Why is there a little blood in the vagina?

Normal leucorrhea should be transparent latex-like, slightly yellowish, but without any excessive symptoms, no odor, and the texture is sticky and can be pulled into threads. However, some leucorrhea is not like this. The inside of the leucorrhea is red, and it looks like there are some very fine blood threads. This is a sign of leucorrhea bleeding. Why does leucorrhea have such bloody symptoms?

(i) Lactobacillus: Normal leucorrhea or candidal leucorrhea contains large bacilli, and the presence of such bacilli indicates the presence of lactobacilli. It is often not found in trichomoniasis leucorrhea, but completely disappears in bacterial vaginosis leucorrhea.

(ii) White blood cells: In the hanging drop smear, only one or two white blood cells can be seen in the high-power field of normal leucorrhea. If there are a large number of white blood cells, trichomoniasis or cervicitis should be considered. There are few white blood cells in the hanging drop smear of leucorrhea caused by candidiasis and bacterial vaginosis.

(III) Trichomonas: It is a protozoan with flagella, slightly larger than white blood cells. If it is active, it is easy to identify, but when it is surrounded by white blood cells, its activity is restricted. About 15%-20% of patients with trichomoniasis have no visible Trichomonas activity in their leucorrhea under a microscope. In this case, the patient should be observed under a high-power microscope and differentiated from the cells based on the activity of their flagella.

(iv) Mycelium: Mycelium can be found under a microscope (100×) in a specimen of vaginal discharge from fungal vaginitis mixed with 10% KOH solution, but no mycelium is present when Candida albicans is present alone in the vagina. On the contrary, bud reproduction can be seen regardless of whether there is infection or not, but methylene blue or Gram or Papanicolaou staining is required.

(V) Clue cells: Clue cells refer to the presence of many bacilli aggregated at the edge of vaginal epithelial cells in bacterial vaginosis, which can be used as a basis for diagnosis. In the hanging drop smear, the edges of the vaginal epithelial cells are granular or stippled, making them unclear, which are clue cells. It is the most sensitive and specific sign of bacterial vaginosis. As long as both clue cell test and amine test are positive, bacterial vaginosis can be diagnosed quickly and correctly.

Leucorrhea cleanliness

The vaginal secretion is smeared and observed under a microscope. The vaginal cleanliness is determined by the number of vaginal bacilli, white blood cells (WBC) and miscellaneous bacteria. There are 4 levels:

Grade I: There are a large number of vaginal bacilli and epithelial cells, no miscellaneous bacteria or white blood cells, the field of vision is clear, and the secretions are normal.

Grade II: There are moderate amounts of vaginal bacilli and epithelial cells, a small amount of white blood cells and miscellaneous bacteria, and it is still normal vaginal secretions.

Grade III: A small amount of vaginal bacilli and squamous epithelium, but a relatively large number of miscellaneous bacteria and white blood cells, indicating milder vaginal inflammation.

Grade IV: There are no vaginal bacilli, only a few epithelial cells, a large number of white blood cells and miscellaneous bacteria. It indicates relatively severe vaginal inflammation, such as candidal vaginitis and Trichomonas vaginitis.