International Journal of Gynecology and Obstetrics 124 (2014) 27–29

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International Journal of Gynecology and Obstetrics

journal homepage: www.elsevier.com/locate/ijgo

CLINICAL ARTICLE

Effects of vaginal discharge on female sexual function

Ayse N.C. Gungor a,⁎, Aysegul Uludag b, Melih Sahin b, Meryem Gencer a, Ahmet Uysal a
a
Department of Obstetrics and Gynecology, Canakkale Onsekiz Mart University Hospital, Canakkale, Turkey
b
Department of Family Medicine, Canakkale Onsekiz Mart University Hospital, Canakkale, Turkey

a r t i c l e i n f o a b s t r a c t

Article history: Objective: To assess the effects of vaginal discharge on female sexual dysfunction (FSD) by using the Female
Received 4 April 2013 Sexual Function Index (FSFI). Methods: In a study at a university hospital in Canakkale, Turkey, women affected
Received in revised form 23 June 2013 by vaginal discharge and age-matched healthy control women were recruited between January and December
Accepted 17 September 2013 2012. Women were grouped in accordance with their vaginal discharge complaints and each participant com-
pleted the FSFI questionnaire. Results: A total of 114 women were included in the study. Women in the first
Keywords:
group (n = 58) had no vaginal discharge or had physiologic vaginal discharge, those in the second group
Female Sexual Function Index
Itching
(n = 29) had abnormal vaginal discharge with itching, and those in the third group (n = 27) had abnormal vag-
Sexual dysfunction inal discharge without itching. Compared with the first group, women in the second and third groups had higher
Vaginal discharge FSFI scores for desire, arousal, orgasm, and pain, in addition to higher overall FSFI scores. Women with genital mal-
odor had significantly higher FSFI scores than patients without genital malodor (23.83 ± 5.07 vs 21.15 ± 4.78;
P = 0.008). Conclusion: Women with abnormal vaginal discharges were found to have better FSFI scores for
some domains. This finding may be attributed to the adverse effects of sexual intercourse on vaginal infections.
© 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

1. Introduction
Sexual dysfunction is prevalent among females and is a serious
health problem that can affect the quality of life of the woman and her
partner. Many studies have been performed to develop tools for the
diagnosis of female sexual dysfunction (FSD) [1,2] and to identify risk
factors for disease. One of the most commonly used and validated
instruments for evaluating FSD is the Female Sexual Function Index
(FSFI)—a self-reported and structured 19-item questionnaire [3].
Many risk factors for FSD have been reported. Menopause [4–7],
obesity [8,9], infertility [10–12], vaginal operations including vaginal
birth [13,14], and pelvic radiotherapy [15] are the main factors previ-
ously studied as risk factors for FSD.
Vaginal discharge, usually a symptom of vaginitis, can make some
females feel uncomfortable and may be chronic or may recur after
treatment. Bro [16] showed that 20% of women with a complaint of
vaginal discharge had normal findings on pelvic examination, whereas
14% of women without a complaint had an abnormal vaginal secretion
on pelvic examination. Rather than the etiology or a definitive diagno-
sis, perceptions of the characteristics of the discharge such as odor,
color, consistency, and duration might make women concerned about
their body image and decrease their self-esteem.
⁎ Corresponding author at: Canakkale Onsekiz Mart University, Medicine Faculty,
Department of Obstetrics and Gynecology, 17100 Canakkale, Turkey. Tel.: + 90
2862635950; fax: + 90 2862180516.
E-mail address: dr_aysecakir@hotmail.com (A.N.C. Gungor).
As a result, the aim of the present study was to identify the possible
effects of vaginal discharge and its characteristics, rather than its etiology,
on FSD via the FSFI.
2. Materials and methods
The current study was conducted between January 1 and December
31, 2012, at Canakkale Onsekiz Mart University Hospital, Canakkale,
Turkey, among women who attended the gynecology department
with a complaint of vaginal discharge and healthy age-matched control
women. Study approval was obtained from the local ethical committee
before data collection. Patients gave written consent to participate in
the study.
Women who had chronic diseases, were aged over 40 years, had
a delivery in the past year, were not married or not living with their
husband, or had a partner with sexual dysfunction were excluded
from the study because these factors might have adverse effects on
sexual function [17,18]. Participants who filled in the FSFI questionnaire
incompletely were also excluded.
The data collected from each participant included age, body mass
index (BMI, calculated as weight in kilograms divided by the square of
height in meters), education, income level, parity, delivery type, interval
from the last delivery, abortion and induced abortion history, contra-
ception usage, vaginal discharge status, vaginal douche history, and
periods of dysmenorrhea. If the woman had an abnormal vaginal dis-
charge, the discharge characteristics (color, odor, consistency, and dura-
tion of the symptoms during the past month) were also recorded.

