Dysbacteriosis of the vagina
The content of the article:
- Causes of vaginal dysbiosis and risk factors
- Forms of the disease
- Symptoms of vaginal dysbiosis
- Diagnostics
- Treatment of vaginal dysbiosis
- Possible complications and consequences
- Forecast
- Prevention
Vaginal dysbiosis (vaginal dysbiosis, vaginal dysbiosis) is a pathological condition of the body in which there is a violation of the normal balance of the vaginal microflora. Violation of the normal composition of microflora can occur against the background of other diseases, and also contributes to the development of a number of pathological processes.
With vaginal dysbiosis, the normal composition of the microflora is disrupted
The microflora of the genital tract in different periods of the development of a woman's body is not the same. In girls, before the onset of menarche, anaerobic and microaerophilic bacteria predominate in the vaginal microflora, and a large number of lactobacilli are noted. In the composition of the bacterial flora of the vagina in healthy women of reproductive age, lactic acid bacteria predominate. The vaginal microflora consists of approximately 80-90% of lactobacilli, 7-12% (during pregnancy up to 20%) of bifidobacteria, and also contains a small amount of other microorganisms (both permanently living and transient). In this case, the pH of the contents of the vagina does not exceed 4.5. In postmenopausal women, the nature of the vaginal flora changes - lactobacilli disappear, peptococci, peptostreptococci, bacteroids predominate. The protective function of lactobacilli is taken over by lymphoid cells.
With the development of vaginal dysbiosis, the number of lactobacilli sharply decreases or lactoflora is absent altogether. Vaginal microflora in case of vaginal dysbiosis is represented mainly by polymorphic anaerobic and facultatively anaerobic bacterial flora, the pH of the vaginal contents is 4.5–6.0.
The disease affects women of different age groups. According to various sources, the prevalence of vaginal dysbiosis is from 5 to 50%.
Causes of vaginal dysbiosis and risk factors
In clinically healthy women, normal vaginal microflora is maintained or it quickly recovers with minor disturbances. However, the impact of a number of factors (both endogenous and exogenous) can lead to a violation of the vaginal microflora.
The most common causes of vaginal dysbiosis are:
- sexually transmitted infections;
- infectious and inflammatory diseases of the pelvic organs;
- diseases of the gastrointestinal tract, violation of the intestinal microflora;
- physiological or pathological changes in hormonal levels (during puberty, in case of menstrual irregularities, irregular sexual relations, pregnancy, abortion, childbirth, in menopause, etc.);
- helminthic invasions;
- multiple sexual partners, promiscuous unprotected sex;
- decrease in general and local immunity;
- hypothermia of the body (both a single severe hypothermia, and regularly recurring);
- stressful situations (single or regular);
- a sharp change in climatic conditions;
- the presence of bad habits (alcohol abuse, smoking, drug intake);
- the use of antibacterial agents;
- the use of improperly selected contraceptives;
- frequent uncontrolled douching (promotes leaching of lactobacilli);
- non-compliance with the rules of personal hygiene;
- improper use of gynecological tampons during menstruation (especially if you change them less often than necessary);
- constant use of panty liners;
- wearing synthetic underwear.
The most common causes of vaginal dysbiosis are STDs and infectious and inflammatory diseases of the pelvic organs
In addition, in girls, before the onset of sexual activity, vaginal dysbiosis can be due to the following reasons:
- the formation of the menstrual cycle;
- instability of hormonal levels;
- anatomical features of the hymen.
Forms of the disease
According to the classification of E. F. Kira (1995), which is used to assess the microbiocenosis (microflora) of the vagina, there are:
- normocenosis (predominance of lactoflora, absence of gram-negative microorganisms, mycelium and spores of yeast-like fungi, single leukocytes, epithelial cells are found);
- intermediate type (moderate or reduced number of lactobacilli, gram-positive coccal bacteria and gram-negative bacilli, as well as epithelial cells, monocytes, macrophages are found);
- dysbiosis of the vagina (the number of lactobacilli is significantly reduced or they are absent, the presence of abundant polymorphic flora, key cells, incompleteness or absence of phagocytosis is observed, the number of leukocytes may vary);
- an inflammatory type of smear, or vaginitis (polymorphic microflora, a large number of epithelial cells, macrophages, pronounced phagocytosis are found).
Symptoms of vaginal dysbiosis
At the initial stage, the pathological process may have an asymptomatic or oligosymptomatic course, and a slight change in the nature of the discharge may be ignored.
The most common symptoms of vaginal dysbiosis are discomfort, itching, burning in the external genital area, as well as the appearance of more abundant than usual discharge that has a yellowish-white color and an unpleasant odor (resembles rotten fish). Also, women with vaginal dysbiosis may experience dryness, discomfort and pain during intercourse, pain and cramps in the genital area and lower abdomen.
