pregnancy, frequent douching, and a diet high in refined carbohydrates. Factors that promote the irritation of the vagina include sensitivities or allergies to sexual lubricants, topical contraceptives and scented hygiene products, as well as frequent or unlubricated sexual intercourse. Hygiene is an important issue, Synthetic fibers, tight clothing around vagina and sitting for long periods on vinyl seats (as in a long car trip) all can facilitate the growth of micro-organisms such as Candida, leading to yeast infections and vaginitis. Poor toilet habits (i.e. wiping back to front after a BM) can also lead to vaginal infection.

Trichomoniasis

Trichomoniasis is caused by Trichomonas vaginalis is a protozoa found in roughly 65% of women, and is responsible for up to 30% of all cases of vaginitis. Characteristic symptoms include itching, burning and a thin pale yellow to greenish malodorous discharge. With acute inflammation there may be “strawberry” colored spots in the mucosa. Symptoms often appear after menses. As many women are asymptomatic carriers for this protozoa, the manifestation of symptoms are often related to other causes, such as a secondary vaginal infection, emotional stress, and lowered resistance and immunity. Sexual partners may also be affected and thus treatment should be to both the woman and her partner to avoid a cycle of reinfection. (Berkow 1992, 1786-88)

Vaginal candidiasis

Vaginal candidiasis, or a yeast infection, is an overgrowth of the fungus Candida albicans, a naturally occurring microbe in the vagina. The infection may be localized in the vagina, but is commonly a reflection of a systemic yeast infection. Both within the vagina and in the gut Candida is kept in check by the Lactobacillus bacteria, and in the vagina specifically by the relatively low pH. The symptoms of a yeast infection can range from mild chronic irritation to a thick white (cottage cheese) discharge with a strong smell, with intense itching, inflammation, and burning upon urination. Candidal infection is more common among women who have diabetes, who use IUDs, who have recently used an antibiotic (e.g. tetracycline for acne), who use corticosteroids regularly, or who are immunodeficient. (Berkow 1992, 1786-88)

Gardnerella

Gardnerella is caused by the Gardnerella vaginalis is a gram-negative bacterium and a frequent cause of vaginal infection. Although it is classified as a sexually transmitted disease, it is a normal constituent of the vaginal flora, and its manifestation is linked with recurrent vaginal irritation, alterations in vaginal pH, emotional stress, and lowered resistance and immunity. The primary symptom of gardnerella is a thin, greyish discharge with a ‘fishy’ odour. (Berkow 1992, 1786-88)

Chlamydia

Chlamydia is caused by the bacteria of the genus Chlamydia, a unique bacteria that acts like virus in that it invades a host cell in order to reproduce. Chlamydia trachomatis is found in humans, and lives in the conjunctiva of the eye, and in the urethra and cervix. In poor countries such as Nepal, chlamydia is the primary cause of blindness. Chlamydia is thought to affect up to half of all sexually active women, although as many as 60% of these women are not bothered by symptoms. As a result, chlamydia often goes untreated and can result in a low grade chronic inflammation that negatively affects fertility. When symptoms do manifest they may include a yellowish or greenish discharge from the cervix, bleeding of the cervix from a Pap smear, irregular vaginal bleeding, lower abdominal pain, and pain upon urination. It is difficult to diagnose chlamydia as it is hard to culture it from vaginal swabs and urine samples, and as a result there is probably a high false negative rate in diagnosis. Women who are at risk for chlamydia are under the age of 24, have multiple sexual partners, and are not using barrier methods of contraception (i.e. condoms). The use of oral contraceptives enhances the likelihood chlamydia infection, as do many surgical procedures that artificially dilate the uterus such as a fitting for an intrauterine devices (IUDs), abortion, dilatation and curettage (D&C), and fetal monitoring. (Berkow 1992, 1786-88)

The treatment of vaginitis and leucorrhea, whether non-specific or caused by a specific agent, is essentially the same, although certain aspects of the treatment are modified in each condition. A watery discharge with blood may indicate malignancy and thus it is important that the patient should have a medical diagnosis to rule out cancer.

