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Les sécrétions vaginales

Vaginal discharge

Pelvi-périnéologie

Résumé

Les leucorrhées sont un des motifs de consultation les plus fréquents en gynécologie. Les modifications des leucorrhées portent sur l’abondance mais aussi la couleur, la consistance et l’odeur. Des signes d’accompagnement comme le prurit, les brûlures locales ou l’existence de lésions permettent d’orienter le diagnostic. Il faut distinguer, d’une part, les leucorrhées physiologiques, dont les variations sont liées à des modifications hormonales ou à des conditions particulières comme la grossesse ou la ménopause, et les leucorrhées pathologiques d’autre part. Dans ce domaine, les infections sont de loin les plus fréquentes (vaginites candidosiques, bactériennes, vaginose bactérienne). Le diagnostic étiologique peut être évoqué sur certains critères cliniques, mais le recours aux examens biologiques est indispensable en cas de récidives. Un grand nombre d’infections génitales basses sont liées à un déséquilibre de la flore vaginale avec modifications quantitative ou qualitative de la flore lactobacillaire. C’est la raison pour laquelle, à côté des traitements anti-infectieux classiques, la thérapeutique actuelle accorde une place grandissante aux traitements de terrain, c’est-à-dire aux produits destinés à rééquilibrer l’écosystème vaginal comme les probiotiques. Des études supplémentaires sont nécessaires pour déterminer la composition idéale de ces probiotiques, leurs indications précises et leurs modalités d’utilisation.

Abstract

Vaginal discharge is one of the most common complaints in gynecology practice. Vaginal discharge changes involve abundance as well as colour, consistency or smell. Associated symptoms such as pruritus, localized burning or lesions can provide a diagnosis. Physiological vaginal discharge due to hormonal changes or specific conditions such as pregnancy or menopause must be distinguished from pathologic leucorrhea. In this context, most of them are due to infections (vaginal candidiasis, bacterial vaginitis, bacterial vaginosis). Clinical criteria can help with the diagnosis, but bacteriological examination of vaginal smears is necessary in the event of recurrence. Most of these infections are due to an imbalance of vaginal flora with quantitative or qualitative changes in lactobacilli. It is the reason why, aside from traditional anti-infective treatments, there is increasing interest in treatments, which could promote vaginal colonization of lactobacilli such as probiotics. Further studies are needed to define the ideal composition of probiotics and their exact indications and conditions for use.

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Correspondence to J. -M. Bohbot.

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Bohbot, J.M. Les sécrétions vaginales. Pelv Perineol 3, 19–24 (2008). https://doi.org/10.1007/s11608-008-0169-x

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  • DOI: https://doi.org/10.1007/s11608-008-0169-x

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