Leucorrhea And Its Homoeopathic Management A Review

Leucorrhea or vaginal discharge is the commonest reproductive tract infection in adult age women. Vaginal discharge is normal when it is fluid, white, clear watery and they change in amount depending on the time of menstrual cycle. Leucorrhea becomes abnormal when it changes in colour, consistency, odour along with itching and burning pain in the vaginal area. In such cases it can be suggestive of any underlying health condition like a vaginal infection. The common cause may be due to unhygienic conditions, infections in the genital tract and impaired immune function. Its prevalence is high but women are embarrassed about the problem and refuse to seek medical help. For the treatment of leucorrhea its important to know the causation. Homoeopathy being a holistic system of medicine has a wide scope in treating leucorrhea. There are many homoeopathic medicines in materia medica which are well proved and which can be prescribed for leucorrhea. Homoeopathy not only cures the infection but also prevents its recurrence. While alleviating the suffering of the patient it also improves the quality of life in patients suffering from abnormal vaginal discharge.


Introduction
Leukorrhea or leucorrhea or lukoria or likoria, white discharge or vaginal discharge, is a mild odorless discharge from the vagina that is clear or milky in colour. It is a physiological vaginal discharge normally preceding menarche and occurs during ovulation, during pregnancy and in response to sexual excitement [1,2,3] . It is strictly defined as an excessive normal vaginal discharge. The symptom of excessive discharge is a subjective one with individual variation, while to declare it to be normal and not an infective one, it requires clinical and laboratory investigations. The term leucorrhea should fulfill the following criteria: • The excess secretion is evident from persistent vulval moistness or staining of the undergarments (brownish yellow on drying) or need to wear a vulval pad. • It is non purulent and offensive.
• It is non irritant and never causes pruritus.
Leucorrhoea is a medical condition in which women experience a thick white or yellowish discharge from the vagina, which mainly occurs during puberty when the sex organs are developing in women. Sometimes it flows as a liquid and sometimes it is sticky and thick. Vaginal discharge is to some extent normal and healthy as it sheds dead cells from the reproductive organs and other toxic organisms. In healthy women, discharge is milky white [4,5] . Abnormal vaginal discharge may be white, yellowish, reddish, and blackish. If it is thick, sticky, white, and inflamed, it requires medical attention. With noticeable symptoms and abnormal discharge, if the discharge is profuse, does not stop, pads should be used or if the discharge is not white but grayishwhite, yellow, greenish brown or rusty in color and itching, it becomes a serious condition that needs immediate treatment [4,5] . Every woman has normal vaginal discharge periodically, which maintains the chemical balance and flexibility of the vaginal muscles, serves as a normal defense system for the vagina. If the discharge is more than usual and becomes a thick, white or yellow liquid with a foul smell, it is called "leukorrhea," which could be a sign of infection or any other causes [5] . Vaginal discharge is characterized by secretions from epithelial cells and Bartholin glands of the vagina, which nourish the vaginal microenvironment. However, there are many pathophysiological conditions that are directly or indirectly associated with alterations in the quantity or quality of vaginal secretions [6,7,8] . The World Health Organization (WHO) has recommended the syndromic management in which women complaining of vaginal discharge are treated for some or all of the five common reproductive tract infections like Chlamydia trachomatis, gonorrhea and trichomoniasis are sexually transmitted diseases and bacterial vaginosis and candidiasis, which are the result of disruption of the normal flora of the vagina [6] . [3,9,10,11] . Physiological leucorrhea is clear or milky white, relatively dilute, odorless and non-irritating. Leucorrhoea can occur normally during pregnancy. This is due to increased blood flow to the vagina due to increased estrogen. In post-pubertal women, there is a significant change in vaginal discharge and the patient can rest assured that the discharge is normal if it is not painful, itchy, has an unusual color or odor. Puberty girls often complain of vaginal discharge. If the discharge is clear, does not have symptoms of itching or has a bad smell, it is most likely physiological vaginal discharge, caused by stimulation of the ovaries by estrogen from the uterus and vagina. It does not require immediate medical attention. It may be a natural defense mechanism the vagina uses to maintain chemical balance as well as keep vaginal tissues flexible. Physiological leucorrhea is caused by the stimulation of estrogen. Changes in the vaginal epithelium, changes in the normal flora and pH of vaginal secretions lead to leucorrhoea. A physical examination will reveal evidence of estrogenic vulva and hymen with no erythema or abrasion. Physiological leucorrhea on inspection revealed few white blood cells, estrogen maturation of vaginal epithelial cells, and no pathogens [3,11,12] . Vaginal discharge can be increased due to vaginal infections and sexually transmitted infections (STIs). Doctors must always be on the lookout for signs of abuse. If symptoms are present, cultures should be obtained. Various pathogens such as Neisseria gonorrhoeae, Candida albicans and several other pathogens such as Urea plasma urealyticum, Chlamydia trachomatis, candida -like organisms and streptococci are responsible for the disease. Often a sign of an organic bacterial infection, vaginal mucus becomes inflamed in the leucorrhea, resulting in vaginal discharge that is yellowish in color and has an odor. Leucorrhoea is also caused by Trichomonas, a group of parasitic protozoa, especially Trichomonas vaginalis. Common symptoms of this disease are burning sensation, itching, and discharge of foamy, thick, white or yellow mucus. Also due to nutritional deficiencies or reproductive tract dysfunction and may be a sign of an infection or an underlying gynecological condition [1] . [3,12] . It can also be the result of inflammation or congestion of the vaginal lining. In case the discharge is yellow or has an odor you should see your doctor as it could be a sign of a number of disease processes including an organic bacterial infection or STDs. After delivery, leucorrhea with back pain and foulsmelling discharge may suggest failed contractions due to infection. Several tests such as wet smear, Gram stain, culture, cervical smear and biopsy are suggested to diagnose the disease. Often a sign of an organic bacterial infection, vaginal mucus becomes inflamed resulting in vaginal discharge that is yellowish in color and has an odor. [3,5,13] .

