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What is The Normal Vaginal Flora?

Many aerobic and anaerobic bacteria are found in the normal vaginal flora of women of reproductive age. The function and cause of the bacterial colony in the vagina are unknown. Still, it is known that there is a pathway to the upper reproductive tract for these bacterial species. These organisms settle where they can survive and where the vagina has no infection-preventing ability.

The vagina secretes leukocyte protease inhibitors to protect it from many toxic substances. This protein protects tissues against toxic, inflammatory substances and infections.

Typically, the pH of the vagina is between 4 and 4.5. Glycogen found in the healthy vaginal mucosa is thought to be a food source for many bacterial species in the vaginal ecosystem. After menopause, the glycogen content in the epithelial cells of the vagina decreases, and this causes the pH of the vagina to change to 6-7.5.

Why is The Normal Balance of The Vagina Disturbed? What Causes Vaginitis?

A small flow of clear or cloudy white fluid is normal in a woman’s vagina. This fluid keeps the vaginal tissue moist and healthy. In normal situations, various organisms such as bacteria and fungi exist in the vagina in balance and function normally. However, factors such as antibiotic use, menstrual cycle, changes in hormonal balance, pregnancy, vaginal douches, menopause, and hysterectomy may disrupt the normal balance of the vagina. Changing any element in the ecology of the vagina can change the incidence of various species. An excessive increase in vaginal flora of anaerobic species such as Gardnerella vaginalis, Ureaplasma urealitikum, fungi and other species causes vaginitis (vaginal infection).

The term vaginitis refers to the diagnosis in women who complain of abnormal vaginal discharge with burning, tenderness or itching of the vulva. It is one of the most common reasons patients apply to a gynaecologist.

What Are The Most Common Types of Vaginitis?

  1. Bacterial Vaginosis (Gardnerella Vaginitis or Non-specific Vaginitis)

    Infection occurs with the excessive proliferation of the microbe called “Gardnerella vaginalis” in the vagina. At the beginning of the symptoms are abundant non-irritating white-grey, sometimes slightly yellowish vaginal discharge and a foul odour of the discharge. The smell increases, especially during sexual intercourse and on menstrual days.

    Some of the factors that increase the risk of bacterial vaginosis are:

    • Washing the vagina with an antiseptic,
    • Oral sex,
    • Smoking,
    • Relationship during menstrual period,
    • Intrauterine device (spiral),
    • Sexual intercourse at an early age,
    • Many sexual partners,
    • Partner’s sexual activity with other women.

  2. Fungal Infections

    Its main symptoms are marked itching and an irritating vaginal discharge. Along with the yeast infection in the vagina, infection is usually seen in the external genital organs. In some cases, the disease can also affect the urinary tract, called the urethra, causing pain while urinating. Other common symptoms include; burning, pain, and swelling during sexual intercourse.

    Vaginal discharge seen in fungal infection is in the form of white milk cuts and adheres to the vaginal wall.

    The disease usually develops due to the overgrowth of a microscopic fungus called Candida in the vagina. Candida infections are most common after antibiotics, during pregnancy and in people with diabetes. Contrary to popular belief, the cause of the fungal infection seen by swimming in the pool or the sea is not the fungus from the water but the change in the pH of the vagina. Apart from these, it also occurs in cases where body resistance decreases during cancer treatment and in AIDS patients. Fungal infections can also be transmitted sexually.

  3. Trichomonas Infections (Trichomoniasis)

    This infection is the most common non-viral, sexually transmitted disease. Unlike other sexually transmitted diseases, some studies have shown that its frequency increases with age. Since trichomonas does not show symptoms in most men, it is diagnosed more frequently in women. However, about 70% of partners of women with vaginal trichomonas have trichomonas in their urinary tract.

    This parasite is often a symptom of high-risk sexual intercourse behaviour. It can be transmitted to the baby at birth and persist for one year.

    In complaints, vaginal discharge is typically described as dirty, thin, and yellow or green. There may also be itching, oedema, skin peeling and pain in the vulva. Subepithelial bleeding or ‘strawberry spots’ may be seen in the vagina and cervix.

    Women with trichomonas infections should also be tested for other sexually transmitted infections.

  4. Atrophic Vaginitis

    Although atrophic vaginitis can cause vaginal discharge and vaginal irritation, it is not the result of infection. It can occur with dryness in the vagina, mostly during breastfeeding and when the woman’s hormone levels decrease after menopause. Symptoms are dryness and burning.

How is Vaginitis Diagnosed?

The most important symptom of vaginitis is vaginal discharge. Depending on the factor, this symptom may be accompanied by itching or odour. Vaginal discharge is typically in the form of curdled milk in fungal infections. In cases of Gardnerella and trichomonas, vaginal discharge smells like stinky fish or burnt wire. In cases where the symptoms are not obvious for the diagnosis, the diagnosis is made by performing a vaginal culture and antibiogram.

How is Vaginitis Treated?

Vaginitis treatment is applied according to the factor that causes the disease. Treatment may be in the form of an oral antibiotic or antifungal medication and/or a cream, tablet or gel applied to the vagina. In some cases, the spouse also needs to be treated.

In order to complete the treatment, the medication should be continued even if the symptoms disappear. The doctor’s instructions should be followed for medications because the disappearance of the symptom(s) does not mean the infection has been cured. It may also cause the symptoms to relapse, and this time it might be necessary to apply other treatments. It is not recommended to have sexual intercourse during treatment.

What Are The Methods of Prevention of Vaginitis?

Dictionary

pH: The measure used to understand the acid or alkaline value of a substance. 0 means extremely acid, seven means neutral, and 14 means extremely alkaline.

Discharge: It is normal to always have wetness in the vagina. Depending on the day of the menstrual cycle, this discharge may be white, clear or thick in consistency. Sometimes a part of the underwear can be smeared. It is odourless. Situations other than this are considered abnormal.

Hysterectomy: Removal of the woman’s uterus.

Estrogen: A female hormone secreted from the ovaries that thicken the inner wall of the uterus and vaginal tissues.

Spermicide Cream: Creams containing substances that kill sperm and are used as a birth control method.

Vulva: The outer part of the female genitalia.

Cervix: The lower, narrow end of the uterus that forms a canal between the uterus and vagina.

Anti-Fungal: Fungicide.

Antibiogram: A test that shows which antibiotic is effective.

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REFERENCES

https://pubmed.ncbi.nlm.nih.gov/25769434/ https://pubmed.ncbi.nlm.nih.gov/23768623/ https://pubmed.ncbi.nlm.nih.gov/26986742/