0020-7292/$ – see front matter © 2013 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.
http://dx.doi.org/10.1016/j.ijgo.2013.07.012
28 A.N.C. Gungor et al. / International Journal of Gynecology and Obstetrics 124 (2014) 27–29

Abnormal color was defined as a yellow or green discharge. Abnor- Table 2

mal odor was defined as malodor that did or did not increase with FSFI scores of the study groups.a

sexual intercourse. Abnormal consistency was defined as a cottage Group 1 Group 2 Group 3 P value
cheese-like or thickened discharge. (n = 58) (n = 29) (n = 27)
Participants then filled in the FSFI questionnaire. The FSFI is a self- FSFI domain score
report questionnaire consisting of 19 questions grouped into the fol- Desire 3.41 ± 0.87 4.07 ± 1.06 3.89 ± 1.18 0.009b,c
lowing 6 domains: desire, arousal, lubrication, orgasm, satisfaction, Arousal 4.26 ± 0.95 4.72 ± 0.96 4.72 ± 0.85 0.038b,c
Lubrication 3.53 ± 1.09 3.94 ± 1.21 4.02 ± 1.03 0.096
and pain [3,19]. Every response provides a score from 0 to 5. Scores ob-
Orgasm 3.43 ± 0.95 3.82 ± 1.15 3.99 ± 1.12 0.049b,c
tained from the questions in each domain are summed and multiplied Satisfaction 2.20 ± 1.06 2.50 ± 1.28 2.86 ± 1.71 0.091
by a constant factor, resulting in a domain score. The overall score ob- Pain 3.72 ± 1.18 4.37 ± 1.12 4.41 ± 1.34 0.014b,c
tained from all domains is called the total FSFI score. A total score of No. of women with 52 (89.7) 21 (72.4) 21 (77.8) 0.105
26.55 or less is defined as FSD. A higher score for an individual domain sexual disorder
Mean total FSFI score 20.56 ± 4.65 23.46 ± 5.21 23.88 ± 4.86 0.004b,c
or a higher total score indicates better sexual functioning. The Turkish
version of the FSFI has been shown to be reliable and valid for the Abbreviation: FSFI, Female Sexual Function Index.
a
Values are given as mean ± SD or number (percentage) unless stated otherwise.
Turkish population [20]. b
Significant between groups 1 and 2.
Statistical analysis was performed via SPSS version 15.0 (IBM, c
Significant between groups 1 and 3.
Armonk, NY, USA). Quantitative data were expressed as mean ± SD,
and qualitative data were expressed as number (percentage). Student
t test was used to compare quantitative data, and χ2 test was used to showed that the only significant relationship was between genital mal-
compare qualitative data. Backward logistic regression analysis was odor and FSFI score: women with abnormal genital odor had better
performed for possible risk factors including age, BMI, education level, FSFI scores.
income, number of children, delivery type, abortion, induced abortion, Regression analysis to determine possible risk factors showed that
contraception usage, time since last delivery, vaginal douching, dys- the orgasm domain had no relationship with having a vaginal discharge
menorrhea, vaginal discharge, itching, color, odor, consistency, and or any of its components. Abnormal consistency of the vaginal discharge
duration of the vaginal discharge in the past month versus the total resulted in higher scores for the total FSFI and each of its domains except
FSFI score or domain scores. A P value of less than 0.05 was considered for the orgasm domain. Abnormal odor of the vaginal discharge was as-
to be statistically significant. sociated with higher scores for the lubrication and satisfaction domains.
Patients with abnormal color of the vaginal discharge had higher scores
3. Results for the pain domain. Lastly, those with vaginal douching also had better
results for the pain domain.
The present study included 114 women who were divided into
3 groups. Women in the first (control) group (n = 58) had no vaginal 4. Discussion
discharge or had physiologic vaginal discharge, those in the second
group (n = 29) had abnormal vaginal discharge with itching, and Vaginal discharge is a common problem that can affect a woman’s
those in the third group (n = 27) had abnormal vaginal discharge with- sexual life. In the present study, the relationship between vaginal dis-
out itching. The sociodemographic properties of the groups are summa- charge and FSD was examined via the FSFI questionnaire. No significant
rized in Table 1. relationship was observed between an abnormal vaginal discharge and
The FSFI scores of the groups are summarized in Table 2. Women FSD prevalence; however, women with an abnormal discharge had sig-
with an abnormal vaginal discharge with or without itching had better nificantly better mean FSFI scores compared with women in the control
FSFI scores than the control group for the desire, arousal, orgasm, and group. This might be due to the small sample size, to the relationship
pain domains. Although the prevalence of FSD according to the total between frequent sexual intercourse and vaginal infections, or to factors
FSFI scores was similar in the control and study groups, the mean FSFI inherent to the FSFI questionnaire.
score in the control group was significantly lower than both of the The FSFI has been criticized because, instead of being fully based
study groups. on clitoral sensation and orgasm, it depends on penile–vaginal inter-
The relationship between vaginal discharge characteristics and course and includes an assessment of organs such as the vagina, which
mean total FSFI score is summarized in Table 3. Further analysis of might be considered to serve a purely reproductive function and to be
the effect of the characteristics of the vaginal discharge on FSFI scores unnecessary for clitoral stimulation or orgasm [21]. The limitations of
the questionnaire are also a limitation of the current study.

