PHYSIOLOGIC DISCHARGE
Physiologic discharge is the result of the thin, watery cervical mucus discharge
seen with estrogen dominance. It is a normal phenomenon and becomes a
complaint with prolonged anovulation, particularly in patients with wide
eversion of columnar epithelium.
Risk factors include chronic anovulatory conditions such as polycystic ovarian
syndrome (PCOS).
The most common patient complaint is increased watery vaginal discharge.
There is no burning or itching.
Speculum Exam: The columnar epithelium of the endocervical canal extends
over a wide area of the ectocervix, producing abundant mucus discharge. Vaginal
discharge is typically thin and watery. The vaginal epithelium is normal,
appearing with no inflammation. Vaginal pH is normal (<4.5).
Wet Mount: Microscopic examination reveals an absence of WBCs, “clue
cells,” trichomonads, or pseudohyphae.
Management: Steroid contraception with progestins, which will convert the
thin, watery, estrogen-dominant cervical discharge to a thick, sticky progestin-
dominant mucus.