Causes of leucorrhea
• The main cause of leucorrhea is an imbalance of hormones, especially estrogen. It is the primary female sex hormone responsible for the regulation and development of the female reproductive system and secondary sex characteristics.
• Pregnancy, menstruation or perimenopause and uterine congestion. Inflammation of the male and female genital organs.
• The use of chemical contraceptives, IUDs and other mechanical factors cause infection and itching.
• Eating poorly, taking too many tranquilizers.
• Lack of hygiene or poor hygiene practices especially during menstruation.
• Health problems like tuberculosis, anemia, gout, arthritis, typhoid, diabetes, etc. may predispose infections due to weakened immunity. • Blister or swelling at the head of uterus .In this case discharge is more profuse than during sexual intercourse. It is grey in colour and looks like coagulated blood.
Pathophysiology [4,5,13] . The physiological basis for normal vaginal discharge depends on estrogen levels. With an increase in estrogen levels, the secretory activity of the endocrine glands becomes abundant, and the vaginal surface epithelium becomes rich in glycogen. The secretion of mucus by the cervical glands is usually weak. The carbohydrate component of the mucin glycoprotein is fermented to lactic acid. However, if the mucus is too much, it will come out at the level of the vulva. The excessive secretion is due to:

Vaginal cause
➢ Physiological excess [15] . The normal secretion increases in conditions when the estrogen levels arehigh. Such conditions are: During puberty: Increased levels of endogenous estrogen lead to marked overgrowth of the endocervical epithelium which may encroach onto the ectocervix producing congenital ectopy (erosion) → increased secretion.
During menstrual cycle 1. Around ovulation-Peak rise of estrogen → increase in secretory activity of the cervical glands 2. ii.Premenstrual pelvic congestion and increased mucus secretion from the hypertrophied endometrial glands.
Pregnancy: There is hyperestrinism with increased vascularity. This leads to increased vaginal transudate and cervical gland secretion.
During sexual excitement: when there is abundant secretion from the Bartholin's glands. ➢ Cervical cause: Non-infective cervical lesion may produce excessive secretion, which pours out at the vulva. Such lesions are cervical ectopy, chronic cervicitis, mucous polyp and ectropion.

