For some years now, the vaginal microbiota has taken center stage in women’s sexual and reproductive health care. A healthy vaginal microbiota protects the mucous membrane of the vagina, protects the mucous membrane of the vagina against the establishment of microorganisms that can cause harm.
The vaginal microbiota is one of the elements of the female genital tract that has most aroused the curiosity of researchers and clinicians. It was first studied by Albert Döderlein, a disciple of Pasteur, at the end of the 19th century. Döderlein observed that the vagina contained a large number of lactobacilli.
For quite some time it was considered that these bacilli were the only inhabitants of the vagina. However, thanks to the progress of science, it has become clear that the vaginal environment is somewhat more diverse. In it, different species of bacteria interact with each other, different species of bacteria interact with each otherIt seems that lactobacilli are the ones that develop control functions, keeping at bay the growth of those that can cause us harm.
There are multiple factors that can destabilize this delicate balance and lead to the overgrowth of undesirable organisms. When this happens, vaginal dysbiosis is generated, leading to vaginitis and vaginosis, which can cause symptoms that are especially bothersome for women. In today’s article we will discuss the main vaginal dysbioses.
The vaginal microbiota
Popularly known as the intimate flora, the vaginal microbiota is the set of microorganisms that inhabit our vaginas.. These coexist in equilibrium and establish complex connections with each other. It is not an isolated population and experts indicate that it is closely related to the intestinal microbiota (the one that lives in our intestines), although its characteristics are quite different.
The vaginal microbiota is not usually very diverse. In fact, in most women (more than 70%), it is characterized by being mainly made up of bacteria of the genus Lactobacillus. These bacteria, which can also be found in yogurt, have a series of properties and qualities that make them very beneficial for our genital tract.
This does not mean that lactobacilli are the only inhabitants, on the contrary, in the vagina can also inhabit other bacteria, describing about 250 different species. This is the case of Atopobium o Gardnerellaas well as the fungus Candidawhich are usually present in smaller numbers and with limited growth.
However, there are women who may present a microbiota dominated by Gardnerella or Atopobium, without this directly implying the existence of a pathological process. This type of microbiota is shown mainly in African-American and Latin American women, which indicates that there may be a relationship between genetics and the type of microorganisms that colonize the human body.
What are its functions?
The vaginal microbiota, far from causing us diseases, works symbiotically with our organism and exerts important protective functions. Specifically, it contributes to the integrity of the mucous membranes of our genital tract and acts as a barrier to the establishment and growth of pathogens that can cause infection. Numerous studies have shown that lactobacilli are responsible for carrying out this function.
Lactobacilli specifically adhere to the vaginal and cervical walls, forming a barrier that prevents pathogens that can cause infection from adhering.
They also produce lactic acid, a product that reduces vaginal pH. reduces the vaginal pH making it more acidic, thus restricting the canonization and growth of pathogens. In addition, they also produce other antimicrobial compounds, such as hydrogen peroxide, in order to keep at bay those microorganisms that can cause an infection.
For this reason, the presence of lactobacilli is considered essential for the maintenance of vaginal balance.
What is vaginal dysbiosis?
Occasionally, the lactobacillus population can be altered and decrease below a critical level.. When this happens, microorganisms that are found in the genital tract in low proportions (thanks to the control exerted by lactobacilli) or others that are not typical of the vaginal environment, can proliferate excessively and behave as pathogens.
This imbalance is called vaginal dysbiosis and although the name may sound like something serious, you can rest assured, it is something that happens frequently. The causes that provoke this alteration are multiple since we must take into account that the vaginal microbiota is something very sensitive and easily alterable.
The most common causes for the decrease of lactobacilli are the abuse of antibiotics, stress and stressful antibiotics, stress and smoking.. It has been shown that diet can also interfere with microbial stability. For example, it has been observed that a high intake of saturated fats can increase their incidence.
