Dysbacteriosis of the vagina
Vaginal dysbacteriosis is a non-inflammatory infection of the vagina in which its normal flora is replaced by anaerobic bacteria association.
This pathology is widespread and is detected in 21-33% of women who come to see a gynecologist. Depending on the severity of dysbiosis, its symptoms can be bright or latent. The disease often has a long-term recurrent nature, does not apply to sexually transmitted infections.
The growth and development of bacterial and fungal flora always occurs in the vaginal lumen. However, this process does not pose any threat to a woman's health, since it is controlled by the hormonal background, the immune system, and the available beneficial microflora. The vast majority of lactobacilli (Doderlein sticks) are present in the vagina. Their share is about 95%. They create an acidic environment around them, thereby preventing other microorganisms from multiplying there.
If the control mechanisms fail, there is a persistent change in vaginal mucus, Doderlein sticks die, or their number decreases and favorable conditions are created for the growth and development of pathogenic flora. This, in a simplified version, is the mechanism of development of vaginal dysbiosis.
- Causes of vaginal dysbiosis
- Symptoms of vaginal dysbiosis
- Diagnostics of the vaginal dysbiosis
- Treatment of vaginal dysbiosis
Causes of vaginal dysbiosis
Vaginal dysbiosis is never caused by any one microorganism. The development of the inflammatory process occurs as a result of the influence of the association of microbes. Most often, such pathogenic agents are gardnerella, mycoplasma, mobilinus. They are called anaerobic bacteria because they do not need oxygen to grow and develop.
The causes of vaginal dysbiosis, in which an uncontrolled growth of pathogenic flora occurs, may be as follows:
Internal causes of vaginal dysbiosis:
- Menopause period. At this time, less growth and reproduction of lactic acid bacteria occurs, since the amount of estrogen produced in a woman's body decreases.
- The period of bearing a child. In this case, the growth of lactic acid bacteria is reduced under the influence of the increased volume of progesterone. In addition, the natural process of reducing a woman's immune defense is triggered to prevent rejection of the fetus.
- Bacterial vaginosis can result from abortion or hormonal stress for the body such as miscarriage.
- Atrophic processes in the vaginal mucosa also contribute to the disruption of its microflora. This pathology is called vulvar kraurosis.
- Intestinal dysbiosis. When the intestinal microflora is disturbed, the vaginal microflora changes.
- Hormonal Disorders.
- The presence of a polyp or cyst in the vagina.
Congenital malformations of the reproductive system.
- Endocrine diseases.
External causes of vaginal dysbiosis:
- Uncontrolled, unreasonably long, or independent use of antibacterial drugs. It is known that antibiotics are not selective and have a detrimental effect on all bacteria in the body.
- Treatment with drugs from the group of cytostatics, antimycotics, or radiation therapy. Pathology in this case develops due to a decrease in immune defense.
- Violation of the rules of intimate hygiene, or neglect of them.
- Excessive hygiene, in particular, douching, excessive use of soap.
- Deformities of the cervix, vagina or pelvic floor muscles that have arisen after childbirth or surgery.
- Foreign bodies in the vagina.
- Using hygienic tampons, installing a diaphragm, cervical cap or intrauterine device.
- Using spermicide products.
- Change of permanent sexual partner.
- Maintaining an active sex life.
- The presence of an inflammatory process in the reproductive system.
Separately, it is worth noting such a reason for the development of vaginal dysbiosis as a violation of the immune system. A decrease in the body's natural defenses can occur for a huge number of reasons, these are: any infections, any non-infectious diseases, the impact of endogenous and exogenous factors. Therefore, any effect that negatively affects the immune system can become a trigger mechanism in the development of the disease.
Symptoms of vaginal dysbiosis
The symptoms of vaginal dysbiosis can vary greatly.
Most often, women note the following signs, which may indicate the presence of a pathological process:
- Discharge from the genital tract, which can be either abundant or scarce. They often have an unpleasant odor, which becomes stronger after intimacy, as well as during the next menstruation. The smell of ammonia, or the smell of rotten fish arises from the vagina due to the active vital activity of conditionally pathogenic flora, in particular, gardnerella. If the process of vaginal dysbiosis is at an early stage of development, then the discharge will be liquid, scanty, with a grayish tint.
- Itching. This is an intermittent symptom that may not be present. However, most women report increased itching during menstruation.
- Painful sensations during intimacy.
Against the background of purulent discharge, sticking of the labia minora is possible.
- The onset of a burning sensation after and during the process of urination.
When a pathological process exists in a woman for a long period of time, the symptoms become more pronounced:
- Leucorrhoea begin to change its consistency. They become more viscous, in composition they are similar to curd mass.
- The color of the discharge changes and takes on a dark green tint.