Prevalence
World Health Organisation estimates up to 357 million new cases of women aged 15-49 years reported with four different gynecological diseases including Chlamydia trachomatis, Neisseria gonorrhoeae, syphilis and Trichomonas vaginalis are prevalent in countries with low economic status like India. Reproductive tract infection is known to be the most common health problem estimated to affect about 30-35 million of the adult population and experience one or more episodes each year. Recent research shows that important risk factors such as age, income, education level, and number of children are associated with patients suffering from leucorrhea. [6] According to an original research article conducted on community based survey among 191 women who presented with abnormal vaginal discharge it was found that the prevalance was more among 30 to 39 years as compared to other age groups. Regarding the parity 6 women were nulliparous and about 73 has at least 3 children. The prevalance of bacterial vaginitis was 67.5% , 11.5 % for vaginal candidiasis and 5.2 % for trichomonas vaginitis and 15.7% were found to have mixed culture [6] . Another article conducted a research assessing the prevalence of leucorrhea among women in reproductive age group and the results obtained were out of 60 women 60% belonged to the age group of 31 to 40 years. 50 % of women suffering from leucorrhea had two or more children [18] . A cross sectional study was conducted to assess the reproductive age group women of Nagpur City and the results reveal that leucorrhea was present in 139 females out of 506 females and leucorrhea was significantly higher in married females as compared to unmarried females [19] .

Scope of Homoeopathy in Leucorrhea
Homoeopathy is a system of medicine which is based on the law of similar 'likes cures like' 'Similia Similibus Currentur' [25] .Homoeopathy treats the patient as a whole taking note of the causative factors, sign and symptoms and forming a totality of symptoms for individualization purpose. It doesn't • Email: editor@ijfmr.com

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Volume 5, Issue 4, July-August 2023 6 emphasize only in treating the signs and symptoms but in giving an overall relief to the patient in body , mind and soul. Homoeopathy addresses all aspects of individual with complete set of symptoms through the constitutional and holistic approach. It will not only treat the leucorrhea but improve other functions as well. A detailed case taking is done and careful assessment is done to treat the disease at the root cause. Another advantage of the selected homoeopathic medicine is to prevent the recurrence of disease which can only be achieved by a well selected indicated remedy from materia medica.

Homoeopathic Therapeutics for Leucorrhea
Sl no.
• Leucorrhea acrid, profuse, transparent, ropy, with burning, worse during day time and after menses. Relieved by washing with cold water. • Corrosive leucorrhea, with smarting in the genital parts. Leucorrhea before and after menses, and often with trembling, fatigue, and colic. • Leucorrhea flesh coloured causes stiffness of the linen. • Constipation. Patient has to strain much even for soft stools. • Another indication of alumina is leucorrhea very profuse and even runs down till the heels.
• Leucorrhea ,acrid ,burning, offensive, thin. Pain as from red hot wires, worse least exertion, causes great fatigue, better in warm room. Stitching pain in pelvis, extending down the thigh. • Pain in the sacrum and in the shoulders.
• Patient exhausted both mentally and physically.
• Restlessness cannot remain in same position or at same place. • Thirst for large quantities of water at frequent intervals.
• Extremely acrid , burning and watery leucorrhea, menses too early, too scanty or too profuse. parts and in the anus. • Aversion to other sex.
• Leucorrhea , like white of an egg with pain about the navel , brown, slimy after every urination. • Diarrhea , greenish, mucous stools , and navel pain during menses. • Menses too early, too free, too dark, clotted, flow more at night. • Pain as if sprained in left side of the abdomen during pregnancy. • Pain in the abdomen ,loins and pains ,compressive or drawing in the back, continuing during the night, when the menstrual discharge is more profuse. • During the menses, vomiting and diarrhea ,drawing in the feet or discharge of blood on going to stool. • Leucorrhea with constipation, stools hard and crumbling.
• Leucorrhea acrid , thick, tough, greenish ,follows menses. Cannot bear tight clothing around waist. Soreness of pubes during menses, metrorrhagia. • Diarrhea before and during menses. Menses too early and profuse, worse at night. Voluptous sensation . • Leucorrhea a few days before or a few days after menses, while walking , like the white of egg, yellow green corrosive ,leaving green spots on clothes. • Excoriation in the inguinal fold during the catamenia.
• Leucorrhea like white of eggs, with sensation as if warm water was flowing. Sensation of distension in clitoris with sticking. • Leucorrhea , corrosive and thick like starch .Acrid leucorrhea ,appearing for two weeks between catamenia ,with swelling of labia and inflamed and discharging Duverney's glands. • Stinging and distended feeling in clitoris.
• During pregnancy , swelling ,itching and burning of vagina ,with a discharge like gonorrhea. • Leucorrhea white as starch , perfectly bland without pain. • Menses too early too soon with nausea .
• Before menses , leucorrhea with headache, colic and chilliness. Cutting pains in the uterus during menstruation • Leucorrhea , milky. Burning and itching of parts before and after menstruation, in little girls. • Much sweat about external genitals.
• Leucorrhea ,with burning itching or else like milk, flowing by fits and during the emission of urine . • It is indicated by its general symptoms and these are always the more important in this affection. More prominent of these are morning hunger, acidity of stomach , cold and damp feet. • Leucorrhea getting worse from exertion or when urinating is a strong indication towards the use of calcarea carbonica. • In little girls who perspire excessively on head and feel very cold. • Patient with unusual craving for boiled eggs and indigestible things like chalk, pencils and lime.

