Download Leucorrhoea and its management with Lukol

(Probe, (1963): 6, 217)
Leucorrhoea and its Management with Lukol
Miss S. Paranjpe, M.D.,
Poona, India.
DEFINITION AND INTRODUCTION
The term `leucorrhoea’ signifies abnormal non-haemorrhagic vaginal discharge not caused by
neoplasm or other serious organic disease.
An understanding of the physiology of the vagina is essential for the assessment and treatment of
vaginal discharges. The vagina is moistened by transudation through its epithelial lining and the
female genital tract is normally moistened by glandular secretions from the vulva, cervix uteri, uterus
and fallopian tubes. Normal vaginal secretion is granular and contains desquamated epithelial cells
which contain glycogen, cervical mucus and lactobacillus of Doderlein. It is scanty and white or grey
in colour. The reaction of the normal secretion is acid (pH 4.5 to 5.7).
Normally the vaginal epithelium is stimulated and built up under the influence of oestrogens and is
rich in glycogen. Glycogen is broken down into sugars by the non-bacterial enzymes which in turn
are converted into lactic acid by Doderlein’s bacillus. Though in early childhood under the influence
of maternal oestrogens secretion may be acid, from early childhood to adolescence oestrogen
influence is lacking. During reproductive life there is normal hormonal influence and normal
biological condition is maintained. The administration of oestrogens to patients in two age groups
with deficient oestrogen stimulus promptly changes the epithelium and secretion to that of normal
vagina.
ETIOLOGY
Interference with the growth and glycogen content of the vaginal epithelium and change in the
normal bacterial flora and pH of the vaginal secretions are pre-disposing factors towards vaginal
disease and abnormal discharge.
The commonest causes of leucorrhoea are normally increased secretion by increased vascularity,
passive congestion during puberty, post-menstrual period and pregnancy, chronic retroverted uterus
and congestive cardiac failure. Gonococcal, trichomanas and monilial infections may be responsible.
Chronic illness, fatigue, malnutrition and emotional disturbances appear to predispose towards
persistent and recurrent vaginal discharge. Vulvovaginitis of childhood and senile vaginitis are
considered as infections of underdeveloped and atrophic vaginal epithelium associated with altered
vaginal physiology and poor resistance to infection.
Lesions in the vaginal wall, pelvic infection, uterine cervix lesions, such as acute and chronic
endocervicitis and uterine causes such as retained products of conception, neoplasms and polypus,
gonococcal, tubercular or senile endometritis and tubal causes such as chronic inflammation,
papilloma and carcinoma of the tube may be responsible for leucorrhoea.
TREATMENT
Vaginal douches destroy normal vaginal flora and if too frequently used can cause chemical
irritation.
The principles of treatment of any type of leucorrhoea aim at eliminating the causative organism,
restoring normal vaginal flora and preventing reinfection in the simplest and most acceptable way to
the patient.
I have seen in my practice, that in spite of recognised treatment in a large number of cases the
symptoms drag on for years together, leading to complete loss of health and neurosis. This problem
induced me to try Lukol tablets in this disorder.
THE DRUG
Lukol contains Loh Bhasma (iron in its most assimilable form), Withania somnifera, extracts of
Saraca indica, Woodfordia floribundi, Symplocos racemosa, Ailanthus excelsa, Leptadenia reticulata
and Asparagus racemosus. All the ingredients act synergistically as uterine tonics and nervine
sedatives and have a stimulating action on the endometrium and ovarian tissues. Some have
astringent action on the mucous membrane and have a sedative effect on the genital tract.
MATERIAL AND METHODS
This series consists of 75 patients attending the Sonavane Maternity Home with leucorrhoea as their
principal complaint. Their ages varied from 13 years to 45 years. As regards marital status, 70 were
married while 5 were unmarried. In unmarried patients, menstruation had started 6 to 8 months
before the onset of leucorrhoea. One patient was in menopause and had senile vaginitis. Fifty
patients were multiparous, 20 sterile and 5 were unmarried girls. The given table gives an idea about
the principal as well as side complaints of the patients.