Topical remedies are an important aspect in the treatment of vaginitis and leucorrhea, and include creams, salves, and douching. Creams, salves and fresh plant juices (succus) are easily customized to relieve individual symptoms. Using a base such as a hypoallergenic Calendula flower (Calendula officinalis) cream, Calendula salve or Calendulasuccus, add to it the tinctures of herbs that have an antimicrobial, antiinflammatory, astringent, and trophorestorative property. Useful antimicrobials include Echinacea root (Echinacea angustifolia), Goldenseal root (Hydrastis canadensis), Myrrh (Commiphora mukul), Western Red Cedar (Thuja plicata), and Wild Indigo (Baptisia tinctoria). Antiinflammatory herbs include Curcuma longa and soothing mucilaginous herbs such as Plantain (Plantago lanceolata) and Comfrey root (Symphytum officinalis). The use of astringent herbs is helpful to enhance tissue repair and includes White Oak bark (Quercus alba), Witch Hazel bark (Hamamelis virginiana), and Bayberry bark (Myrica cerifera). Essential oils too may be included in the cream, such as Lavender, Tea tree, Cajeput, Rosemary, Juniper and Geranium, to enhance tissue repair and antimicrobial activity. Using such an approach, we might construct a cream as such:

Quercus alba / White Oak bark 5 mL
Hydrastis canadensis / Goldenseal 5 mL
Echinacea angustifolia / Purple Coneflower 5 mL
Plantago lanceolata / Plantain 5 mL
Total: 20 mL in 60 g cream/lotion base (i.e. 30% v/v), add Lavender E.O. 10 gtt.

Such a cream should be applied twice daily, covering the entire vulva and just inside the vagina. Ideally, the application of the cream should be preceded with a herbal sitz bath. A sitz bath is a procedure by which the entire pelvic region is immersed in a specially prepared solution, best implemented by using a shallow tub, placed in the bathtub. The sitz can be prepared with similar herbs, using them as an infusion, or as a diluted tincture, 15 mL of the tincture formula per 250 mL of water. Infusions and decoctions are an obvious choice for sitz baths, including a decoction of Pau D’arco (Tabebiua spp.), which has potent antifungal properties. An apple cider vinegar sitz bath has also been stated to be helpful in Candida infection (1 cup per gallon of water), as is the topical application and douching with live, natural yoghurt.

Apart from external therapies, herbs that enhance immunity, have an antimicrobial activity, provide analgesic and antispasmodic activity, and are trophorestorative to the genitourinary tract are important. In the treatment of Candida is often wise to include antifungals as well. Important immunomodulants include Ashvagandha (Withania somnifera), Codonopsis (Codonopsis pillosa), He Shou Wu (Polygonatum multiflorum), Astragalus root (Astragalus membranaceus), and Reishi mushroom (Ganoderma lucidum). Herbs that have a general antimicrobial activity include Echinacea (Echinacea angustifolia), Goldenthread root (Coptis spp.), Myrrh (Commiphora mukul), Neem (Azadirachta indica),Isatis (Isatis tinctoria), Manjishta (Rubia cordifolia), Sandalwood (Santalum album), Japanese Honeysuckle (Lonicera japonica) and Goldenseal root (Hydrastis canadensis). Botanicals that have a specific antimicrobial activity in the genitourinary tract however, include Cubeb (Piper cubeba), Gokshura (Tribulus terrestris), Pipsissewa (Chimaphila umbellata), and Bearberry (Arctostaphylos uva-ursi). Useful analgesic and anodynes include Kava (Piper methysticum) and Pasqueflower (Anenome occidentalis), with the rather toxic but effective Henbane (Hyocyamus niger) used when nothing else works. Important trophorestoratives in the genitourinary tract include fresh Corn Silk (Zea mays), Couch Grass (Agropyron repens), and Marshmallow root (Althaea officinalis). Antifungals to include in a general anticandida regimen are Echinacea (Echinacea angustifolia), Garlic (Allium sativum), Pau D’Arco (Tabebuia spp.), Chaparral (Larrea tridentata), Sweet Annie (Artemisia annua), Reishi mushroom (Ganoderma lucidum), Barberry (Berberis vulgaris), and Myrrh (Commiphora mukul).

Dietary consideration are important in vaginitis and leucorrhea, with the reduction of refined carbohydrates and the emphasis of proteins to acidify the urine and vaginal secretions. Food rich in the Lactobacillus bacteria should be consumed frequently, such as live yoghurt, kefir, and unpasteurized sauerkraut. Useful supplements include vitamin C to bowel tolerance, vitamin B complex (50-200 mg daily), vitamin A (10,000-25,000) IU daily for a maximum of a month), vitamin E (400 IU daily), and zinc citrate (50 mg daily). In cases of Candida a course of Lactobacillus and Bifido bacteria is helpful to re-establish a healthy gut flora, as is the regular consumption of herbs rich in fructo-oligosaccharides such as Slippery Elm (Ulmus fulva) that are exclusively fermented by these bacterium. Homeopathic Candida 10X or 30X (which is actually a nosode, and not a homeopathic per se), 5-10 gtt. may also be helpful.