8.
Caulophylum Thalictroides [20,21] • Leucorrhea , with moth spots on forehead. Needle like pains in the cervix. • Dysmenorrhea with pains flying to other parts of body. Menses and leucorrhea profuse. • Leucorrhea sharp , acrid very weakening, with heavy eyelids ,of profuse bland mucus, in little girls with forcing down pains, with sterility. • Tension and fullness in hypogastrium , sensation as if uterus congested. Spasmodic pains in uterus. Painful menstruation ,spasmodic, intermittent pains in bladder, stomach, groins, even chest and limbs. • Before menses: pain in small of back,great aching and soreness of lower limbs, bad breath, bitter taste, vertigo, flow very scanty, blood very light, with intense nausea and vomiting of yellow bile.
• Menses delayed and scanty, parts sensitive .Breast enlarged and becomes painful before and during menses. • Ill effects of repressed sexual desire or suppressed menses, or from excessive indulgence . • Burning , acrid , corrosive, and pungent leucorrhea, accompanied or precede by colic. • Cramps in the uterus, with pinchings or contracting, or with digging above the vulva, accompanied by tension in the abdomen , and shootings extending to the left side of the chest.  [5,20,21] .

Calcarea Phosphorica
• Leucorrhea like white of egg. Worse in the morning . • Menses too early , excessive ,and bright in girls .If late blood is dark ,sometimes ,first bright then dark with violent backache. • During lactation with sexual excitement. Nymphomania , with aching , pressing, or weakness in uterine region . • Leucorrhea day and night, < morning after rising, of sweetish odour , increased whites with a stool of bad odour.
• Leucorrhea with dragging pain in the sacral region, with prolapse , especially after a miscarriage. Pruritus vulva . • Weight and soreness in the womb conscious of womb. Menses too frequent , too profuse . • Breast swollen , nipples panful and tender. Parts red, hot and swollen burn and itch terribly. • Leucorrhea with atony and anemia .
• Erosion and excoriation of the cervix. Leucorrhea , worse after menses, acrid and corroding shreddy, tenacious. • Pruritus vulvae , with profuse leucorrhea .Sexual excitement. Tumour of breast , nipple retracted. • Aching pains in small of back at climaxis , uterine affections with debility and digestive disorders . • Hot watery discharge from the uterus .Leucorrhea with ulceration the os , cervix , and vagina . • Presence of some liver complaint or constipation in women along with leucorrhea is another strong feature for using Hydrastis canadensis. • Mucous leucorrhea, the discharge hanging from the os in long viscid strings, profuse debilitating albuminuos discharge immediately after menses. • Great sinking and prostration at the epigastrium with violent and continued palpitation of the heart. 15. Iodium [20,21,23] .
• Wedge like pain in the right ovarian region.
• Profuse leucorrhea worse at the time of menses.
• Chronic oophoritis with thick , yellow ,burning leucorrhea , >after eating. • Pain in the lower abdomen , < in the left ovarian region ,>by motion and after eating. • Iodium is of great help in cases of leucorrhea where the discharges are so acrid that they make holes in the linen.
• Leucorrhea , yellow acrid , odour of green corn , worse between periods . • Corrosive itching within vulva , burning and swelling of labia .Violent itching between labia and thighs . • During menses , hardness of hearing , discharge of fetid wind , constipation and incarceration of flatus, buzzing and roaring in head ,with pressive pains colic ,cuttings sacral pains , shivering , or sweat on the back and on the chest. • After menses, abdominal spasms ,pressure in the genitals . • Leucorrhea , which stains the linen yellow accompanied with great weakness in legs . • Shootings in the vagina as if produced by electricity.