In addition, the vaginal habitat undergoes frequent changes due to the menstrual cycle. For example, menstruation causes changes in the vaginal pH, making it more neutral. This circumstance makes it more difficult for lactobacilli to grow and creates a scenario where other pathogenic microorganisms are more likely to develop. Another destabilizing factor is the prolonged use of tampons, which also tend to raise the pH, as well as the use of soaps that are too aggressive for the intimate area.
The 3 types of vaginal dysbiosis
A decrease in lactobacilli can lead to vaginal infections. Let us see which vaginal infections are associated with this microbial destabilization and what their symptoms are.
Bacterial vaginosis
This is the most common manifestation of vaginal dysbiosis and is very frequent among sexually active women. Although there is some debate among the experts, in general is not considered a sexually transmitted infection (STI). (STI).
It is caused by an overgrowth of bacteria naturally found in the vagina, upsetting the natural balance. In most cases, it is caused by Gardnerella vaginalisalthough other bacteria can also cause it.
Bacterial vaginosis is usually considered a nuisance rather than a serious infection. However, it can increase the risk of STI infection, such as HIV and gonorrhea.
Bacterial vaginosis usually presents with a grayish vaginal discharge and a very strong vaginal odor. very strong vaginal odor reminiscent of fish. It may cause itching and burning during urination. However, in approximately 50% of cases there are no symptoms.
There are a number of risk factors:
-
Having multiple sexual partnersBacterial vaginosis: Although physicians do not fully understand the relationship between sexual activity and bacterial vaginosis, it has been found to occur more frequently in people who have more than one sexual partner. It has also been found to be more prevalent among bisexual women and lesbians.
-
Natural absence of lactobacilliHaving a low abundance of lactobacilli makes you more prone to vaginosis.
-
Excessive washingExcessive washing of the intimate area can upset its natural balance. In addition, the vagina cleans itself, so it is necessary to clean it. Therefore, if it is done, it is recommended to use specific soaps that respect the vaginal pH and only do it on the external area.
Treatment is based on the administration of antibiotics orally or vaginally. If your partner is a man, no treatment is necessary. However, if it is a woman, it is recommended that she also undergo tests to assess whether she also suffers from it and needs treatment.
2. Candidiasis
It is an infection caused in most cases by the fungus Candida albicans. It is a fungus commonly present in the vaginal microbiota and causes infection when it reproduces in an accelerated manner. It is a very common infection, and although it can cause considerable discomfort, it is not usually a serious infection.
As far as symptoms are concerned, candidiasis usually causes itching or itching in the vagina and vulva and a burning sensation, especially during sexual intercourse or when urinating. The vaginal discharge is usually thick and white, similar to yogurt, but unlike bacterial vaginosis, it does not have a fishy odor.
Risk factors include the use of antibiotics, which can deplete the vaginal lactobacilli population. High estrogen levels caused by pregnancy or the use of birth control pills can also lead to candidiasis, as well as diabetes and a weakened immune system.
Treatment is based on the use of antifungalsThese are available in the form of creams, tablets or suppositories for vaginal application. These eliminate the symptoms quickly and cure the infection in a course of one week. While on treatment, sexual intercourse should be avoided. In addition, antifungals can weaken the stability of condoms and diaphragms.
3 Desquamative inflammatory vaginitis
Also called aerobic vaginitis, this is a recently recognized syndrome. It is often confused with bacterial vaginosis, but unlike bacterial vaginosis, the change in the microbiota is caused by bacteria capable of generating local inflammation such as Escherichia coli, Staphylococcus aureus y Streptococcus agalactiae.
The mechanism leading to the loss of the usual vaginal microbiota is unknown, but it is thought to be usually in response to systemic inflammatory processes, although it is more common in menopausal women or women who have just given birth.
The vaginal discharge is usually yellowishwith pus and no fishy odor. Women with this condition often experience vaginal dryness and discomfort during sexual intercourse. The vulva appears irritated and reddened.
Treatment consists of antibiotics in the form of vaginal cream or vaginal ovules. In some cases topical estrogens are administered to improve the thickness of the vaginal mucosa.