Table 1
Sociodemographic characteristics of the study groups.a Table 3
Relationship between characteristics of the vaginal discharge and mean FSFI score.
Characteristic Group 1 Group 2 Group 3 P value
(n = 58) (n = 29) (n = 27) Characteristic No. of women FSFI score P value

Age, y 30.7 ± 5.3 32.4 ± 5.0 31.2 ± 5.4 0.398 Itching

BMI 24.1 ± 4.3 25.6 ± 5.4 24.3 ± 4.1 0.387 Yes 37 23.02 ± 5.49 0.112
Number of children 1.41 ± 0.5 1.44 ± 0.5 1.3 ± 0.5 0.472 No 72 21.39 ± 4.79
Time passed from last birth, y 6.9 ± 3.8 8.4 ± 6.0 6.2 ± 4.9 0.396 Consistency
No. of abortions 1.8 ± 0.4 1.8 ± 0.4 1.8 ± 0.4 0.526 Normal 60 21.62 ± 4.56 0.093
No. of induced abortions 1.8 ± 0.4 1.7 ± 0.5 1.8 ± 0.4 0.377 Abnormal 41 23.34 ± 5.62
Education ≤5 yb 14 (28.6) 9 (29.6) 12 (50.0) 0.192 Odor
Income ≤1500 TLb 30 (57.7) 18 (69.3) 21 (91.3) 0.015 Normal 56 21.15 ± 4.78 0.008
Cesarean deliveryb 23 (63.9) 5 (27.8) 3 (15.8) 0.001 Abnormal 43 23.83 ± 5.07
Not using contraceptive methodb 10 (21.3) 4 (17.4) 6 (28.6) 0.400 Duration during past month
Vaginal douchingb 22 (40.0) 10 (37.0) 11 (42.3) 0.925 b15 d 45 22.46 ± 5.09 0.620
≥15 d 49 22.96 ± 4.75
Abbreviations: BMI, body mass index (calculated as weight in kilograms divided by the
Color of the discharge
square of height in meters); TL, Turkish lira.
a Normal 67 21.78 ± 5.28 0.339
Values are given as mean ± SD or number (percentage) unless stated otherwise.
b Abnormal 37 22.77 ± 4.55
Some values missing.
 A.N.C. Gungor et al. / International Journal of Gynecology and Obstetrics 124 (2014) 27–29
Other limitations of the study include its small sample size and use
of subjective data on vaginal symptoms. No diagnostic criteria were
used except for patient history. Because the study was not concerned
with the etiology of the vaginal discharge, the relationship between
the woman’s feelings about her vaginal discharge and the FSFI score
was examined. We considered that a woman’s perception of the charac-
teristics of her discharge—such as the odor, color, consistency, and dura-
tion (rather than the etiology or a definitive diagnosis)—might induce a
poor body image and therefore promote sexual dysfunction; however,
this was not found to be the case.
Previous studies investigating the prevalence of FSD via the FSFI
have reported varying results in different communities. For example,
Kadioglu et al. [9] found a 41% (11/27) prevalence of FSD among healthy
Turkish women. Oksuz and Malhan [22] evaluated 518 Turkish women
for FSD via their FSFI score and concluded that the prevalence of FSD
was 41% for women aged 18–30 years and 48.3% for women of all age
groups. In the present study population, there was a relatively higher