• Leucorrhea with every stool and after exercise .
• Menses black , clotted. Pain in back and thighs . Metrorrhagia, worse at night. Great excitement at every period. • Leucorrhea preceded by cramps in the abdomen or especially during movement. • Cramps in uterus ,sometimes with pans extending to thighs . • During catamenia , paleness of face ,with pains in loins and depression, fainting , pain in left leg 20. Murex [20,21] .
• Leucorrhea green or bloody , alternate with mental symptoms and aching in sacrum. • Thick, serousgreenish leucorrhea becoming sanguineous , reappearance of sanguineous leucorrhea while at stool. • During pregnancy: Leucorrhea , sensation of pelvic bones getting loose. • Nymphomania .Least contact of parts causes violent sexual excitement .Sore pain in uterus. • Menses irregular, profuse, frequent ,large clots .Feeling of protrusion .Prolapse , enlargement of uterus with pelvic tenesmus and sharp pains extending towards breasts, aggravated lying down. • Dysmenorrhea and chronic endometritis, with displacement .Must keep legs tightly crossed . • Extreme irritation of the parts ,with ardent sexual desire to a degree almost maniacal slightest touch reawakens desire . 21. Natrium muriaticum [20,21] .
• Leucorrhea acrid watery , bearing down pain worse in morning. Hot during menses. • Acrid greenish leucorrhea with yellow colour of face. Increased discharge when walking. • Abundant discharge of transparent , whitish , and thick mucus from vagina . • Itching of external parts with falling off of hair.

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Volume 5, Issue 4, July-August 2023 13 sickness with sour vomiting. • Menses too early, pale, thin watery. Sterility, with acid secretions from vagina. • Menses five days early. During menses ,feet icy cold by day burn at night in bed, pressure in right eye, flow at first paler than usual. After menses, symptoms <, trembling at heart, headache, paralytic aching in right wrist, knees feel as if tendons shortened.
• Leucorrhea brown , flesh coloured, watery or stringy, offensive . • Menses reappear a few days after cessation , a pale red , fourteen days after cessation not profusely. Stringy mucous leucorrhea . Leucorrhea leaving spots with black borders on linen. • "Leucorrhea where the syphilitic taint is the basis of affection". • The inguinal glands are sympathetically affected with leucorrhea. • Offensive leucorrhea , offensive catarrh and breath, foetid foot sweat. • Thin bloody , excoriating leucorrhea at all times or at any time. • After menses, violent pains through abdomen and a sudden gush of "muddy water'',brown or thick leucorrhea. 24. Platina [20,21,24] .
• Leucorrhea like white of eggs, flowing chiefly after urinating , and on rising from the seat. • Sensation of bearing down towards the genital organs ,with aching in abdomen. Unnatural increase of sexual desire ,with painful sensibility and voluptuous tingling from genitals up to the abdomen . • Nymphomania which may occur during the lying in period . Induration of the uterus. Sanguineous congestion of the uterus. • Metrorrhagia of thick, deep coloured blood ,with drawings in the groin. • Menstruation when the discharge is very abundant , thick and black like tar and is very exhausting ,spasms and screaming at every at every menstrual period .
• Leucorrhea like albumen , only in the day time, without sensation. Painful pressing towards the genital organs as if the menses would make their appearance ,passing off in the evening but returning with morning . 25. Pulsatilla [5,20,21] .