Discomfort, itching, burning - symptoms of vaginal dysbiosis
With the development of an inflammatory process against the background of vaginal dysbiosis, cramps appear during urination, purulent discharge, in some cases, the body temperature rises.
In girls, before the onset of sexual activity, vaginal dysbiosis is not manifested by abundant secretions, since the openings of the hymen usually do not allow secretions to be excreted in the same volume in which they are formed. This, in turn, contributes to the development of the inflammatory process. For this reason, virgins have a higher risk of inflammation against the background of vaginal dysbiosis.
Diagnostics
Due to the fact that vaginal dysbiosis often has an asymptomatic or oligosymptomatic course, pathology can be detected during a routine examination by a gynecologist.
To make a diagnosis, during an examination, biological material is taken from the vagina for a general smear on the vaginal microflora, which makes it possible to assess the state of the vaginal scene and the microbiocenosis of the vagina. When conducting examinations, the coincidence of two of the three following criteria makes it possible with a high degree of probability to assume the presence of vaginal dysbiosis:
- when carrying out microscopy of vaginal smears, stained according to Gram, the absence of lactoflora and polymorphonuclear leukocytes is noted, key cells are found;
- a positive amino test result (the test is based on the appearance or enhancement of a specific unpleasant odor of discharge, which resembles the smell of rotten fish, when vaginal contents are mixed with a special reagent);
- when carrying out a pH-metry of the vagina, the acidity level of vaginal discharge exceeds 4.5.
Vaginal pH meter can be checked with a special test
To clarify the diagnosis, in some cases, carry out: bacteriological sowing of the contents of the vagina on a nutrient medium, determination of the sensitivity of microorganisms to antibiotics, polymerase chain reaction (to determine genital infections), high-voltage electrophoresis of vaginal swabs (determination of volatile amines), mass spectrometry and gas chromatography of secretions from the vagina (determination of trimethylamine), laser correlation spectroscopy, etc.
Treatment of vaginal dysbiosis
Treatment of vaginal dysbiosis is primarily aimed at eliminating the factors that provoke the pathological process. Shown are antibacterial drugs for local (intravaginal) use. In addition, agents are prescribed to help restore and maintain normal vaginal microflora (eubiotics). Most often, topical preparations (vaginal suppositories) are used, but the use of oral preparations or the combined use of local and oral preparations may be required.
In some cases, immunomodulators, vitamin complexes, and a diet are prescribed (reducing the amount of carbohydrates in the diet, avoiding fatty, spicy, spicy, heavy foods, the basis of nutrition is dairy-vegetable). The scheme of therapy for vaginal dysbiosis can also be supplemented with phytotherapy methods (douching, baths, medicinal tampons).
Full treatment of vaginal dysbiosis during pregnancy is not possible, as it can adversely affect the health of the pregnant woman and the fetus. For this reason, the therapy of pathology during pregnancy is symptomatic, full treatment is carried out already in the postpartum period.
In the absence of sexually transmitted infections, with vaginal dysbiosis in a woman, treatment of the sexual partner is not required. It is recommended to use condoms during treatment for sexual intercourse.
For the period of treatment of vaginal dysbiosis, it is recommended to use condoms
After the therapy of vaginal dysbiosis, diagnostic tests are carried out in order to control the cure.
Possible complications and consequences
Dysbacteriosis of the vagina contributes to the occurrence of such pathological conditions as inflammatory diseases of the urinary tract (including facilitating infection with sexually transmitted infections). This, in turn, can cause more serious pathologies, including infertility. The prolonged course of vaginal dysbiosis reduces the quality of life, contributes to the deterioration of the psycho-emotional state, relations between sexual partners and the psychological climate in the family.
Vaginal dysbiosis during pregnancy can lead to the development of such complications:
- delayed prenatal fetal development;
- the threat of termination of pregnancy;
- chronic placental insufficiency;
- complications in childbirth (weakness of labor, premature rupture of amniotic fluid and rupture of the membranes);
- the birth of a small baby.
Forecast
With timely diagnosis, properly selected treatment and lifestyle modifications, the prognosis is favorable.
Prevention
To prevent the development of vaginal dysbiosis, it is recommended:
- avoid self-medication of any diseases, uncontrolled intake of antibiotics is especially dangerous;
- avoid accidental unprotected sex;
- undergo regular preventive examinations by a gynecologist;
- to refuse from bad habits;
- refuse to wear underwear made of synthetic materials;
- observe the rules of personal hygiene;
- eat rationally.
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Anna Aksenova Medical journalist About the author
Education: 2004-2007 "First Kiev Medical College" specialty "Laboratory Diagnostics".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