prevalence of FSD. Among the healthy controls, 52 women (89.7%)
had FSD. By contrast, the prevalence of FSD in the vaginal discharge
groups with and without itching was 72.4% and 77.8%, respectively.
The higher prevalence of FSD observed in the current study might
be due to differences in the sociodemographic properties of the study
populations. The present patients were less educated and had a lower
income compared with women in previous studies.
Genital malodor can have many etiologic factors. Regardless of the
cause, however, it might seriously affect a woman’s self-esteem and
relationships [23]. A striking finding in the current study is the signifi-
cantly higher FSFI scores among participants with genital malodor.
This might be due to the relationship between frequent sexual inter-
course and genital infections. After adjusting for possible contributing
factors, participants with malodor had better scores in the lubrication
and the satisfaction domains in the current study.
An abnormal consistency of vaginal discharge was to found to posi-
tively affect both the total FSFI score and all other domain scores except
for orgasm. This observation might be due to the adverse effects of
sexual intercourse on vaginal flora.
Giraldo et al. [24] studied the FSFI scores of 58 women assigned to
3 groups: 11 in a recurrent vulvovaginal candidiasis group; 18 in a local-
ized provoked vulvodynia group; and 29 in a control group. They found
that the 2 study groups had significantly lower FSFI scores compared
with the control group; and that the candidiasis group had lower scores
for all domains except for desire compared with the control group.
In addition, women with vulvodynia had lower scores for the orgasm
and satisfaction domains compared with control women. Although
their findings seem to contrast with those of the present study, Giraldo
et al. [24] evaluated patients with recurrent vulvovaginal disease, which
is a rare chronic condition beyond a vaginal discharge with itching.
They also evaluated vulvodynia, a condition that was not considered
in the present study. Thus, both the pathology and the symptoms of
Giraldo et al.’s study population differed from those of the present
study population.
In summary, the relationship between FSD and an abnormal vaginal
discharge and its characteristics has been examined. Although at first
glance the results seem unexpected, when considered carefully they
29
might provide insight into the effects of sexual intercourse on vaginal
infections and vaginal flora.
Conflict of interest
The authors have no conflicts of interest.
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