- The discharge is evenly distributed along the walls of the vagina, becomes sticky and stringy.
- The number of secretions increases, up to 20 ml of them can be collected per day at a rate of 2-4 ml
- The risk of developing vaginitis increases, since the pathogenic flora joins the opportunistic flora.
- Moderate itching occurs around the vulva.
- Possible violation of the process of urination. It becomes more frequent and more painful.
In this case, visible signs of the inflammatory process may not be observed. The mucous membrane of the vagina is not changed, has a uniform pink color. Colposcopy also does not give positive results.
In some women, the symptoms of vaginal dysbiosis persist for a long period of time, and some women feel any changes only periodically, under the influence of adverse factors.
Diagnostics of the vaginal dysbiosis
Diagnosis of vaginal dysbiosis is in the competence of a gynecologist. He collects an anamnesis of the patient, finds out her complaints. During the examination, the doctor visualizes a homogeneous discharge on the walls of the vagina. They can be whitish or grayish in color. Sometimes an unpleasant fishy odor emanates from the vagina.
It is mandatory to take a smear from the vagina. It allows you to visualize desquamated epithelial cells to which pathogenic bacteria (key cells) attach. Normally, these cells should not be. In addition, with vaginal dysbiosis, epithelial cells will prevail over leukocytes, and the number of Dederlein rods will be reduced.
Additionally, the acidity of the vaginal environment is determined. This is done using a special test strip. Dysbacteriosis is indicated by an increase in the acidity of the environment to 4.5 and above.
Another diagnostic sign indicating dysbiosis is the appearance of the smell of rotten fish when potassium alkali is added to the vaginal leucorrhoea.
A doctor can make a diagnosis if a woman has three out of four positive diagnostic criteria:
- The presence of key cells in the smear;
- Stale fish smell when performing a reaction using leucorrhoea;
- Acidity more than 4.5;
- Visualization of specific leucorrhoea during examination.
If there are indications, then the woman is referred for consultation to other specialists, such as: endocrinologist, venereologist, gastroenterologist, etc.
Treatment of vaginal dysbiosis
Therapy begins immediately after diagnosis. The success of treatment directly depends on the correct selection of medicines.
Treatment of vaginal dysbiosis is carried out in two stages:
- First, it is necessary to achieve normalization of conditions for the reproduction of lactobacilli in the vagina. For this, both local and general immunity should be stimulated, hormonal levels should be put in order, and the vaginal mucosa should be rid of the abundance of pathogenic flora.
- The second stage is the direct restoration of the normal flora.
To achieve these goals, it will be necessary to normalize the acidity of the vaginal environment, to eliminate pathogenic agents. Treatment of a sexual partner does not make sense, since vaginal dysbiosis is not sexually transmitted.
So, for the treatment of vaginal dysbiosis, a woman is given the following medical recommendations:
The use of tablets and suppositories. Most often, doctors prescribe a drug such as Trichopolum with the active ingredient - metronidazole. This drug helps to eliminate anaerobic bacteria. Drugs of choice are also: Ornidazole, Tinidazole, Clindamycin. The duration of treatment should not exceed 10 days.
Patients should be informed about possible side effects when taking drugs inside. They can be reduced if used topically. Perhaps the appointment of such vaginal suppositories as: Flagil, Neo-Penotran, Klion-D, Trichopolum, Clindacin. Also, doctors prescribe the installation of tampons with creams or gels applied to them: Dalatsin, Rosamet, Metrogyl-gel, Rozex.
- Vitamin therapy. During treatment with antibacterial suppositories, a woman is shown taking vitamin C in an increased dosage. This promotes the activation of immune forces, improves the rate of healing of damaged mucous membranes, and reduces vascular permeability.
- Performing vaginal installations. For 7 days, once a day, it will be necessary to place tampons soaked in lactic or boric acid of 2% concentration into the vagina. This will create an acidic environment that is unfavorable for the multiplication of anaerobic bacteria.
- Antiallergenic drugs. Often, in addition to general treatment, doctors prescribe antihistamines such as: Cetrin, Suprastin, Tavegil.
- Restoration of normal vaginal flora. The final point in the treatment of vaginal dysbiosis is the intervaginal administration of biological products. For this purpose, candles are used: Bifikol, Bifidumbacterin, Atsilakt, Laktozhinal. The course of treatment, as a rule, is no more than 10 days.
With a competent approach to the treatment of vaginal dysbiosis, normal microflora is restored, followed by the absence of relapses of the disease.
The author of the article: Lapikova Valentina Vladimirovna | Gynecologist, reproductologist
Education: Diploma in Obstetrics and Gynecology received at the Russian State Medical University of the Federal Agency for Healthcare and Social Development (2010). In 2013 completed postgraduate studies at N. N. N. I. Pirogova.