Keluarnya cairan dari vagina di luar masa haid seringmebuat para wanita jadi kahwatir. Tapi sebenarnya cairan atau “vaginal discharge” seperti apa yang harus diwaspadai? Apa yang dimaksud dengan “vaginal discharge”? Discharge berarti cairan yang dikeluarkan dari suatu ruangan yang berongga. Vaginal discharge adalah keluarnya sekret dari vagina. Sekret yang keluar dari vagina bervariasi berdasarkan pada konsistensi, warna, dan bau. Vaginal discharge dapat terjadi secara fisiologis maupun patologis. Vaginal discharge fisiologis terjadi karena adanya mukus yang dihasilkan oleh serviks. Mukus yang dihasilkan berwarna jernih dan bila terpapar oleh udara akan menjadi putih atau kuning. Jumlah mukus yang dihasilkan oleh serviks tergantung oleh kadar estrogen. Beberapa faktor yang mengakibatkan vaginal discharge fisiologis antara lain:
  • Keadaan emosional
  • Masa ovulasi
  • Ketertarikan seksual
Pada umumnya, vaginal discharge patologis terjadi karena adanya infeksi dari organ reproduksi wanita. Pengeluaran sekret vagina yang purulen dapat disebabkan adanya infeksi dari bakteri Gardnerella vaginalis, trichomoniasis, moniliasis. Selain itu, penyakit herpes progenitalis dan gonorrhoea juga dapat menyebabkan terjadinya vaginal discharge. Jika tidak ada kerusakan pada struktur anatomi, maka sekret yang keluar tidak disertai dengan darah. Banyak dari jenis bakteri, jamur, dan parasit ditemukan dalam vagina normal tanpa menimbulkan suatu gangguan. Vagina bersifat asam karena asam laktat yang dihasilkan oleh bakteri yang tinggal di dalam vagina. Asam dan bakteri yang ada di dalam vagina berfungsi sebagai protektor terhadap mikroorganisme lain yang seharusnya tidak ada di dalam vagina yang dapat menimbulkan berbagai macam gangguan. Tetapi pada jamur seperti Candida, dapat ditemukan dalam vagina dalam jumlah yang sedikit sehingga tidak menimbulkan gejala yang mengganggu. Pada wanita hamil, terjadi penambahan produksi mukus pada serviks. Sehingga discharge yang dihasilkan juga meningkat. Mukus yang dihasilkan oleh serviks pada keadaan normal berwarna jernih. Tetapi selain mukus, discharge dapat berbentuk pus/nanah, darah, keputihan, dsb. Apa sebabnya? Discharge dari serviks
  1. Mukus dihasilkan oleh serviks dalam keadaan normal dan akan meningkat pada siklus menstruasi (karena perubahan kadar hormon). Ini merupakan hal yang normal terjadi dan dapat juga terjadi pada saat hamil maupun menggunakan kontrasepsi oral. Kelebihan sekresi mukus ini tidak membuat vagina menjadi iritasi, namun wanita akan merasa kurang nyaman karena vaginanya akan terasa basah setiap saat.
  2. Perubahan dari discharge dapat disebabkan oleh Chlamydia dan Gonorrhoea yang merupakan STI (Sexually Transmitted Infection).
  3. Karsinoma endometrium.
  4. POS (Polisitic Ovary Syndrome).
  5. Karsinoma serviks.
  6. Hamil anggur.
  7. Neoplasma lain.
Bentuk discharge pada infeksi biasanya berupa pus dan dapat menyebabkan iritasi. Keputihan disebabkan oleh jamur Candida yang melebihi normal. Sedangkan pada kasus neoplasma, terutama yang bersifat ganas akan memiliki bentuk discharge berupa darah. Discharge bentuk darah inilah yang harus diwaspadai karena pada umumnya pasien mengganggapnya sebagai sisa dari menstruasi saja.

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Discharge dari vagina
  1. Vaginosis bakterialis. Disebabkan oleh meningkatnya jumlah bakteri normal yang menghuni vagina. Dalam jumlah sedikit tidak akan menimbulkan gangguan.
  2. Candidiasis.
  3. Infeksi.
  4. Inflamasi vaginitis deskuamosa. Menghasilkan pus atau nanah dalam dischargenya. Penyebabnya belum jelas.
  5. Polip pada vagina. Merupakan suatu jenis neoplasma yang jinak.
Bagaimana rasa yang ditimbulkan oleh karena discharge? Discharge yang fisiologis dirasakan hanya sebagai basah di daerah sekitar vagina. Infeksi Gonorrhoea dan Chlamydia akan menyerang tuba falopi dan ovarium sehingga sering menimbulkan nyeri sekitar panggul. Nyeri juga dapat dirasakan saat kencing, melakukan hubungan seks, ataupun setelah berhubungan. Trichomoniasis dapat menyebabkan iritasi dan nyeri saat kencing. Vaginosis bakterialis tidak menimbulkan ketidaknyamanan, namun dapat menjadi iritasi ketika berhubungan seks. Sedangkan, keputihan dapat menyebabkan iritasi kulit, pembengkakan, kemerahan, dsb. Seperti apa bentuk dischargenya? Discharge fisiologis berwarna jernih atau sedikit putih. Perubahan yang tidak seperti biasanya perlu diwaspadai dan segera ditindaklanjuti. Bagaimana cara mendiagnosanya? Diagnosa yang tepat tidak dapat dilakukan hanya dengan melihat cairan yang keluar. Dibutuhkan sampel cairan yang digunakan di laboratorium sebagai penegak diagnosa. Bagaimana cara mengatasinya? Untuk menjaga dan mengobati vaginal discharge ada beberapa hal yang dapat dilakukan, antara lain:
  • Menjaga daerah genital tetap kering dan bersih.
  • Jangan melakukan douching. Hal ini akan memperburuk vaginal discharge karena akan membuang bakteri yang baik dalam vagina yang berfungsi sebagai pertahanan diri terhadap infeksi.
  • Gunakan over-the-counter cream atau obat yang merangsang vagina jika vaginal discharge disebabkan oleh infeksi jamur.
  • Mengurangi stress.
  • Makan yogurt untuk menghindari infeksi jamur.
  • Gunakan kondom ketika melakukan hubungan seksual.
  • Pertahankan gula darah bagi penderita diabetes.
Daftar Pustaka: Differential diagnosis in primary care, 4th edition OBGYN Williams http://www.nlm.nih.gov/medlineplus/ency/article/003158.htm Kutipan dari: International Society for the Study of Vulvovaginal Disease Komite Informasi untuk Pasien. Desember 2003.