Question

28 years old married female anxious about conception. C/o profuse vaginal discharge. No h/o itching. 12 days since LMP.

• A. Candida
• B. Trichomonas
• C. Bacterial vaginosis
• D. Physiological

Hint:

Consider the phase of the menstrual cycle and the absence of any inflammatory symptom like itching.

Answer 1

The Correct Option is D

Step 1: Analyse the clinical presentation.
The patient is a 28-year-old married woman, 12 days since her last menstrual period (LMP) -- which corresponds to the peri-ovulatory phase of the menstrual cycle. She has profuse vaginal discharge with NO itching.

Step 2: Understand physiological vaginal discharge around ovulation.
Normal physiological discharge varies throughout the menstrual cycle. Around day 12-14 (ovulation), under peak oestrogen influence, cervical mucus becomes abundant, clear, watery, and elastic (spinnbarkeit). This increase in discharge is completely normal and is not associated with itching, odour, or dyspareunia.

Step 3: Exclude pathological causes.
- Candidiasis: causes thick, white, curdy (cottage cheese-like) discharge WITH intense pruritus (itching) -- absent here.
- Trichomonas vaginitis: causes frothy, greenish-yellow, offensive discharge WITH itching and dyspareunia.
- Bacterial vaginosis: causes thin, greyish-white discharge with a fishy odour (positive whiff test), generally no significant itching.

Step 4: Correlation with timing.
12 days post-LMP = peri-ovulatory phase. Profuse, non-itchy discharge is characteristic of physiological mid-cycle cervical mucus.

Conclusion: The correct answer is Physiological discharge.