Complaint
Leucorrhoea
Irregular menses
Severe backache
General debility
Pruritis vulva
Arthritis
..
..
..
..
..
..
No. of cases
75
18
5
3
1
1
The cardio-respiratory and other systems of the patients included in this series were normal.
INVESTIGATIONS AND FINDINGS
Routine urine and blood examinations were done in all cases. Haemoglobin estimation was done by
Sahli’s method. Careful vaginal examinations were done in all married patients before starting the
therapy.
Findings on vaginal examinations were as follows:—
Positive finding
Mild non-specific vaginitis
Senile vaginitis
Monilial vaginitis
Erosion cervix
Cervicitis
Bulky subinvoluted uterus
Retroverted mobile uterus
Retroverted fixed uterus
Tubo-ovarian masses
DOSES AND DURATION OF THERAPY
..
..
..
..
..
..
..
..
..
No. of cases
11
1
1
9
4
4
10
12
4
Every patient received 2 tablets of Lukol orally thrice daily. The duration of treatment ranged from 1
to 6 weeks. The average duration of treatment was of 3 weeks. Anaemic patients received antianaemic drugs along with or prior to Lukol therapy.
FOLLOW-UP
Vaginal examinations were done every fortnight during the period of therapy and bimonthly during
the follow-up period of 6 months. Patients under treatment were interviewed every week and
subjective findings were noted down. Clinical results were labelled as excellent when the discharge
was completely controlled and there was no recurrence on the cessation of therapy and when
accompanying complaints like backache, irregular menses and general debility were corrected. They
were considered as fair when there was moderate clinical response and poor when there was little or
no response.
OBSERVATIONS
Uncomplicated cases of leucorrhoea of less than two months’ duration usually responded excellently
within a fortnight of Lukol therapy. Chronic cases, however, needed treatment for 3 to 6 weeks. All
unmarried patients were completely relieved. Improvement in the general condition was noticed in
all the treated cases. In patients with vaginitis, response to Lukol at the end of the first week’s
therapy was not satisfactory. During the subsequent weeks, on adding antibiotics and local therapy
with pessaries results were gratifying. Endocervicitis was better in 4 cases. Erosion in 6 cases
showed healing while other 3 cases needed cauterisation. Tubo-ovarian thickenings and fixity of
uterus remained unaffected by Lukol therapy. Seventy cases were regular in treatment as well as
follow-up after initial improvement they have been omitted from the series.
The following table gives the results of the Lukol therapy:Total no. of cases
70
Excellent
50
Fair
9
Poor
11
SIDE-EFFECTS OR TOXIC REACTIONS
In this series of 70 cases Lukol tablets were administered orally in doses of 2 t.d.s. for an average
duration of 3 weeks, yet not a single side-effect or sign of toxicity was observed.
All patients tolerated the drug excellently.
SUMMARY AND CONCLUSIONS
In spite of regular treatment with standard drugs in gynaecological practice, one often comes across
persistent and refractory leucorrhoea cases. In our series of 70 cases of leucorrhoea oral Lukol
therapy in doses of 2 t.d.s. daily rendered excellent results in 71% cases while 16% cases showed
poor response, 13% cases showed moderate improvement. In the cases where the response was
classified as excellent there were no recurrences during the 6 months that the cases were followedup. The general condition of all the treated patients improved considerably and backache and
irregular menses were corrected. The beneficial action of Lukol in this disorder can be ascribed to its
astringent action on the mucous membranes of the vagina and cervix and to its effects as a uterine
tonic and nervine sedative. Lukol did not produce any toxic reaction or untoward side-effect.
Considering its efficacy and safety, it can well be acclaimed as a promising remedy in the
management of leucorrhoea.
ACKNOWLEDGEMENTS
I am grateful to The Himalaya Drug Co., for liberal supplies of Lukol tablets.
REFERENCES
1.
2.
3.
Naik, H.Y., The Indian Practitioner, 1956, 5, 491.
Bhagwat, S.S., The Current Medical Practice, 1962, 3, 145.
Bagchi, H.N., The Advance of Medicine, 1956, 2, 151.