Sabina
• Yellowish , fetid , thick leucorrhea like starch with itching. • Metrorrhagia with discharge of clotted or bright red blood , and pains resembling labour pains in the sacrum and in the groins ,< at night. • Menses continue too long .Menstrual discharge partly fluid, partly clotted and offensive .It may be either bright red or dark and coagulated, flows mostly in paroxysms , which are brought on by slightest motion or flow ceases when walking about. • Suppressed catamenia with very offensive smelling leucorrhea(like meat washings.). • Chronic Catarrh of vagina with granulations , copious leucorrhea. Bloody leucorrhea.
• Watery milky leucorrhea, thick ,whitish, foul smelling, with spasmodic pains in the uterus . • Pulsative pain in the womb with swelling ,as if from a tumour or dropsy ,the uterus swollen ,as if full of cysts, especially on the right side ,the neck of the womb swollen and hot ,military eruption and heat in the vulva . • Bloody discharge at other times than the menstrual period as during climaxis.
• 'Pelvic organs relaxed .Bearing down sensation as if everything would escape through vulva must cross limbs to prevent protrusion, or press against the vulva .  [5,20,21] .

Silicea Terra
• A milky, acrid leucorrhea , during urination. Itching of vulva and vagina ,very sensitive. • Discharge of blood between menstrual periods. Increased menses , with paroxysms of icy coldness over whole body. • Leucorrhea preceded by gripings in umbilical region. • During the menses , pains in the abdomen ,pale appearance of objects, or burning sensation and excoriation in vulva. • "Constipation before and during menses ,of hard lumps which remain long in the rectum. [5,20,21] .

Sulphur
• Leucorrhea , burning, excoriating .Pudenda itches. Much offensive perspiration. • Menses too late, short, scanty, difficult, thick, black, acrid, making parts sore. Menses preceded by headache or suddenly stopped. • Before menses, headache , itching in the parts , spasmodic colic , cough, toothache, pyrosis, epistaxis, leucorrhea and asthmatic sufferings. • Cancer of uterus offensive, corrosive , ichorous leucorrhea, sensation of heat in crown of head coldness of feet, flushes of heat pass off in a perspiration with faintness, weak at pit of stomach 11a.m. to 12. • A weak feeling in genitals .Sore feeling in genitals during an embrace. Labour like pain over symphysis. Uterine pains running from groins to back. • Complaints that are always relapsing (menses, leucorrhea, etc),patient seems to get almost well when the disease returns again and again. • < before, during and after menses (headache, leucorrhea).

General Management of Leucorrhea
• Cleanliness and hygiene of reproductive organs is very important. Washing the genitals carefully during every bath and do not let moisture retain in the genitals area after the bath. Let the water flow on anus and vulva in plenty as to wash them clean. Also wash vagina clean after urinating. • Clean the innerwear with a good quality detergent which has bactericidal and fungicidal properties.
• Inner wear made of Nylon material should be avoided in summer because as it may retain sweat in the genital area. Cotton is best choice for undergarments. • Fresh curds can be added to the diet as it contains lactic acid, which can reduce the discharge.
• Self-medication should be avoided because some women are allergic to certain kinds of medicines and use of such medicine may cause further infections and will complicate the issue. • Drink plenty of water to flush out the toxic substances from the body.
• All sugary foods such as pastries, sweets, custards, ice-creams and puddings must be avoided if there is profuse discharge. • Hot and spicy foods should be avoided.
• Moderate exercises and morning walk should be advised; because when body is stress free, immunity will receive a boost against illnesses . • Using few drops of freshly squeezed lemon juice and water to clean the vaginal area.
• Once a day, drink one glass of fresh cranberry juice, ideally without sugar. It's great for vaginal health. • Soak some coriander seeds in water overnight and drink the water on an empty stomach the following day after straining it. • Increase intake of seasonal fruits, green leafy vegetables, and salads

Conclusion
In this review article which is entitled with leucorrhea gives an insight of leucorrhea and its homoeopathic management. An overview of the definition, symptoms, types, pathophysiology has been ennumerated. Leucorrhea is seen to have a high prevalence in India and mostly affecting the adult age group of 30 to 40 years. It affects a woman's daily life routine and decreases the quality of life. Multiple researches and studies conducted have proved that homoeopathy has a wonderful role in treating leucorrhea .With the knowledge of materia medica and repertory a remedy can be selected. Life style modifications such as hygiene, healthy diet, meditation and exercise also help to alleviate the symptoms of leucorrhea along with homoeopathic management. Homoepathy can offer a complete, gentle and permanent cure in cases of leucorrhea.