music It's a typical day. A patient has noticedsome itching, or maybe an unpleasant vaginal odor. During her exam, the ian willcheck vaginal pH, examine any discharge that's present, and collect a sample. Then, it'son to the microscope. music This is where you'll gather more specificinformationabout what's causing those vaginal symptoms. We'll show you how to prepare andexamine vaginal wet preps and how to do a whiff test. The results, combined with the patient's vaginal pH test, will aidthe diagnosis.
Under the microscope, you'll be looking for trichomonads, yeast, and the clue cells associated with bacterial vaginosis. We'll show you how to recognize them. music First, the microscope itself: This is a compoundlight microscope. It has several objective lenses on a rotating mount. For our purpose,one of these has to be a 10x low power objective, and one has to be a 40x for greater magnifiion.This flat part, under the objectives, is the stage. Under the stage is the condenser. Belowthat, at the base of the microscope, is the light source. There are two knobs that controlfocus; one for coarse adjustment and one for
fine adjustment. And these are the oculars,or eyepieces. We'll come back to the microscopea minute, but first, let's look at how to prepare wet mount slides. The complete vaginal wet mount involves botha saline prep and a potassium hyoxide, or KOH, prep. When the vaginal sample was collected,the swab was placeda test tube with approximately half a milliliter of saline. So, for the salineprep, you only have to take a op of the suspension and place it on a slide. Add acoverslip, being careful to avoid trapping air bubbles. Your saline slide is ready.Place a second op of the vaginal sample on another slide and add one op of 10 percentKOH. Sniff the preparation immediately, using
your hand to waft any odor toward your nose.This is the whiff test. Note if there's a fishy or amine odor. Then add a coverslip,avoiding air bubbles. Keepmind that you must work quickly to prepare and examine thewet mounts. That's because trichomonads may lose their characteristic motility within15 to 20 minutes. Before we move on now, though, let's lookat the cast of characters you may discover. These are normal squamous epithelial cellsfoundthe vagina. They're large, flat cells with a small nucleus and a large area of cytoplasm.Note that there is some granularitythe cytoplasm.
Polymorphonuclear leukocytes are known asPolys, or PMNs. They may also be called white blood cells, or WBCs. These are small roundcells. Several lobes of the nucleus are visible within the surrounding cell cytoplasm. Findingmany PMNs may indie infection. Trichomonads are pearshaped protozoa whichmove by means of flagella. Trichomonads are similarsize to PMNs and are identifiedby their characteristic jerking movement. The actual flagella may be too thin and toorapidlymoving to be seen. A clue cell is a squamous epithelial cellcoated with enough small bacteria that at least 75 percent of the cell's border is obliterated.It may look as if someone has spread glue
over the cell and pressed itsand. Cluecells are associated with bacterial vaginosis, a conditionwhich the normal microbialflora of the vagina is disrupted. Yeast may be foundtwo forms. Pseudohyphaeare the long, tubular, branching forms. Budding yeast are paired yeast cells that resemblea shoe print. The larger part is the sole and the smaller bud is the heel of the shoe. The saline prep will allow you to see epithelialcells, PMNs, trichomonads, and clue cells. You can also see yeastsaline, but sometimesit's hidden by epithelial cells or by PMNs. Red blood cells, sperm, and bacteria can alsobe seen.
My Vaginal Discharge Smells Like Chlorine
My vaginal discharge smells like chlorine. Are you sure you just aren't overbleachingyour launyé No, this problem remains whether I wear tidywhities or not. It can take on a chemical smell if you'veused a lot of condoms. That's called safe sex. It can take on a chlorinelike smell whenyou've used some types of lubricantsaddition to a condom. Then I don't need to be worried about thesmell if it can be traced to some intimate
activities. Some guys' semen smells like bleach or afaint sugary smell. Condom use pretty much precludes that cause. Now if it smells metallic, that is a signblood is mixed with the vaginal fluids. If I had my period, I'd notice the blood. Blood has more of a copper smell, but if there'san infection like something with lesions and a tinny smell, you could have an STD causingthe off smell. I know fresh blood when it isn't the righttime for it is a problem.
And your period is usually dark red or brownby the time it shows up. But it won't have a chemical smell, justmean I need to use real chlorine bleach to clean up. Your body has a natural pH of 7.4. That's a little alkaline. Yes, since it is higher than 7. Conversely,bleach has a very high pH. Yeah, around 12, but your vagina usually putsout an acidic discharge. The vagina's normal pH is between 3.8 and4.5. If you have vaginosis or some sexually
transmitted disease, the pH can go higherthan 4.5. Then the bleachy smell isn't because theoutput is becoming alkaline. No, but an STD can alter its pH and smell,and when your brain doesn't know what it is, it assigns the first chemical that isanything close. If my biochemistry has altered that much,I have a problem. It isn't an alkaline diet; any diet thatalters your biochemistry that much will kill you. However, an STD could alter the chemistrydown there enough to take on a chemical or acidic smell.
What if I said it smells like ammoniaé Then I would say it is vaginosis due to bacterialgrowth, though it could be due to excessive sweating or dehyation and concentrated urinetoo. And I could end up blaming a urinary leak. Or just sweating a lottight pants whileinking caffeine and energy inks instead of water. But at least that's somethingyou can fix by taking a long hot bath to relax.